Psychological Medicine, 1978, 8, 695-704 Printed in Great Britain

The value of feedback in teaching interviewing skills to medical students

PETER MAGUIRE,1 PHILIP ROE, DAVID GOLDBERG, SIMON JONES, CLIVE HYDE AND TERRY O'DOWD
From the Department of Psychiatry, University of Manchester SYNOPSIS

Forty-eight medical students took part in a study to assess the value of giving students some feedback about their interviewing skills. During the study they all received training from their clinical firms. In addition, 36 of the students received 1 of 3 types of feedback training. This was given by tutors who used television replays, audiotape replays or ratings of practice interviews conducted by the students. As in previous studies there was little improvement in the interviewing skills of those students who only received training from their clinical firms. In contrast, all 3 feedback groups improved their ability to elicit accurate and relevant information. However, only the television and audiotape groups also showed gains in techniques. While the differences between these 2 groups were not significant, they all favoured the television group. INTRODUCTION The apprenticeship method of clinical training often fails to equip medical students with essential skills (Heifer, 1970; Maguire & Rutter, 1976 a). Consequently, several medical schools have been experimenting with new approaches (Jason et al. 1971; Werner & Schneider, 1974; Rutter & Maguire, 1976). Some have purchased expensive videotape recording and playback systems in the belief that television feedback of performance is both effective and the optimal mode. Yet even if television feedback improves interviewing skills, much simpler and cheaper methods, such as feedback by audiotape, might be as beneficial. A study has, therefore, been carried out to evaluate 3 different modes of feedback. typically of asking students to interview several patients and then discussing the histories that they obtained in seminars or on Ward Rounds. Three of the students were also assigned to 1 of 3 methods of feedback training: feedback by tutors using television replays, audio replays or ratings of the students' practice interviews. The remaining student received no additional teaching, and so acted as a control for the feedback programme. Before feedback training began, each of the 3 'feedback' students within a quartet was asked to interview the same patient (Table 1). They were given the task of trying to establish the patient's main problems within 15 minutes. They were also informed that their interviews would be videotaped to allow rating of their interviewing skills and that they should write up a history afterwards based on the information they had elicited during the 15-minute interview. As the main purpose of the experiment was to compare the 3 feedback programmes, the order in which students interviewed the patients was so balanced that the first, second and third positions were equally represented among the 3 feedback groups. The students assigned to the control group saw the same patients under identical conditions but a day later. It was considered that separating the

PATIENTS AND METHODS Forty-eight medical students were drawn randomly in groups of 4 from those doing a clerkship in psychiatry. All the students in each quartet received training in history-taking from their clinical firms by the traditional apprenticeship method. This firm teaching consisted
1 Address for correspondence: Dr Peter Maguire, Department of Psychiatry, The University Hospital of South Manchester, West Didsbury, Manchester.

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Peter Maguire and others The difference between the training given to the television and audiotape groups lay in the method of feedback. This was given in sound only for the audiotape group. In the group which received feedback from a tutor unaided by either television or audiotape, the tutor first saw a television replay of the interview without the student. He then rated it on a series of rating scales. (These will be described later.) He next met with the student and asked him to reflect on his interview. The student was shown his ratings and his performance was discussed. He was also encouraged to learn the relevant symptom repertoires. The same amount of time was spent with the tutor as in the other feedback groups. The 3 students within a quartet were seen by the same tutor. Three tutors participated in the teaching (P.M., S.J., C.H.). They had met together before the study to discuss the handouts, watch television replays of interviews, and agree on the interviewing methods which were to be taught.

Table 1. Training programme for each quartet

Week 1 3 feedback students Interview to assess skills before training followed by feedback session First practice interview followed by feedback Second practice interview followed by feedback Interview to assess skill after training 1 control student Interview to assess skills before training No interview No interview Interview to assess skills after training

2 3 4

control students from the feedback groups would reduce the chance of their feeling antagonistic because they were not to receive any feedback until after the experiment was over. The patients who took part in these and subsequent interviews were in-patients or daypatients suffering from an affective disorder, neurosis or alcoholism. They were selected by medical staff who were independent of the study.
Training

When these interviews were completed, the 3 students in the feedback groups met with a tutor. They were given 2 printed handouts. The first handout described the areas of information which they should follow. These areas included details of the patients' problems, their impact on the patients' daily life, the patients' view of these problems, his or her predisposition to develop similar problems in the past and questions designed to elicit any other difficulties. The second handout focused on the techniques that they should use. It was divided into 3 sections: beginning the interview, pursuing the main task and ending the interview (Maguire & Rutter, 1976 A). After discussing these handouts with the tutor the students arranged to see him for individual feedback between 2 and 4 days later. Each student in the television group watched a television replay of this first interview with his tutor. The tutor discussed the student's performance in relation to the standards set in the handout. He also stressed the importance of learning the relevant repertoires of psychiatric symptoms. While both the student and tutor could stop and replay parts of the interview, this first session was limited to 45 minutes.

Subsequent training

Each 'feedback' student conducted a practice interview 1 week and 2 weeks after the initial interview. They were set an identical task. Each of the 3 'feedback' students within a quartet saw the same patient. They interviewed these patients in the same order as before and received the same mode of feedback. However, the feedback sessions were limited to 30 minutes. A different patient was seen each week.

Post-training interviews

Three weeks after the initial interviews, each student within a quartet interviewed a further patient. The order and conditions under which they did so were the same as the initial interviews. This interview provided a measure of their skills after training. Care was taken to ensure that both 'feedback' and control students conducted the same number of interviews on their clinical firms during the period of the experiment. Each student clerked 1 new patient and interviewed, on average, 3 patients who were already known to them each week.

Value offeedback in teaching interviewing skills Videotape recordings of the interviews conducted in the first (pre-training) and fourth (post-training) weeks were rated in terms of the techniques used and the information obtained. These ratings were carried out independently of the tutors by raters who were blind to the training method to which the students had been assigned. They used rating scales designed for this purpose (see Appendix). These scales allow ratings to be made of discrete techniques, such as a student explaining who he was, as absent (0) or present (1). Where the techniques are more complex, for example responding to verbal leads, a 5-point frequency scale (0-4) is used. A score of ' 0 ' would mean that the student had failed to respond to any leads but he would score ' 4 ' if he responded to them all. The amount of information which is elicited is assessed similarly. Thus on the item 'possible precipitants', a score of ' 0 ' would mean the student failed to establish any, while he would score ' 2 ' if he found out about half of them. The written histories were rated on the number of items of accurate and relevant information which they contained. Relevance and accuracy were judged by reference to criteria given by the senior registrars looking after the patients. Reliability of the ratings The 2 raters were trained initially by a third experienced rater (P. M.). A trial using a sample of 24 interviews was held before the experiment began to assess the level of agreement between the raters. A second trial using a further 24 interviews was held 9 months later to assess the consistency of the ratings. Intraclass correlation coefficients derived from an analysis of variance were used to estimate the level of agreement between the raters and the rate-rerate reliability for both sets of ratings (Ebel, 1951; Maxwell & Pillner, 1968; Bartko & Carpenter, 1976). Agreement between raters was found to be high for both techniques (coefficient = 0-92, P < 0001), and information elicited (coefficient = 0-86, P < 0001). Similar high levels of agreement were found when the ratings and reratings of both techniques (coefficient = 0-83, P < 0001) and information (coefficient = 0-92, P < 0001) were compared.

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RESULTS Analyses of variance were carried out between the 4 methods and within each method for the pre- and post-training interviews. The Newman-Keuls test was used to test the significance of any differences which emerged. It was chosen in order to reduce the chance of reporting as significant any differences which had arisen by chance (Armitage, 1971). A probability level of less than 5 % was taken as the acceptable level of significance. Comparison of skills before training The 4 groups differed little in their history taking skills before the feedback programmes began (Tables 2-5). The only exception was the control students' superiority over the television group on their written histories (Table 5). The total score was the sum of the scores on the following 4 scales: beginning and ending the interview (range 0-34), the information elicited (range 0-188), the techniques used (range 0-44) and overall performance (range 0-16). Comparison of skills after training All 3 feedback groups obtained greater total scores than the control group on the ratings made on the post-training interviews (Table 2). On the subscale, 'the amount of information elicited', both the television and audiotape groups performed better than the control group (Table 3). This scale covered the following areas: current problems, onset and precipitants, treatment to date, effects of illness on day-to-day functioning, mood disturbance, attitudes to illness, and predisposing factors. On another scale, 'the techniques used', both the audiotape and television groups again obtained higher scores than the control group (Table 4). The techniques measured included clarification, avoidance of jargon, repetition, complex and leading questions, response to verbal leads, facilitation, the ability to discuss more personal matters and control. The television group were also superior to those students who had received feedback based on the tutor's ratings of their interviews. However, of the 3 feedback groups, only the television group recorded significantly more

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Table 2. Total scores

For comparison of scores across weeks Feedback by Tutor + television Tutor+ audiotape Tutor + rating scale Apprenticeship method only (control) Before training 54-717-2 55-712-8 52-712-7 55-9ll-5 After training 96-617-7 93-219-7 83-3121 60-920-8 df 3,44 3,44 3,44 1,22 F-ratio 11 -36"* 903** 10-95*** 0-53 For comparison after training P < 005 P < 005 P < 005 NS

For comparison between groups after training, /'-ratio = 9-67 (df = 3,44), P < 0001. All 3 feedback groups superior to control on Newman-Keuls test at < 5 % level. * P < 0-001.

Table 3. Information elicited

For comparison of scores across weeks Feedback by Tutor + television Tutor+ audiotape Tutor + rating scale Apprenticeship method only (control) Before training 24-77-4 24-57-5 24-47-9 26-8 7-2 After training 41-312-6 40-4 100 37-27-2 28-712-5 For comparison before and after training P < 005 P < 005 P < 005 NS

df
3,44 3,44 3,44 1,22

F-ratio 6-08*** 5-07** 4-54" 0-21

For comparison between groups after training, F = 335, P < 005. For comparison television and audio v. control, significance of difference < 5 % level (Newman-Keuls). * P < 0 0 1 . P < 0-001.

Table 4. Techniques used in main part of interview

For comparison of scores across weeks Feedback by Tutor + television Tutor + audiotape Tutor + rating scale Apprenticeship method only (control) Before training 15-561 15-65-6 15-36-l 15-95-9 After training 25-l5-6 22-85-9 18-94-7 17-36-5 df 3,44 3,44 3,44 1,22 F-ratio 4-97" 2-90* 1-75 0-32 For comparison after training P < 005 P < 005 NS NS

For between groups comparison after training, F = 4-65, P < 0 0 1 .

For comparisons television v. direct and control and audio v. control, significance of difference < 5 % level (NewmanKeuls). P < 0 0 5 . * P < 0 0 1 .

information on their written histories than the control group (Table 5).

Comparison of skills before and after training

All 3 feedback groups gained significantly in their ability to elicit information (Table 3,

Fig. 1) and record it (Table 5) between the first and fourth weeks. However, only the television and audiotape groups showed significant improvement in their techniques (Table 4, Fig. 2). Despite the teaching which they received from their clinical firms, students in the control group failed to demonstrate any significant gains in the basic skills measured in the study.

Value offeedback in teaching interviewing skills Table 5. Written histories

For comparison of scores across weeks Feedback by Tutor + television Tutor + audiotape Tutor + rating scale Apprenticeship method only (control) Before training ll-24-8 15-05-4 12-2 4-2 16-860 After training 27-49-6 23-36-5 20-67-7 17-77-4 df 3,44 3,44 3,44 1,22 F-ratio 1215*" 3-45* 3-71* Oil For comparison after training P < 005 P < 005 P < 005 NS

699

For between groups comparison before training, F = 3-07, P < 005, control > television on Newman-Keuls. For between groups comparison after training, F = 3-27, P < 0-05. For comparison video v. control, significance of difference < 5 % level (Newman-Keuls). i < 0-005. * P < 0-O01.

Score 40-

Television Audio Ratings

30/// > < Control

20-

10-

Pre-training

Post-training

FIG. 1. Information elicited. Possible range of scores was 0-188.

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Score 25H Television

Audio

2<H

15H

Pre-training

Post-training

FIG. 2. Changes in technique. Possible range of scores was 0-44.

DISCUSSION An analysis of variance was carried out to determine possible order effects. No relationship was found between the order in which students interviewed and the techniques they used, but the patients did volunteer more information to those who came later in the order. This may explain why the control students elicited and wrote up more information in their histories than

the' feedback' students on their initial interviews. It also suggests that the control group's poor performance on the post-training interview cannot be attributed to the reluctance of the patients to be interviewed a fourth time. However, it could be argued that the control group suffered in comparison with the feedback groups because they carried out only 1 practice interview under the experimental conditions before the post-training assessment. The control

Value offeedback in teaching interviewing skills Table 6. Main differences in use of technique
Technique Control Avoiding repetition Asking personal questions Response to verbal leads Television feedback 2-670-89 2-750-75 2-16103 2-27017 Audio feedback 2-25O-75 2-170-94 l-75O-83 1-831-03

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group's opportunity to practise under strict conditions was limited because such practice was an essential component of the 3 feedback programmes and it was considered important to determine how much the control students had improved as a result of the teaching they received from their clinical firms. Our findings confirm that this teaching was relatively ineffective. This should not be surprising. Little attention is usually paid to how a student obtains a history or relates to his patients. Instead, it is assumed that what he reports back on Ward Rounds or in seminars reflects how he actually interviewed, although this is known not to be the case (Muslin etal. 1968). In contrast, all 3 of the training programmes which combined practice under controlled conditions with some kind of feedback of performance resulted in the students covering the key areas of history more consistently. However, only the 2 methods which allowed the students to see and/or hear their interviews led to their learning essential interviewing techniques. Questionnaires administered to the students after their training indicated that each of the 3 feedback groups considered that their method of training had been most satisfactory. So the superior performance of the television and audiotape groups did not seem due to the halo effect of the students believing that their methods were superior to the others. Nor did it seem due to the training having motivated the television and audiotape groups to practise their techniques more. For all 3 feedback methods resulted in students using the interviews they conducted on their clinical firms as a chance to practise. While the main differences between the audiotape and television groups were not significant statistically, they favoured students in the tele-

vision group. Television appeared to be of particular value in helping students learn how and when to interrupt and bring the patient back to the point (control), avoid needless repetition of topics, ask questions about personal matters such as marital or sexual adjustment, and detect any important verbal leads (Table 6). Thus, it seems clear that the time and effort spent in providing television feedback of interview performance will be amply repaid by gains in skills. It is also possible that the much simpler method of audiotape feedback would be as effective if given over a more extended period. Despite the benefits of television and audiotape feedback, the students were still some way from the criterion. This was particularly so on the subscale, 'the amount of information elicited'. However, they would have required a much longer time for their interviews if they were to have covered all the areas rated on that scale. There were also students in each group who failed to show much improvement. They interviewed in a way which alienated their patients, and yet claimed they intended to be practising clinicians, and their inability to master such basic interviewing skills is a serious problem. It could be that a more extensive training programme would help them improve. Alternatively, other methods of training might be employed. For example, a student's area of weakness could be identified and he would then be given an opportunity to practise a particular skill (microcounselling) until he improved significantly (Moreland et al. 1973). The use of simulated patients would allow the student to carry out such practice (Maguire et al. 1977). The student might also learn more effectively if he were given the chance to discuss with the real or simulated patient what the patient's reactions were to the interview (Kagan et al. 1969). Even if such modifications prove effective in promoting the learning of essential interviewing skills, it remains to be seen if this learning is maintained over time and generalizes to the students' work with general medical and surgical patients. We are grateful to Mrs Bluhm for her help with the interview ratings. This work was supported by the Nuffield Foundation.

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Peter Maguire and others that half of the available data was obtained. The amount of available data is judged by reference to the patients' case notes.) Covered 1. Details of main problems No (a) Elicited the key complaints (b) Defined start of problems within one month (c) Elicited main precipitants of problems (d) Elicited key events in course of problems (e) Covered treatment of current episode (i) Treatments (ii) Dose (iii) Duration (iv) Effects wanted (v) Unwanted effects (/) Established current supports available 2. Impact on the patient and family Established extent of disruption of normal functioning due to current problems in relation to: (i) Job and chores (ii) Sex (iii) Social activities (iv) Leisure activities (v) Key interpersonal relationships (vi) Other interpersonal relationships 3. Patient's view of the problems Elicited patient's attitude to problems 01 0 0 0 3 45 2 1 2 1 2 3 3
Yes

APPENDIX RATING SCALE FOR HISTORY-TAKING INTERVIEWS Student... Patient... Rater... Date... Comments...

7 8 4

Observer ratings for each section Observer Overall

A B C D

4 4

Section A. Beginning the interview (Scores '1' if behaviour observed, '0' if absent.) 1. Greeting and seating (a) Gave a verbal greeting to patient (i) Mentioned the patient's name (c) Gave a handshake (d) Established direct eye contact (e) Gave a verbal indication where to sit (/) Made a non-verbal indication of where to sit 2. Self-introduction (Score T if behaviour observed, '0' if absent.) {a) Mentioned own name (b) Mentioned own status (c) Explained who he/she is working with 3. Orienting the patient (a) Mentioned purpose of interview (b) Mentioned time available for interview (c) Mentioned note taking (d) Enquired as to acceptability of note taking (e) Mentioned the circumstances of the interview (/) Enquired if patient at ease prior to task Section B. Areas of information covered (A score of '0' indicates that the area was not covered at all. A maximum score of 4 (or 8 in the case of key complaints) means that all the possible available data were obtained, whether volunteered spontaneously or not. A score of 2 (or 4) indicates 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 No 0 0 0 0 0 0 Yes 1 1 1 1 1 1

0 0 0 0 0 0

2 2 2 2 2 2

4 4 4 4 4 4

0 0
0 0

1 1 1 1 1

2 2 2

2 2

3 3 3 3

4 4 4 4

No 0 1

Yes 3 4

4. Factors predisposing to the development of similar problems No (a) Obtained description of previous personality (b) Obtained relevant information about previous episodes of mental illness (i) Type (ii) Similarity to present problem (iii) Treatment (iv) Effect and outcome

Yes

0 1 23 4

0
0

1 1 1

2
2 2

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Section B (cont.) Covered No about previous episodes of physical illness (i) Type (>') Similarity to present problem (iii) Treatment (iv) Effect and outcome (d) Checked if family history of mental illness (i) Type (ii) Similarity to present problem (iii) Treatment (iv) Effect and outcome (e) Checked if family history of physical illness (0 Type (ii) Similarity to present problem (iii) Treatment (v) Effect and outcome
5 . Screening questions (a) For symptoms of depression (c) Obtained relevant information

Section C. Techniques used in main part of interview Yes Score interviewer's use of each technique as follows: Poor use of technique, virtual total
omission

Score 0 Score 1 Score 2 Score 3 Score 4

0 0 0 0 0 1 0 0 0 0 0 0 0 0

1 1 1 1 2 3 1 1 1 1 1 1 1 1

2 2 2 2 4 2 2 2 2 2 2 2 2

Fairly poor use of technique, many omissions Reasonable use of technique, some omissions Good use of technique, few omissions Very good use of technique, no
omissions 1. Clarifying

Interviewer questions in depth to elicit full information, resolve ambiguities and inconsistencies 2. Avoiding jargon Interviewer avoids using technical or ambiguous wording 3. Rejecting jargon Interviewer asks for definition of technical or ambiguous words used by patient

0 12 3 4

0 12 3 4

0 12 3 4

0) Appetite (ii) Weight (iii) Energy (iv) Sleep pattern (v) Bowel habits (vi) Feelings re future (vii) Diurnal variation
(b) For suicidal risk

0 0 0 0 0 0 0

1 2 3 4

12 3 4
1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4

4. Handling of emotionally loaded material Interviewer does not avoid, and 0 12 3 4 handles sensitively, topics which may be disturbing or embarrassing to the patient 5. Controlling the interview Interviewer maintains the structure 0 12 3 4 of the interview by keeping to a sequence of relevant topics; by allowing the patient sufficient time to respond fully, but not to elaborate unnecessarily 6. Avoiding repetition Interviewer does not himself request, 0 1 2 3 4 or allow the patient to persist in giving information which has already been elicited in the interview 7. Picking up verbal leads Interviewer is responsive to state0 12 3 4 ments by patient which may indicate unexplored problems 8. Encouraging precision Interviewer encourages the patient to give precise information particularly where it can be dated or quantified 0 12 3 4

4
4

Elicited if any suicidal ideas or attempts (0 For symptoms of anxiety (i) Palpitations (ii) Sweating (iii) Headaches (iv) Vomiting (v) Tremor (vi) Diarrhoea (d) For physical illness (i) Cardiovascular (ii) Central nervous system (iii) Respiratory system (iv) Gastrointestinal (v) Locomotor (vi) Urogenital

0 1 2 3 4 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4

2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 12 3 4

Total

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Peter Maguire and others and other verbal and non-verbal behaviour, the interviewer shows that he has regard and concern for the patient 4. Competence The interviewer uses appropriate interview skills to elicit key information from the patient while maintaining a relaxed and mutually responsive relationship
0 12 3 4

Section C (cont.)
9. Facilitating Interviewer verbally and non-verbally 0 1 2 3 4 encourages the patient's responses 10. Use of open questions Interviewer asks questions which do 0 1 2 3 4 not direct the patient's answers 11. Use of brief questions Interviewer asks single, brief questions; does not ask long, complex questions Section D. Ending the interview Scoring: For each item in summary and terminating sequence: score 0 if not true; score 1 if true 1. Summary (a) Interviewer states that he/she is about to summarize (b) Summary contains no inaccuracy (c) Summary is not too elaborate nor too brief 2. Interviewer enquires if summary accurate and complete 3. Interviewer makes a concluding statement Section . Overall ratings Scoring: For each item: Very poor Poor Moderate Good Very good 1. Self-assurance The interviewer appears confident, open and relaxed; does not show confusion, hesitancy, shyness or embarrassment 2. Empathy The interviewer shows, by asking appropriate questions and making appropriate responses, that he understands the nature of the patient's illness, the effect the illness has on his life, and the way in which the patient himself perceives his problems 3. Warmth By smiling, sitting attentively, facilitating the patient's responses, Score 0 Score 1 Score 2 Score 3 Score 4 0 12 3 4 0 12 3 4

Total Note. This scale was developed by Dr Maguire in collaboration with W. C. Clarke and B. Jolley of the B.L.A.T. Centre for Health and Medical Education, British Medical Association, Tavistock Square, London WC1H 9JP.

REFERENCES
0 0 0 0 2 2 2 2
Armitage, P. (1971). Statistical Methods in Medical Research. Blackwell Scientific Publications: Oxford. Bartko, J. J. & Carpenter, W. T. (1976). On the methods and theory of reliability. Journal of Nervous and Menial Disease 163, 307-317. Ebel, R. L. (1951). Estimation of the reliability of ratings. Psychometrica 16, 407-424. Heifer, R. E. (1970). An objective comparison of the paediatric interviewing skills of Freshman and Senior Medical Students. Paediatrics 45, 623-670. Jason, H., Kagan, N., Werner, A., Elstein, A. S. & Thomas, J. B. (1971). New approaches to teaching basic interview skills to medical students. American Journal of Psychiatry 111, 1404-1407. Kagan, N., Schauble, P., Regnikoff, A., Danish, S. J. & Kxathwohl, D. R. (1969). Interpersonal process recall. Journal of Nervous and Mental Disease 148, 365-374. Maguire, G. P. & Rutter, D. R. (1976a). History-taking for medical students. I. Deficiencies in performance. Lancet ii, 556-558. Maguire, G. P. & Rutter, D. R. (19766). Training medical students to communicate. In The Development and Evaluation of a Training Procedure in Communications between Doctors and Patients (ed. A. E. Bennett), pp. 45-74. Oxford University Press: London. Maguire, G. P., Clarke, D. & Jolley, B. (1977). An experimental comparison of three courses in history-taking skills for medical students. Medical Education 11, 175-182. Maxwell, A. E. & Pillner, A. E. G. (1968). Deriving coefficients of reliability and agreement for ratings. British Journal of Mathematical and Statistical Psychology 21, 105-116. Moreland, J. R., Ivey, A. E. & Phillips, J. S. (1973). An evaluation of microcounselling as an interviewer training tool. Journal of Counselling and Clinical Psychology 2, 294300. Muslin, H. L., Singer, P. R., Meuser, M. F. & Leahy, J. P. (1968). Research and learning in psychiatric interviewing. Journal of Medical Education 43, 398-403. Rutter, D. R. & Maguire, G. P. (1976). History-taking for medical students. II. Evaluation of a training programme. Lancet ii, 558-560. Werner, A. & Schneider, J. M. (1974). Teaching medical students interactional skills. New England Journal of Medicine 290, 1232-1237.

0 12 3 4

0 12 3 4