Reliable measurement of student capability for a skill allows educators to verify student mastery. A major part of a physician's ability to gather information involves patient interviewing, and instruction of this skill is a substantial portion of a medical curriculum. Since 1974, the University of Arizona College of Medicine has employed patient-instructors (PIs), lay persons who function in the roles of patient and teacher for training of interview skills in the Preparation for Clinical Medicine (PCM) program. PIs provide "real" patient-interview experiences and immediate feedback to the students. The PCM program currently has four topic areas: Adult, Pediatric, Geriatric, and Psychiatric. The Arizona Clinical Interview Rating (ACIR) Scale was developed in 1976 to measure the technical performance aspects of interviewing. This study was undertaken to determine reliability of the ACIR. Implication of the results are discussed and suggestions made for the continued application of the ACIR Scale. (Abstract shortened with permission of author.)

Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record.

The ability to gather accurate and complete information is important in scientific endeavors and the field of medicine is no exception. The medical interview is one of the primary methods by which the physician gathers information. His/her method should be no less than that used by the scientist. There are two components to the medical interview: The content, or the specific information, and the process, or the method by which the information is obtained. Traditional methods for teaching interviewing skills to medical students emphasized an on-the-job type of experience with students going out on the wards to interview actual patients. The method had several problems including lack of standardized methods of teaching and evaluating. This dissertation looks at a competency-based method of teaching and evaluating medical interview skills used at The University of Arizona College of Medicine. It uses patient instructors (PIs) to objectively evaluate interviewing skills. PIs are highly trained non-physicians who have been trained to function as patients, teachers, and evaluators. Analysis of the data collected on student interview performance from the classes of 1982-1984 indicated that there was no significant difference in content or process scores due to sex or prior occupational experience in a health-related profession. However, significant differences were found in content and process scores due to the age of the interviewer with students older than the class average scoring higher than the younger students.

Objective--Identify patient history intake questions common to four fields of medicine - allopathic, naturopathic, chiropractic and Traditional Chinese Medicine to be included in an Integrated Patient History Intake Tool. Background--The use of complementary and alternative medicine (CAM) is on the rise in the United States. 80% of those who used CAM therapies in 1990 did so in conjunction with allopathic medicine, and 70% of those who used CAM therapies did not tell their conventional practitioner. Lack of awareness of patients' use of CAM therapies may hinder practitioners' ability to provide adequate healthcare. Methods--A three-round modified Delphi technique was utilized to generate consensus among 106 Oregon health care practitioners on the importance of specific patient history intake questions. A panel of faculty members from Oregon Health and Sciences University, the National College of Naturopathic Medicine, the Oregon College of Oriental Medicine, and Western States Chiropractic College identified 321 patient history intake questions, which then were distributed to the Oregon healthcare practitioners. The healthcare practitioners were asked to rate the importance of each question through a series of two surveys over the period of eleven weeks. Suggestions for additional intake questions also were invited. Results--The Delphi process narrowed the 321 initial questions plus 150 additional suggested questions down to a list of 52 intake questions to be included in the Integrated Patient History Intake Tool. There was an overall response rate of 47% with a 64% response rate to SURVEY I, and a 74% response rate for SURVEY II. Discussion--The patient history intake questions have been identified for use in an Integrated Patient History Intake tool. This Delphi study illustrated the differences that are held unique for each paradigm of medicine. Determining unique characteristics of complementary and alternative medicine from allopathic medicine is an important aspect of building collaboration among allopathic and CAM providers within the state of Oregon. The proposed model of an integrated patient history intake form provides a platform from which to build further cooperation and awareness. / Graduation date: 2003

Purpose: Pharmacists must ensure the safe and effective use of medication, but often have only the documented patient history to guide assessment of therapy. There is a lack of information on the incidence of claimed drug allergies or the validity of these self-reported drug allergies in the South African population. Mislabelling of patients as being allergic to medication often deprives them of important therapeutic drugs and alternative agents may be more dangerous, less effective and more costly (Hung et al., 1994). The aim of the research was therefore to determine the incidence of drug allergies in patients admitted to a private hospital and to assess the validity of these self-reported drug allergies. Methods: A descriptive, non-experimental study design was used. Data was collected using a concurrent, cross-sectional approach and collected from patients admitted to hospital using Medical Chart Reviews and researcher-led, questionnaire based interviews. During the seven month sampling period, 693 patients were identified with one or more self-reported drug allergies. A subset of 99 patients (14.2%) consented to a researcher-led interview. The allergies were assigned to one of three groups based on the history: (i) High probability: signs and symptoms typical of an immunological reaction. (ii) Low probability: signs and symptoms of the reaction were predictable reactions or side effects of the drug. (iii) Unknown status: no information concerning the reaction history was available. Results: A total of 953 allergies were identified in the 693 patients, with a ratio of drug allergy to patient of 1.4:1. The majority of claimed allergies were to penicillin (39.2%), opioid analgesics (17.6%), other antimicrobials, including co-trimoxazole (13.5%), NSAIDs (9.9%) and unspecified “sulphur” allergy (8.7%). Descriptions of the “allergic” reactions were only recorded on 8.9% (62, n=693) of the reviewed charts. Only 56.5% (35, n=62) of the symptoms recorded as “allergy” were indicative of the event being allergic or immunological in nature. In total, 1.3% (9, n=693) of the patients with a self-reported allergy received the allergen while in hospital. In three cases this was the result of a pharmacist overlooking the recorded allergy, and dispensing the allergen to the patient. A total of 118 allergies were identified in the 99 interviewed patients, with a ratio of drug allergy to patient of 1.2:1. Inaccurate allergy history was found in 9.1% (9, n=99) of the interviewed patients. Overall, the majority of self-reported drug allergies (67.8%) had a “high probability” of being a true drug allergy. Allergies that were assigned into the high probability group were: penicillin (74.1%), co-trimoxazole (91.7%), NSAID‟s (55.6%) and 75.0% of opioids. Conclusion: In summary, the validity of self-reported drug allergies need to be determined before excluding medication from a patient‟s treatment options. Detailed descriptions can assist in the evaluation of self-reported allergies which would be advantageous to both prescribers and patients. Pharmacists need to play a bigger role in ensuring accurate documentation of drug allergy history, with detailed descriptions, in order to ensure safe and effective drug use within the hospital environment.

Thesis (M.A.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 39-43).

No description available.

We used the results from two large scale cardiovascular investigations as a platform for examining ways in which psychological response style measures could improve the prediction of cardiovascular health outcomes. Of particular focus was the long-standing conceptual controversy over whether response styles are better treated as confounds to the self-report of stress-related personality characteristics or as separate personality traits. Study 1 consisted of a 3-year prospective study of ambulatory blood pressure levels in a healthy adult sample of males and females (N=T25). Study 2 comprised a pharmacological treatment study among ischemic heart disease patients (N=95). Questionnaire batteries completed in each study included self-report measures of depression, anger expression, daily stress, and hostility, along with self-deception and impression management response style scales. In each study, we investigated direct relationships between the response style measures and cardiovascular outcomes, moderator relationships between response style x psychological risk factor interactions and cardiovascular endpoints, and finally between the psychological risk factors and cardiovascular measures after statistically extracting response style variance from the p sychological risk factor scores. Results most strongly supported the main effects model. Higher self-deception scores predicted elevated 3-year diastolic and systolic blood pressure means in study 1, and poorer treatment outcomes in study 2. In both investigations these relationships proved stable after controlling for baseline cardiovascular standing. Importantly, efforts to statistically control for response style effects within the psychological risk factors did not improve predictive power with these measures. The above findings favor efforts to treat response styles as potentially independent psychological contributors to cardiovascular health outcomes, and support ongoing attempts to identify biobehavioral mechanisms through which personality dispositions may impact the appearance or progression of disease.

We used the results from two large scale cardiovascular investigations as a platform for examining ways in which psychological response style measures could improve the prediction of cardiovascular health outcomes. Of particular focus was the long-standing conceptual controversy over whether response styles are better treated as confounds to the self-report of stress-related personality characteristics or as separate personality traits. Study 1 consisted of a 3-year prospective study of ambulatory blood pressure levels in a healthy adult sample of males and females (N=T25). Study 2 comprised a pharmacological treatment study among ischemic heart disease patients (N=95). Questionnaire batteries completed in each study included self-report measures of depression, anger expression, daily stress, and hostility, along with self-deception and impression management response style scales. In each study, we investigated direct relationships between the response style measures and cardiovascular outcomes, moderator relationships between response style x psychological risk factor interactions and cardiovascular endpoints, and finally between the psychological risk factors and cardiovascular measures after statistically extracting response style variance from the p sychological risk factor scores. Results most strongly supported the main effects model. Higher self-deception scores predicted elevated 3-year diastolic and systolic blood pressure means in study 1, and poorer treatment outcomes in study 2. In both investigations these relationships proved stable after controlling for baseline cardiovascular standing. Importantly, efforts to statistically control for response style effects within the psychological risk factors did not improve predictive power with these measures. The above findings favor efforts to treat response styles as potentially independent psychological contributors to cardiovascular health outcomes, and support ongoing attempts to identify biobehavioral mechanisms through which personality dispositions may impact the appearance or progression of disease. / Arts, Faculty of / Psychology, Department of / Graduate

This study evaluated the ability of subjects at 3 levels of expertise, expert physicians, residents and medical students, in the acquisition, representation, and utilization of patient information in the context of solving a complex medical problem. Each subject interviewed a volunteer medical outpatient and was subsequently requested to provide a differential diagnosis. The doctor-patient dialogue was analyzed using cognitive methods of discourse analysis. These methods were used to characterize differences in the content and nature of the history-taking process and in the development of problem representations. The study characterized differences at two levels of representation, observations and findings. Observations are the minimal semantic units of the doctor patient discourse. Findings are higher order units that derive meaning in specific medical contexts. / Differences were found between groups of subjects in the accuracy of diagnoses and in the qualitative nature of representations. These differences were manifested most clearly in terms of a series of efficiency measures designed to characterize the ability of subjects to generate findings. In general, the expert physicians were more selective in the elicitation and processing of critical and relevant findings. An attempt is made to characterize these differences in terms of the strategies used to acquire and represent patient information.