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Coding transcripts of focus groups is considered standard practice, but transcription is labor intensive and often expensive. In the context of coding answers to specific questions, we compared the feasibility and reliability of reviewing videos and transcripts of focus group discussions. Two teams, each composed of one faculty member and two experienced research assistants, completed the coding. One team watched DVDs of the focus groups, while the other worked with transcripts. Both teams analyzed the same three focus groups of African American adults discussing influenza vaccination and coded responses to questions about the flu and the flu shot. The teams identified 121 unique responses and agreed on the coding of 104 (86% agreement, Kn = .72). Discrepancies were due to coder error, transcription errors, and inability to decipher the tone of the statement from the transcripts. Findings suggest that coding directly from video is a feasible option that provides high-quality data and may reduce time and e...

Objective Interpersonal and communication skills are a core area of competency for medical students, residents, and practicing physicians. As reflection and self-assessment are essential components of skill-building, we examined the content of medical students’ assessments of their own developing communication skills. Methods Between 2000 and 2003, a total of 674 first-year medical students completed self-assessments of their communication skills after viewing videotapes of their interaction with simulated patients. Self-assessment forms were open-ended, providing ample space for students to write about the strengths and weaknesses they observed. Completed forms were coded by two members of the research team trained in content analysis. Students identified an average of 5.0 things that went well (range 1–15, S.D. = 2.2) and 2.8 areas for improvement (range 1–9, S.D. = 1.3). Results The most frequently observed strengths were: elicited information/covered important topics (54%); made a personal connection/established rapport (51%); was supportive/encouraging/helpful (40%); attended to conversational flow and transitions (34%); ensured patient comfort (32%). The most frequently noted weaknesses involved problems with: eliciting information/covering important topics (35%); paralanguage, particularly in terms of tone, rate, volume, and disfluencies such as “uh”, “um” (32%); discussing health risks (26%); attending to conversational flow and transitions (23%); students’ own comfort/organization/preparation (20%). Conclusion We observed that a video-based, open-ended approach to self-assessment is feasible, practical, and informative. While the self-assessments covered a broad scope, students clearly attended to tasks and skills relevant to effective communication and relationship building. Practice implications Videotaped clinical encounters allow learners to review their own behavior and make specific comments supported by tangible examples. An open-ended approach to self-assessment of communication skills can serve as one important component of a systematic education and evaluation program.

In this issue, Brenner and colleagues report a correlation between the frequency of negative comments in the "dean's letter" and future problems during a psychiatry residency program. Their study makes an important contribution to the body of literature on factors that predict professionalism-related performance issues during residency and suggests the importance of dependable data that can be used to predict and hopefully intervene early in the training of future physicians across all specialties. As we think about the implications of this study, important issues involving the standardization of medical student performance evaluations (MSPEs) and the assessment of professionalism are raised. Despite the Association of American Medical Colleges' 2002 guidelines for MSPEs, subsequent studies have revealed that considerable inconsistencies among the evaluations still remain. To enhance the accuracy and usefulness of the MSPEs in predicting "problem residents," improved standardization is necessary. Moreover, Brenner's findings call for the development of more vigorous assessment of professionalism in undergraduate medical education, as well as more accurate reporting of these assessments to residency programs. Longitudinal assessment of professionalism with robust tools allows for the identification and possible remediation of students early in their undergraduate training. Insofar as unprofessional behavior in medical school is predictive not only of problems during residency but also of later disciplinary action against the practicing physician by state medical boards, it is the obligation of the medical school to the residency program and to society to identify and report these behaviors.

Although professionalism has always been a core value in medicine, it has received increasingly explicit attention over the past several years. Unfortunately, the terms used to explain this competency have been rather abstract. This study was designed to identify and prioritize behaviorally based signs of medical professionalism that are relevant to patients, physicians, and nurses.The qualitative portion of this project began in 2004 with a series of 22 focus groups held to explore behavioral signs of professionalism in medicine. Separate groups were held with patients, inpatient nurses, outpatient nurses, resident physicians, and attending physicians from different specialties, generating a total of 68 behaviorally based items. In 2004-2006, quantitative data were collected through national patient (n = 415) and physician leader (n = 214) surveys and a statewide nurse (n = 237) survey that gauged the importance these groups attach to the behaviors as signs of professionalism and determined whether they are in a position to observe these behaviors in the clinical setting.The surveys of patients, physician leaders, and nurses provided different perspectives on the importance and visibility of behavioral signs of professionalism. Most of the behaviors were deemed very important signs of professionalism by at least 75% of patients, physicians, and/or nurses; far fewer were considered observable in the clinical setting.This study demonstrates that it is possible and instructive to define professionalism in terms of tangible behaviors. Focusing on behaviors rather than attributes may facilitate discussion, assessment, and modeling of professionalism in both medical education and clinical care.

Background Widely used models for teaching and assessing communication skills highlight the importance of greeting patients appropriately, but there is little evidence regarding what constitutes an appropriate greeting. Methods To obtain data on patient expectations for greetings, we asked closed-ended questions about preferences for shaking hands, use of patient names, and use of physician names in a computer-assisted telephone survey of adults in the 48 contiguous United States. We also analyzed an existing sample of 123 videotaped new patient visits to characterize patterns of greeting behavior in everyday clinical practice. Results Most (78.1%) of the 415 survey respondents reported that they want the physician to shake their hand, 50.4% want their first name to be used when physicians greet them, and 56.4% want physicians to introduce themselves using their first and last names; these expectations vary somewhat with patient sex, age, and race. Videotapes revealed that physicians and patients shook hands in 82.9% of visits. In 50.4% of the initial encounters, physicians did not mention the patient's name at all. Physicians tended to use their first and last names when introducing themselves. Conclusions Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names.