Psychiatric Interviewing and Clinical Skills

Abstract

Does the ability of medical students to assess and relate to their patients through the psychiatric interview reflect in traditional academic achievement scores? A previous publication by our group offers data suggesting that certain personality traits of final year medical students have a fundamental importance in determining a successful performance on a psychiatry rotation. As the literature is vague and contradictory about the relation-ship between the psychiatric interview and clinical performance, a study was developed to determine what outcome variables are associated with the performance of clinical clerks on the Psychiatric Interview’ An attempt was made to develop and test a new scale designed to measure the Psychiatric Interview. The Psychiatric Interview Scale was used to measure performance on 33 final year medical students on a 1 month psychiatry rotation at a University of Toronto teaching hospital, and subsequently, as a basis for analysis and training of these students in interviewing. Inter-rater reliability of the Psychiatric Interview Scale was rho = 0.72 and internal reliability was 0.74. Psychiatric Interview Scores were compared with other achievement scores, and with patients’ ratings of the students interviews. A significant correlation emerged between the Psychiatric interview scores and final clinical examinations, but surprisingly, there was no relationship between the patients’ evaluation of the Psychiatric Interview and the raters’ evaluations and a strongly significant negative correlation between patients’ ratings and clinical scores. The importance of observed psychiatric interviews in teaching and evaluation are discussed along with the interesting implications of the differing evaluations of a successful interview by patients and psychiatrists. The relevance of training in the Psychiatric Interview to general medicine and family practice is emphasized.

The effects of patrol officers' defensivesness toward the outside world on their ethical orientations

“…Besides inhibiting this type of breach of public trust, which has received the greatest scholarly attention, 36 a service ethic also prescribes impartial decision making and nonprejudicial execution of duties and responsibilities. 37 Yet, in the case of the police, not only are certain segments of the community viewed as suspect, but, as Sherman has observed, most of the public is seen as the enemy. 38 In order to deal with the constant threat of being in a dangerous situation involving persons who cannot be identified in advance, the police come to view everyone with suspicion,* 39 and thus the police become isolated from the rest of society.…”

“…They especially feel they should have the right and ability to use force when necessary, since force is a clear symbol of their authority and legitimate dominance in interaction with the public and the most effective method of control. 48 Thus, when police officers resent what they perceive as an infringement of their authority by the courts or by civilian review boards, this resentment may not derive from a subculturally supported authoritarianism 49 but instead from a perceived threat to their sense of professionalism.…”

“…10 However, a formal code of ethics is undermined by a police subculture that police scholars find not only vitiates individual adherence to ethical standards but also militates against the obligation implied by a regulatory code of ethics to identify and mete out professional sanctions against those fellow practitioners who have failed to perform their duties properly. 11 Because the police subculture requires that its members be loyal and trustworthy, officers feel obligated to cover up a fellow officer's brutal acts, petty thefts, extortionate behavior, abuses of power, and other illegalities.…”

“…40 Their suspicion is reinforced by their work experiences, where they are so frequently in an adversarial relationship with the public and where they are confronted daily by people who are weak and corrupt, as well as dangerous. 41 The suspicion, isolation, and alienation the police experience is fostered largely by their perception of public hostility toward law enforcement and police officers. Whether or not public hostility toward the police exists in the intensity and to the extent the police perceive, they, nevertheless, believe it does.…”

Assessment and validation of diagnostic interviewing skills for the mental health professions

“…Many practitioners have documented how to conduct such an interview (e.g., Hersen & Turner, 1985;Shea, 1988). Although it is widely recognized that the development of diagnostic interviewing skill should be one of the main objectives of mental health education (Borus & Yager, 1986;Maguire, 1982;Pollock, Shanley, & Byrne, 1985), there has been little systematic study on the assessment of diagnostic interviewing competence (McCready & Waring, 1986;Rutter & Cox, 1981;Shea & Mezzich, 1988).…”