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An objective comparison of the pediatric interviewing skills of freshman and senior medical students.

The use of videotapes to observe senior medical students as they interviewed mothers of children has demonstrated a deficit in their ability to communicate with these parents. Seniors often fail to obtain the vital information pertaining to the child as an individual within a family unit. This study was performed to test the hypotheses that freshmen would obtain (1) more interpersonal and (2) less factual information from mothers of ill children than would seniors. Randomly selected freshmen and seniors videotaped interviews of three simulators who were programmed to portray mothers of a child with a serious organic illness with related psychosocial problems. The use of the programmed "mother" permitted each student to obtain a standardized interviewing experience. The students were given identical information about these children and informed that the mothers were simulators. Objective measurements were made by five trained observers who rated each videotape using a modified interaction analysis technique and an objective checklist of facts obtained. An interrater reliability coefficient for each group of ratings was high, rarely falling below 0.80.
 The results clearly demonstrated that freshmen obtained significantly more interpersonal information (i.e., the affect of the illness upon the child and his family) and asked fewer leading questions than did seniors (p < 0.01). Seniors obtained more factual information (p < 0.001). The ramifications of these data are far reaching. It would appear that, as medical students move through their training, a certain degree of their innate ability communicate with mothers of ill children seems to have been altered by their desire to obtain factual information. This alteration may well limit their effectiveness as the child's physician.