The student text, Smith's Patient-Centered Interviewing: An Evidence-Based Method (McGraw-Hill 2018), details the steps involved in medical interviewing, a challenging, complex, and ultimately rewarding task for clinicians.1 Teaching interviewing to students can be a demanding undertaking.2–4 Not only must we be expert interviewers ourselves, we must also understand the educational principles required to effectively teach interviewing to others. We may be faced with learners who are busy, sometimes more interested in biomedicine, and who on occasion may view interviewing, particularly patient-centered interviewing, as too “touchy-feely” or as irrelevant to their concerns about becoming “real” clinicians. Despite these understandable tensions, we can recall that most students are very interested in interviewing and that they are especially enthused by their first real exposure to clinical medicine. We have an eager, receptive audience for our introduction to the most central skill in medicine—a superb opportunity for establishing a biopsychosocial atmosphere. Most students want to be good clinicians and know that they must be good interviewers to reach their goal.
Our own experiences in teaching interviewing revealed firsthand how difficult it can be. We first had to brush up on our own interviewing skills—and found that feedback on a regular basis was invaluable. Recording interviews in the clinic and self-critiquing them and, better yet, having a peer or learner provide feedback has been most useful. The usual standard in medicine of “see one, do one, teach one” does not work very well for improving interviewing skills.
Intensive training for instructors can be useful and has been helpful to all of us. The Academy of Communication in Healthcare (ACH) (www.achonline.org) offers an annual conference course for clinicians to improve their interviewing and teaching skills. ACH also offers a 1-year Relationship-Centered Communication Facilitation Program that “develops future facilitators” to facilitate ACH programs to train trainers who teach communication skills. This is a program that “prepares your institution's future trainers to deliver high-quality communication training to peers.” ACH also offers a longer (2–4 years) program called the Faculty-in-Training program that is “a learner-centered professional development program where experiential learning is coupled with guidance from a personal mentor (www.achonline.org, 2017).
Regular meetings of local groups of instructors can enhance your teaching skills by marshaling the considerable existing expertise that exists in many schools and programs throughout the country. Local training is particularly effective if both medical and mental health professionals are involved and if the work includes personal awareness development. A combination of national and local activities is ideal.
With this backdrop, we want now to describe how one might structure the teaching process for “Interviewing 101.” We do not address advanced interviewing skills involving the integration of personal awareness training with the more mechanical tasks of interviewing, as these have been described elsewhere.5 We do mention some basic personal awareness issues that can be included in Interviewing 101. Teaching will not be effective if it is based on traditional educational pedagogy, that is, didactic lectures, to master cognitive content; nor will only reading the textbook or watching the companion video.6,7 A specific course is required—where the instructor also teaches at behavioral (e.g., modeling) and experiential (e.g., actual interviewing) levels. Presenting a specific, behaviorally defined model, as the text depicts,1 has been shown to be a particularly effective teaching tool.8,9
Although teaching basic interviewing requires a rather structured approach, we encourage instructors to maintain a balance of learner-directedness within the confines of this structure.9–11 It is critical for learners to: (1) identify course goals as their own (e.g., patient-centeredness); (2) identify their own interviewing and self-awareness challenges and devise learning goals and teaching techniques (e.g., role-play) to address them; (3) lead discussions and provide feedback to each other, taking responsibility for some teaching as well as learning; and (4) assist in directing their own learning (e.g., controlling the video playback during critiques). Learner-centeredness actively involves learners, enhances their self-efficacy, and creates opportunities for faculty to model the very behaviors they would like to see embodied in learner performance.10,11
Teaching an integrated approach to preclinical students and other new learners, as presented in Chapters 1 to 6 of the textbook1 and in the videos, available on the AccessMedicine website www.accessmedicine.com/SmithsPCI,6,7 is outlined here. In essence, the instructor presents the data-gathering and relationship-building (facilitating) skills, then focuses repeatedly upon the first five steps of the interviewing model, next integrates clinician-centered steps (Steps 6–10) of the model, and moves to the end of the interview (Step 11). Virtually all students and residents have been able to learn these skills quickly. The curriculum presented has more sessions than likely are available in some instances, but one can easily modify them to fit the time available, often teaching clinician-centered interviewing in a later semester or year, rather than in tandem with patient-centered interviewing. This teaching supplement does not present guidelines for the end of the interview (informing and motivating), as these are usually best taught during clinical years. They can be derived easily from the material in Chapter 6 of the textbook.1
Our teaching recommendations are directed to medical, advanced practice nursing, and physician assistant students, but the approach is easily adapted to residents, practitioners, faculty, and learners in other allied fields.