Patient Education and Counseling 54 (2004) 275–282 Communication behaviours of skilled and less skilled oncologists: a validation study of the Medical Interaction Process System (MIPS) Sarah Ford a,∗ , Angela Hall b a The Ethox Centre, University of Oxford, Institute of Health Sciences, Oxford, UK b Graduate Entry Programme, St. George’s Hospital Medical School, London, UK Received 25 January 2003; received in revised form 20 November 2003; accepted 1 December 2003 Abstract The Medical Interaction Process System (MIPS) was originally developed in order to create a reliable observation tool for analysing doctor–patient encounters in the oncology setting. This paper reports a series of analyses carried out to establish whether the behaviour categories of the MIPS can discriminate between skilled and less skilled communicators. This involved the use of MIPS coded cancer consultations to compare the MIPS indices of 10 clinicians evaluated by an independent professional as skilled communicators with 10 who were considered less skilled. Eleven out of the 15 MIPS variables tested were able to distinguish the skilled from the less skilled group. Although limitations to the study are discussed, the results indicate that the MIPS has satisfactory discriminatory power and the results provide validity data that meet key objectives for developing the system. There is an ever-increasing need for reliable methods of assessing doctors’ communication skills and evaluating medical interview teaching programmes. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Cancer consultation; Interaction analysis; Communication skills 1. Introduction The ability to identify emotional disturbance in patients and the ability to manage emotional illness are characteris- tics of an accomplished interview style and reflects the pos- session of good communication skills [1,2]. This assertion is based on a large body of research conducted in the late 1970s to early 1980s in general practice, which demonstrated that there were wide variations between family doctors in the way in which they interviewed their patients and in their ability to make accurate assessments of emotional distress [3]. Crucially, the authors found that those doctors who were better able to identify emotional distress maintained eye contact with patients throughout the interview, interrupted the patient less, made more facilitating noises, responded to verbal cues suggestive of emotional distress, asked more questions about patients’ feelings, enquired about home life and made supportive comments [4]. Subsequent research has confirmed the importance of these behaviours in in- teractions between health professionals and patients with cancer. ∗ Corresponding author. Tel.: +44-1865-227049; fax: +44-1865-226938. E-mail address: sarah.ford@ethox.ox.ac.uk (S. Ford). For example, after a series of 12 residential workshops on communicating with cancer patients, Maguire et al. es- tablished which skills most promoted patient disclosure and which inhibited it [5,6]. Skills that promoted disclosure in- cluded: acknowledging and exploring verbal cues, open di- rective questions, establishing and maintaining eye contact, being empathic, summarising and making educated guesses. Empathy is one of the key skills in building the doctor– patient relationship [7,8]. It involves the understanding and sensitive appreciation of another’s predicament or feelings and the communication of the understanding back to the pa- tient in a supportive way [9]. Behaviours that inhibit disclo- sure included giving premature reassurance, the use of closed and leading questions and adopting a narrow medical focus. Maguire [10] also advocates a patient-centred interview- ing style for promoting patient disclosure, described by Stewart [11]: “An interviewing style which both focuses on eliciting symptoms and signs of illness and shows genuine inter- est in patients as individuals, their reasons for seeking help, their perceptions of what might be wrong, their feel- ings about this and the impact of any problems on their daily lives, mood and personal relationships is more ef- fective, leading to greater patient compliance with advice and treatment, as well as to greater patient satisfaction.” 0738-3991/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2003.12.004