The influence of personality dimensions on communication style: a study on medical students.

INTRODUCTION The shift from the “disease-centered” approach to the “patient-centered” attitude in medicine lead to an increasing attention to communication skills in the medical training and to the relational aspects involved in the medical encounter. The ability to well conduct a clinical inquiry is not any more believed to be only an inborn skill, but something that can be learned (Mead and Bower, 2000). Many researches have been done in the last decade on which teaching issues could be the best way in achieving doctors more patient-centered (narrative medicine, problem based learning and so on). A big work was done on the role of physician empathy in patient care (see Hojat, 2007), but still partially unexplored is the relevance of more general personality differences and how individual differences can affect physicians/medical students relational style and communication attitudes with patients OBJECTIVE The first research question is if a patient-centered relational style is related to personality differences or not. The second question to be tentatively answered is what dimensions could be associated to a "patient centered" communicative style SAMPLE 21 students (14 females, 7 males) (2= 3th year, 4= 4th year, 1= 5th year) of the Medical Faculty, Milano Bicocca University, attending the elective course “The difficult patient”; all the students had at least one year of ward experience. PROCEDURE Each student acted as doctor in a standardized role-playing, with a standardized patient (played by a skilled psychologist). 21 role-plays (mean duration = 14, 65) were videotaped and subsequently analyzed by the Roter Interaction Analysis System (Roter, 2002) and the Verona Network on Sequences Analysis. Immediately after the role play – and before the general discussion usually done in group at the end – each student was asked to fill in four questionnaires. Combining “Instrumental” and “Affect” categories of RIAS (Mead and Bower 2000) with “emotional exploration “ and “no emotional exploration "of Verona, we obtained 4 type of interview: CMM/ES, CM/ES, CMM/NES, CM/NES (CMM/ES more "patient centered“, CM/NES less "patient centered"). The mean scores obtained in each questionnaire were compared with respect to the type of interview conducted INSTRUMENTS -Interpersonal Reactivity Index (IRI) (Davis, 1983) was created specifically to measure four factors related to empathy: Perspective Taking (PT): measures the tendency to take the psychological point of view of others. You could probably look at this as cognitive (thinking) empathy Empathic Concern (EC): measures sympathy and concern for others. You could probably look at this as emotional empathy. Personal Distress (PD) : measures the kind of feelings (anxiety, etc.) that gets in the way of helping others. Fantasy Scale (FS): measures the tendency to get caught up in fictional stories and imagine oneself in the same situations as fictional characters. You could probably look at this as imaginative empathy, this Scale is not considered in the analysis. - Self-Monitoring Scale (SMS) (Snyder, 1974): “self monitoring” refers to a person’s ability to adjust his or her behavior to external situational factors. Individuals high in self monitoring show adaptability in their behavior. Low self monitors tend to display their true dispositions and attitudes in every situations. -Questionnaire for the assessment of the organization of personal meaning (QSP) (Picardi et al. 2003): the questionnaire was developed within the framework of cognitive psychotherapy to evaluate individual differences. From a more complex profile the following dimensions were extracted : Emotional control: the need to keep under control their and others' emotions. Sensitivity rating: the tendency to define itself in relation to the definitions of others. Rigor and logic: the tendency to refer to rules and abstract principles. - Patient-Practitioner Orientation Scale (PPOS) (Krupat, 2004): assess the relevance given by the subjects to the relational aspects in the doctor - patient relationship by a two dimensions score: Caring: referring to the extent that doctor believes that a) caring about emotions and good interpersonal relations is a key aspect of medical encounter, and b) that practitioners should care about the patient as a whole person rather than as a medical condition. Sharing: reflects the extend to which the doctor believes that a) practitioners and patient should share power and control on a relatively equal basis, and b) that practitioners should share as much information with their patients as possible CONCLUSIONS The comparison between the dimensions investigated showed the importance of the empathic issues, in particular the subscale “perspective taking”, that measures the tendency to take the psychological point of view of others. The relevance given by the students to the relational aspects in the doctor - patient relationship appears as a fundamental component in the "patient centered“ interview. The stability of behavior encourages the exploration of patient emotion, while a high need for emotional control leads to more “disease centered” discussion. So we think that is important for our students learning the importance of relational aspects in doctor –patient relationship, and then it’s fundamental for them, learning the manage of own and patients’ emotions.