Training residents to employ self-efficacy-enhancing interviewing techniques: Randomized controlled trial of a standardized patient intervention

Anthony F Jerant, Richard L Kravitz, Rahman Azari, Lynda White, Jorge A Garcia, Heather A Vierra, Maria Catrina Virata, Peter Franks

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Current interventions to enhance patient self-efficacy, a key mediator of health behavior, have limited primary care application. Objective: To explore the effectiveness of an office-based intervention for training resident physicians to use self-efficacy-enhancing interviewing techniques (SEE IT). Design: Randomized controlled trial. Participants: Family medicine and internal medicine resident physicians (N∈=∈64) at an academic medical center. Measurements: Resident use of SEE IT (a count of ten possible behaviors) was coded from audio recordings of the physician-patient portion of two standardized patient (SP) instructor training visits and two unannounced post-training SP visits, all involving common physical and mental health conditions and behavior change issues. One post-training SP visit involved health conditions similar to those experienced in training, while the other involved new conditions. Results: Experimental group residents demonstrated significantly greater use of SEE IT than controls, starting after the first training visit and sustained through the final post-training visit. The mean effect of the intervention was significant [adjusted incidence rate ratio for increased use of SEE IT∈=∈1.94 (95% confidence interval = 1.34, 2.79; p∈<∈0.001)]. There were no significant effects of resident gender, race/ethnicity, specialty, training level, or SP health conditions. Conclusions: SP instructors can teach resident physicians to apply SEE IT during SP office visits, and the effects extend to health conditions beyond those used for training. Future studies should explore the effects of the intervention on practicing physicians, physician use of SEE IT during actual patient visits, and its influence on patient health behaviors and outcomes.

Original languageEnglish (US)
Pages (from-to)606-613
Number of pages8
JournalJournal of General Internal Medicine
Volume24
Issue number5
DOIs
StatePublished - May 2009

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Self Efficacy
Randomized Controlled Trials
Physicians
Health Behavior
Health
Office Visits
Internal Medicine
Primary Health Care
Mental Health
Medicine
Confidence Intervals
Incidence

Keywords

  • Education, medical
  • Patient simulation
  • Physician-patient relations
  • Randomized controlled trials
  • Self-efficacy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Training residents to employ self-efficacy-enhancing interviewing techniques: Randomized controlled trial of a standardized patient intervention",
abstract = "Background: Current interventions to enhance patient self-efficacy, a key mediator of health behavior, have limited primary care application. Objective: To explore the effectiveness of an office-based intervention for training resident physicians to use self-efficacy-enhancing interviewing techniques (SEE IT). Design: Randomized controlled trial. Participants: Family medicine and internal medicine resident physicians (N∈=∈64) at an academic medical center. Measurements: Resident use of SEE IT (a count of ten possible behaviors) was coded from audio recordings of the physician-patient portion of two standardized patient (SP) instructor training visits and two unannounced post-training SP visits, all involving common physical and mental health conditions and behavior change issues. One post-training SP visit involved health conditions similar to those experienced in training, while the other involved new conditions. Results: Experimental group residents demonstrated significantly greater use of SEE IT than controls, starting after the first training visit and sustained through the final post-training visit. The mean effect of the intervention was significant [adjusted incidence rate ratio for increased use of SEE IT∈=∈1.94 (95{\%} confidence interval = 1.34, 2.79; p∈<∈0.001)]. There were no significant effects of resident gender, race/ethnicity, specialty, training level, or SP health conditions. Conclusions: SP instructors can teach resident physicians to apply SEE IT during SP office visits, and the effects extend to health conditions beyond those used for training. Future studies should explore the effects of the intervention on practicing physicians, physician use of SEE IT during actual patient visits, and its influence on patient health behaviors and outcomes.",
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author = "Jerant, {Anthony F} and Kravitz, {Richard L} and Rahman Azari and Lynda White and Garcia, {Jorge A} and Vierra, {Heather A} and Virata, {Maria Catrina} and Peter Franks",
year = "2009",
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AU - Jerant, Anthony F

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AU - Azari, Rahman

AU - White, Lynda

AU - Garcia, Jorge A

AU - Vierra, Heather A

AU - Virata, Maria Catrina

AU - Franks, Peter

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N2 - Background: Current interventions to enhance patient self-efficacy, a key mediator of health behavior, have limited primary care application. Objective: To explore the effectiveness of an office-based intervention for training resident physicians to use self-efficacy-enhancing interviewing techniques (SEE IT). Design: Randomized controlled trial. Participants: Family medicine and internal medicine resident physicians (N∈=∈64) at an academic medical center. Measurements: Resident use of SEE IT (a count of ten possible behaviors) was coded from audio recordings of the physician-patient portion of two standardized patient (SP) instructor training visits and two unannounced post-training SP visits, all involving common physical and mental health conditions and behavior change issues. One post-training SP visit involved health conditions similar to those experienced in training, while the other involved new conditions. Results: Experimental group residents demonstrated significantly greater use of SEE IT than controls, starting after the first training visit and sustained through the final post-training visit. The mean effect of the intervention was significant [adjusted incidence rate ratio for increased use of SEE IT∈=∈1.94 (95% confidence interval = 1.34, 2.79; p∈<∈0.001)]. There were no significant effects of resident gender, race/ethnicity, specialty, training level, or SP health conditions. Conclusions: SP instructors can teach resident physicians to apply SEE IT during SP office visits, and the effects extend to health conditions beyond those used for training. Future studies should explore the effects of the intervention on practicing physicians, physician use of SEE IT during actual patient visits, and its influence on patient health behaviors and outcomes.

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