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Study Objective: To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents.Design: Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching.Setting: Community-based, primary care-oriented residency program at Michigan State University (MSU).Subjects: All 28 interns from the single-track MSU residency program during 1986/87-88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89. TEACHING INTERVENTION: An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients.Measurements and Main Results: The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group x gender), the trainee group showed significantly greater gains (p less than 0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents' acceptance of the program was high.Conclusions: Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training. [ABSTRACT FROM AUTHOR]

Objective: To identify the frequency and quality of certain prevention-oriented counseling skills of resident physicians and to compare these skills with the residents' attitudes towards and knowledge about primary prevention.Design: Longitudinal descriptive study.Patients/participants: 54 PGY-1-3 internal medicine and family practice residents enrolled in three training programs affiliated with Michigan State University's College of Human Medicine.Intervention: Trainees' attitudes towards and knowledge about certain prevention activities were captured by an instrument designed for this study using 127 Likert scales. Counseling skills were assessed with one of two standardized patients. Residents were unaware of the simulation, which occurred in their routinely scheduled ambulatory care setting. Audiotapes of the interactions were rated by blinded, independent raters. Residents had strong positive beliefs about the role of primary care physicians in counseling patients, high levels of knowledge about what the counseling should entail, and high self-assessment about the frequency and quality of their own counseling interventions. Skill levels, however, were at or below a level defined as minimally acceptable.Conclusion: Resident physicians' skill levels, as measured in this study, are inadequate to accomplish routine counseling interventions in the primary care setting. These results suggest that more reliance should be placed on direct observation of physicians, ideally in nonreactive settings, for purposes of drawing conclusions about physician performance. Further, these results have implications for the training of students and residents in the area of counseling for prevention. [ABSTRACT FROM AUTHOR]

Background: Interviewing and the physician-patient relationship are crucial elements of medical care, but residencies provide little formal instruction in these areas.Objective: To determine the effects of a training program in interviewing on 1) residents' attitudes toward and skills in interviewing and 2) patients' physical and psychosocial well-being and satisfaction with care.Design: Randomized, controlled study.Setting: Two university-based primary care residencies.Participants: 63 primary care residents in postgraduate year 1.Intervention: A 1-month, full-time rotation in interviewing and related psychosocial topics.Measurements: Residents and their patients were assessed before and after the 1-month rotation. Questionnaires were used to assess residents' commitment to interviewing and psychosocial medicine, estimate of the importance of such care, and confidence in their ability to provide such care. Knowledge of interviewing and psychosocial medicine was assessed with a multiple-choice test. Audiotaped interviews with real patients and videotaped interviews with simulated patients were rated for specific interviewing behaviors. Patients' anxiety, depression, and social dysfunction; role limitations; somatic symptom status; and levels of satisfaction with medical visits were assessed by questionnaires and telephone interviews.Results: Trained residents were superior to untrained residents in knowledge (difference in adjusted post-test mean scores, 15.7% [95% CI, 11% to 20%]); attitudes, such as confidence in psychological sensitivity (difference, 0.61 points on a 7-point scale [CI, 0.32 to 0.91 points]); somatization management (difference, 0.99 points [CI, 0.64 to 1.35 points]); interviewing of real patients (difference, 1.39 points on an 11-point scale [CI, 0.32 to 2.45 points]); and interviewing (data gathering) of simulated patients (difference, 2.67 points [CI, 1.77 to 3.56 points]). Mean differences between the study groups were consistently in the appropriate direction for patient satisfaction and patient well-being, but effect sizes were too small to be considered meaningful.Conclusion: An intensive 1-month training rotation in interviewing improved residents' knowledge about, attitudes toward, and skills in interviewing. [ABSTRACT FROM AUTHOR]

In a rare study of effectiveness of an interviewing method, we previously reported a randomized controlled trial demonstrating that training in a step-by-step patient-centered interviewing method improved residents' knowledge, attitudes, and skills and had a consistently positive effect on trained residents' patients. For those who wish to use this evidence-based patient-centered method as a template for their own teaching, we describe here for the first time our training program--and propose that the training can be adapted for students, physicians, nurse practitioners, physician assistants, and other new learners as well. Training was skills-oriented and experiential, fostered positive attitudes towards patient-centered interviewing, and used a learner-centered approach which paid special attention to the teacher-resident relationship and to the resident's self-awareness. Skills training was guided by a newly identified patient-centered interviewing method that described the step-by-step use of specific behaviors.

Recovery status is an important characteristic of staff members working within substance abuse treatment. Recovering and nonrecovering staff members were contrasted previously, however there is a third group: Individuals who are not recovering themselves but are part of families with recovering or addicted members. The purpose of the present study is to compare background, roles within program and approaches to treatment of these three groups. Six hundred and thirty-four staff members of fifty-one treatment programs completed questionnaires. Five hundred and seventy-five completed an item indicating their recovery status. Forty-four percent identified themselves as nonrecovering, 30 percent as recovering, and 26 percent as nonrecovering but part of families with an addicted or recovering member. Nonrecovering staff with addicted or recovering family members differed from the other two groups on gender, more of them were female, but were similar to nonrecovering staff in their approach to treatment but fell between recovering and nonrecovering staff on measures of roles within programs and background. Recovering counselors reported to pursue a wider range of treatment goals and to use more varied treatment techniques than nonrecovering counselors. The implication of these findings for training and licensure of paraprofessionals in the field of substance abuse treatment is discussed.

We describe a program model designed to achieve high adherence, a major problem for work-site exercise/fitness programs. Our model is a 6-month program consisting of 15 1-hour program meetings, with participants exercising on their own time four times per week. Procedures employed to enhance adherence are contracting, group competition, monitoring, and social support. This program model has been applied nine times. One hundred fifty-nine university employees took part in the initial test with a dropout rate of 9% (15 persons). The average adherence rate for nondropouts was 98%, which is higher than rates usually reported in the literature. Adherence was defined as exercising four times a week.

Study Objective: To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents., Design: Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching., Setting: Community-based, primary care-oriented residency program at Michigan State University (MSU)., Subjects: All 28 interns from the single-track MSU residency program during 1986/87-88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89. TEACHING INTERVENTION: An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients., Measurements and Main Results: The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group x gender), the trainee group showed significantly greater gains (p less than 0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents' acceptance of the program was high., Conclusions: Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training.

Blacks in the general population experience alcohol-related health problems to a greater extent than Whites, even though surveys of drinking behavior find that Blacks generally drink no more than Whites and, in fact, at younger ages Blacks actually drink less than Whites. In this study, Blacks and Whites entering randomly selected state-supported substance abuse treatment programs within a given period of time were interviewed and administered a battery of assessment instruments; results are derived from the Addiction Severity Index. A major research question was whether the higher rates of alcohol-related problems for Blacks in the general population were matched by greater severity of life-problems for Blacks in a clinical treatment population. Blacks had more severe problems than Whites in two problem areas: employment support and other drug use. Results point to socioeconomic factors as well as combined alcohol and other drug use as potential contributors to the greater alcohol-related health problems for Blacks in the general population. Comprehensive study of alcohol and other drug use norms and customs within the Black community is recommended to aid in the development of prevention and treatment strategies for alcohol-related problems among Blacks.

Abstract A stress management program was implemented at two worksites to answer the following questions: 1) Is it feasible to design a stress management program that is of sufficient duration to change old habits, is tailored to the specific needs of the individual, and yet is administratively manageable? 2) To what degree does the use of powerful, reliable, independent variables make it possible for program participants to adhere to a stress management goal of their choosing? A program of six months duration that included personal stress management projects attracted a total of 21 participants at the two worksites. They met their weekly personal project commitments more than 80 percent of the time, and significant changes occurred on a measure of social anxiety.

Objective: To identify the frequency and quality of certain prevention-oriented counseling skills of resident physicians and to compare these skills with the residents' attitudes towards and knowledge about primary prevention., Design: Longitudinal descriptive study., Patients/participants: 54 PGY-1-3 internal medicine and family practice residents enrolled in three training programs affiliated with Michigan State University's College of Human Medicine., Intervention: Trainees' attitudes towards and knowledge about certain prevention activities were captured by an instrument designed for this study using 127 Likert scales. Counseling skills were assessed with one of two standardized patients. Residents were unaware of the simulation, which occurred in their routinely scheduled ambulatory care setting. Audiotapes of the interactions were rated by blinded, independent raters. Residents had strong positive beliefs about the role of primary care physicians in counseling patients, high levels of knowledge about what the counseling should entail, and high self-assessment about the frequency and quality of their own counseling interventions. Skill levels, however, were at or below a level defined as minimally acceptable., Conclusion: Resident physicians' skill levels, as measured in this study, are inadequate to accomplish routine counseling interventions in the primary care setting. These results suggest that more reliance should be placed on direct observation of physicians, ideally in nonreactive settings, for purposes of drawing conclusions about physician performance. Further, these results have implications for the training of students and residents in the area of counseling for prevention.

Given the marginal success rates of formal smoking cessation clinics and the small number of smokers who have participated in such clinics, it must be concluded that their impact on the public health problem of smoking has been negligible. This paper speculates about changes that would improve their performance and suggests the following: (1) clinics should be offered at existing organizational units, e.g., workplaces, where all the smokers can be readily informed about the program and also provide mutual support for nonsmoking; (2) an immediate inducement (money) should be made available to smokers for successful participation in the clinic; and (3) a pervasive social support system should be employed to help the smoker with the difficult problem of maintaining abstinence after it has been achieved. A program model is proposed that meets those criteria. Should the model prove effective, it might well apply to other health risk factors such as obesity, hypertension, and serum cholesterol level, which, like smoking, are essentially behavior problems.

Previous research documenting the association between the level of client disturbance and distress in a significant other has generated two competing causal models. Investigators measuring the level of family burden have suggested that it is the discharged patient who causes distress in the family. Investigators of family factors in patient relapse have suggested that it is the family who disturbs the patient. In this study the relative strengths of these two causal models are compared in a sample of outpatients over a six-month period of time. The data indicate that the significant other is causally predominant in the exacerbation of client disturbance.

Patients with alcohol and other substance abuse problems have poorer prognoses if there is a concomitant psychiatric diagnosis. However, because severity of psychiatric problems contributes more than the specific psychiatric diagnosis to prognosis, the nature of the interaction between substance abuse treatment outcome and an accompanying psychiatric diagnosis can be questioned. In this article an attempt is made to understand the poor-prognosis-with-psychiatric-diagnosis interaction through a literature review and an analysis of various problem areas that clients bring to substance abuse treatment. Problem areas were measured with a variety of instruments. The results show that groups that vary in severity of psychiatric problems also differ in severity of problems in other areas. As there is no doubt that such dual diagnosis patients pose a considerable treatment challenge, the implications of these findings for theoretical consideration and treatment planning are discussed.

Our purpose in undertaking this review has been to extract from the literature behavioral prescriptions for physicians and strategies for prevention. We have demonstrated that the physician who wishes to be a successful counselor needs to ensure that the patient knows what to do, work toward patient commitment to behavior change, negotiate and tailor the specifics of the treatment, and be a warm, attentive interviewer who provides support to patients by attending to emotional responses as they arise. We have suggested ways that the encounter can be embedded in a functioning primary care organization where other members of the team are involved, and where follow-up mobilization of social support and the systematic application of behavioral techniques can achieve permanent behavior change.

The four most inactive schizophrenic patients were selected by an observational technique from a ward of severely ill chronic patients. Of the four, two patients repeatedly refused to accept any dispensable rewards. Applying Premack's principle of reinforcement, consistent work behavior was shaped and maintained, using sitting as the reinforcer. The results indicate that the strict application of Premack's principle may have considerable therapeutic potential for those patients who, by refusing all tangible rewards, fail to respond to a reinforcement regime.