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Evaluation of an interviewer as a function of interviewer gaze, reinforcement of subject gaze, and interviewer attractiveness.

Male subjects were interviewed by female interviewers who gazed constantly, intermittently, or not at all. Experimental subjects were reinforced with green light feedback whenever they gazed at the interviewers and were punished with red light feedback when they averted gaze for more than 6 seconds. Control subjects received noncontingent green and red light feedback. Although gaze of experimental subjects toward the interviewers was increased significantly, their attitudes toward the interviewers remained the same. This was probably because the subjects did not discriminate that their gazing behavior had changed. Subjects gave the most unfavorable reactions to the nongazing interviewers, rating them as least attractive, giving them the shortest answers, and sitting farthest from them during the debriefing session. Subjects did not discriminate between high and low attractive interviewers, except that the latter were rated disproportionately low on attentiveness if they did not gaze. Interviewers with high rates of talking were preferred over interviewers with low rates of talking. It was concluded that interpersonal attraction is related to gaze and physical attractiveness through a number of mediating variables which will have to be isolated more specifically in future research.

Adolescent

Children's type A interview: interrater, test-retest reliability, and interviewer effect.

The Miami Structured Interview--1 was developed to assess Type A behavior in preadolescents and adolescents in the United States and Greece. This report describes the interrater and test-retest reliability of the Miami Structured Interview--1, and the effect of different interviewers on the assessment process. Interrater agreements on the A vs not A scale were 73% for Greek American (k = 0.49, p less than 0.01, n = 88), 80% for Mixed American (k = 0.61, p less than 0.01, n = 69), and 88% for Native Greek interviews (k = 0.76, p less than 0.01, n = 65). Exact agreements on a five-point scale were 48% (weighted k = 0.73, p less than 0.01), 42% (weighted k = 0.70, p less than 0.01), and 48% (weighted k = 0.80, p less than 0.01), respectively. Although levels of agreement were all greater than chance, rater bias was observed. Test-retest administrations within 10 min showed 91% agreement (k = 0.82, p less than 0.01) on the A vs not A scale. Analyses suggest interviewers can affect the assessment of Type A behavior. These findings indicate the Miami Structured Interview--1 can (1) reach acceptable levels of interrater reliability, (2) is susceptible to rater bias, (3) has sufficient test-retest reliability for use in longitudinal studies, and (4) must be presented in a standardized way before ratings from interviews conducted by different interviewers can be combined or compared. The strengths and limitations of the Miami Structured Interview-1 are discussed.

Adolescent

The predictive utility of behavior-based interviewing compared with traditional interviewing in the selection of radiology residents.

RATIONALE AND OBJECTIVES: This study compares the predictive use of measures based on traditional faculty and resident interviews of residency applicants with measures obtained through behavior-based interviewing. A special emphasis was placed on predicting residents' noncognitive abilities. METHODS: One hundred fifty-one resident applicants, over a 3-year period, were interviewed using standard interviews by faculty and residents. These residents also were interviewed with an experimental behavior-based accomplishment interview. Four years later, during their diagnostic radiology residency, evaluations of performance were gathered on these applicants from their residency director. RESULTS: Results indicated that scores based on responses given during the accomplishment interviews added considerable predictive utility to the low prediction demonstrated by traditional interviews. CONCLUSIONS: These findings imply that improving unstructured faculty and resident interviews to obtain, in a more rigorous manner, desired information about noncognitive abilities may be a key to successful resident selection.

Behavior

Interviews with survivors of suicides: procedures and follow-up of interview subjects.

In a series of 104 suicides in women, 91 primary informants were interviewed face-to-face. Sixty-two informants participated in a follow-up interview by phone, conducted by an independent investigator in order to determine their attitudes toward the initial interview. One third thought that the initial interview shed new light on the suicide, and two thirds considered the interview emotionally beneficial. In all, the initial interview was a positive or neutral experience for 54 informants and negative for 6. All but one of these were recognized as problematic interview subjects at the initial interview. The remaining two subjects could not be judged at the follow-up. In order to avoid negative consequences of the interviews, the investigator should adjust the procedures and provide support in the crisis reaction.

Affective Symptoms

Sex of interviewer, place of interview, and responses of homosexual men to sensitive questions.

Effects of sex of interviewer and place of interview on the responses of 57 AIDS patients and 145 other homosexual men were studied. Data on sensitive topics were collected by five male and three female medical officers at places convenient to respondents. Male physicians recorded fellatio more frequently, but female physicians recorded younger ages of initiating homosexual activities and more frequent use of certain recreational drugs. These differences apparently were due to different patterns of sexual contact and drug use in four cities. Patients with AIDS tended to be interviewed in hospitals and doctors' offices, other men tended to be interviewed in hotel rooms, and patients tended to be different from other men. After adjustments were made for confounding, sex of interviewer and place of interview seemed to have little influence on the answers obtained.

Acquired Immunodeficiency Syndrome

Teaching the difficult interview in a required course on medical interviewing.

A module dealing with the difficult patient interview is part of a required medical interviewing course for second-year students. Using a classification of difficult doctor-patient interactions, students identify what goes wrong during interviews with simulated patients and then learn techniques to remedy these problems in order to obtain reliable medical histories. Skills taught to the students include identifying the specific problem within an interview and recognizing and using their own feelings as information about the patient. Attitudes encouraged in students include recognizing that the source of the problem may be the patient, the interviewer, or both; that the physician rather than the patient may be the so-called "poor historian"; and that the goal of managing a difficult patient interview is not counseling but rather the acquisition of accurate and precise information.

Education, Medical

Interviewer effects in psychiatric epidemiology: a study of medical and lay interviewers and their impact on reported symptoms.

Utilizing data from a field study of psychiatric disorder, the study examined sex differences in patterns of response to interviewers in contrasting status positions. The dependent variables in the analysis were mean scores on nosological scales measuring three dimensions of symptomotology identified in a factor analysis. Independent variables were interviewer status and respondent sex. Three categories of interviewers were randomly assigned to administer a structured interview schedule. Strong interaction effects between interviewer status and respondent sex were noted. Women disclosed significantly fewer symptoms to the high status interviewers (identified physicians), whereas males reported most symptoms to this group. Theoretical explanations derived from the literature on sex roles were offered regarding the origins of women's response to high status figures.

Behavior

The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients.

To study delirium in hospitalized elderly, a delirium symptom interview (DSI) was developed by an interdisciplinary group of investigators. This interview was administered in an acute care hospital to 50 patients who were over the age of 65 years. Results from the interview were compared to assessments of major symptoms of delirium made independently by a neurologist and a psychiatrist. This interview had good validity and reliability. The sensitivity of the DSI was .90 and the specificity was .80, when compared with the clinical judgment of a psychiatrist and neurologist. Interrater reliability, using lay interviewers, was .90 for the detection of major symptoms of delirium. These results indicate that the DSI could be used by lay interviewers to assess reliably the symptoms of delirium.

Aged

Teaching medical interviewing. A basic course on interviewing and the physician-patient relationship.

Recent advances in educational theory and methodology have made it possible to teach medical interviewing with as much rigor as other clinical skills. We describe a first-semester, first-year medical student course that effectively teaches basic interviewing skills. This course provides faculty development, small group learning, detailed faculty and student coursebooks, and an interview checklist that delineates specific interviewing skills and content areas, serving as a template for teaching, practice, and feedback. Students have many opportunities for practice in role play and with patients, followed by feedback by self, peers, and faculty. Use of audiotape and videotape reviews enhances the learning experience. This article describes our course, suggests educational principles and standards for the teaching of medical interviewing, and presents educational research demonstrating significant gains in students' skills associated with improvement in standardized patient satisfaction.

Education, Medical, Undergraduate

The polydiagnostic interview: a structured interview for the polydiagnostic classification of psychiatric patients.

A structured interview (PODI) for the polydiagnostic evaluation of affective and schizophrenic disorders is presented. The interview includes elements of the Structured Clinical Interview for DSM-III (SCID) and of the Present State Examination (PSE). The central idea of this interview is to break down complex criteria into their elements, to assess a wide area of such elements, and to recombine them by a computer program according to different algorithms that are included in a greater number of operational diagnoses. Reliability data will be presented which show sufficiently high kappa and Yule coefficients for a selected set of diagnostic criteria for depressive, manic and psychotic disorders. The applicability of the PODI was established in about 180 interviews.

Diagnosis, Differential

Interviewer predictions of applicant qualifications and interviewer validity: aggregate and individual analyses.

The relative effects of varied interviewee cues on line managers' hiring decisions were examined, as was the relative predictability of various criteria by line managers' interview impressions. Aggregate and individual regression analyses revealed that 3 nursing directors' impressions of 186 nursing applicants shaped their hiring recommendations more than did the applicants' resume credentials. Moreover, managers' interview impressions significantly predicted employees' job attitudes, though predictions of attitudes did not exceed predictions of performance. Finally, individual managers based hiring decisions on different interview impressions, and these impressions forecast employees' job attitudes with differential validity. Implications for future interviewing research are discussed.

Adult

Interviews with anti-HIV-positive individuals detected through the systematic screening of blood donations: consequences on predonation medical interview.

This study is based upon interviews with 74 individuals found to be human immunodeficiency virus (HIV)-seropositive through the screening of blood donations between January 1988 and December 1990. The donation history and the risk factor of HIV infection were established. Questions about the use of blood donation as a diagnostic test and on the notion of a predonation medical interview evoking the risk factor were asked. The majority of the individuals had a risk factor of HIV infection and had given their blood for serological testing. This data can help to adapt the predonation medical interview to the present epidemiological context of HIV infection. The improvement of this interview will contribute to the decrease of the residual transfusional risk of HIV infection.

Adolescent

Comparison of computer- and interviewer-administered versions of the Diagnostic Interview Schedule.

A group of 150 psychiatric patients were administered the Diagnostic Interview Schedule (DIS) on two occasions, once by a trained layperson and once using a computerized interview format in which the patient interacted directly with the computer. Agreement between the two methods on 15 diagnoses was relatively modest, as indicated by a mean kappa score of .51, but was similar to agreement rates reported in other studies of the DIS. The discrepancies may have been due to the high number of acutely ill inpatients studied, patients' reporting more symptoms in one of the interviews, and difficulty translating some of the DIS questions to the computer. Patients had positive feelings about both methods, but a significant majority liked the computer interview better and found it less embarrassing. The authors conclude that computerized administration of the DIS is as reliable as other methods but that exclusive reliance on the DIS for clinical diagnosis is inappropriate.

Adolescent

Assessment of a brief interviewing course using the Helping Relationship Inventory: an interviewing course assessment.

A brief second year interviewing course consisting of 9 hours of small group meetings was evaluated by administering the Helping Relationship Inventory (HRI). Other studies have used the HRI to assess longer interviewing courses that included both small groups and large class lectures. The purpose of this study was to use the HRI to see if objective improvement in communication skills could be found in this relatively brief interviewing course. One hundred and nine students, representing an 80% return rate, completed all questions on the HRI pre- and post-tests. Analysis of pre- and post-test data showed that students became significantly more understanding (p less than 0.0001) and significantly less 'supportive' or pacifying (p less than 0.0001) by the end of the course. There were no differences found on pre- and post-test HRI scores comparing males (n = 71) and females (n = 38). This study demonstrates that even brief small group interviewing courses can effect a positive change in students' communication skills.

Communication

The automated interview versus the personal interview. Do patient responses to preoperative health questions differ?

Laboratory testing of presurgical patients has been shown to be excessive, thereby increasing costs, reducing resources for other health care uses, and increasing risks to both patients and physicians. As one step toward reducing the number of unnecessary preoperative tests ordered, we used an automated method to aid preoperative assessment of 239 patients in Chicago and in Winnipeg. The "HealthQuiz," a small hand-held device containing a computer chip and video screen, uses a decision tree to ask a minimum of 60 health-related questions (the patient's response to certain questions determines the number of questions presented). The device then generates a summary printout of patient answers, the health areas needing further attention, and the laboratory tests most likely to uncover clinically important abnormalities in that patient. HealthQuiz responses are intended to aid the physician and not to replace the personal interview. As an aid, the automated interview highlights possible problem areas for in-depth pursuit by the physician. The need for nonselective batteries of tests is eliminated because recommendations for tests are based on specific elements of a patient's history. To be effective, responses to the HealthQuiz should be the same as responses to similar questions asked by a physician. We tested that premise in this study. Patient's answers to the HealthQuiz were compared with their responses to a randomly selected set of the same questions in a personal interview. Ninety-seven percent of the response pairs were identical, and most of the 3% that differed involved changes from "not sure" replies to the HealthQuiz. Laboratory tests suggested by responses to the two methods of questioning did not differ.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

The interviewer's "presenting problems" in the initial interview.

Complex countertransference responses that contribute to the interviewer's presenting problems in the initial interview with a patient are related to: the clinician's preinterview fantasies, the interviewee's empirical reality, and the patient as experienced creatively. Presenting problems may be an unavoidable component of clinical contact, but when the interviewer responds to them with psychological-mindedness, they can contribute to realistic assessment and positive case disposition.

Countertransference

[Decisions of the physician in a psychoanalytic interview. Patient characteristics in the initial psychodiagnostic interview].

The focus of our investigation is the question which criteria of the first psychodiagnostic dialogue are associated with the decision of a physician to make a psychoanalytic interview. 51 patients have been investigated who had contacted the out-patient department of the Psychosomatic Hospital at the Central Institute of Mental Health in Mannheim. Patients who have been provided with a psychoanalytic interview by the therapist have been estimated as having a greater motivation for psychotherapy and they seemed more likely to consider their complaints as being psychologically caused. Younger patients have been regarded as having a greater motivation for psychotherapy than older ones and they could more likely attribute their complaints to psychologic causes, especially if they are females and belong to the middle social stratum. Furthermore, those patients who had been decided by the therapist to undergo a psychoanalytic interview more than the other group of patients showed a pattern of values which was similar to that of the therapists.

Adult