Slicing it thin: New methods for brief sampling analysis using RIAS-coded medical dialogue Debra L. Roter a, *, Judith A. Hall b , Danielle Blanch-Hartigan b , Susan Larson a , Richard M. Frankel c a Johns Hopkins Bloomberg School of Public Health, Baltimore, USA b Department of Psychology, Northeastern University, Boston, USA c Indiana University School of Medicine, Indianapolis, USA 1. Introduction Surprisingly small amounts of information derived from direct observation of behavior, often called ‘‘thin slices,’’ have been shown to accurately provide insights into the attitudes and emotions of individuals and the nature of the relationship between interactants [1,2]. The assumption underlying thin slice analysis is that brief observational samples capture representative elements of the ongoing behavior stream and therefore provide a window into the totality of interaction [3]. A handful of thin slice studies have been conducted in the medical context using brief slices of medical interaction to predict a variety of outcomes. The majority of studies have focused on prediction of patient satisfaction and utilization [4–9], but others reported correlates of interpersonal rapport [10], therapeutic efficacy [11], and physicians’ malpractice history [12]. Thin slices of communication behavior range in duration from less than one second to several minutes long. The thin slice samples are drawn in a variety ways, sometimes purposively throughout a visit, for instance, the first or last minute of a session or at set points like the middle of each third of the visit or randomly. Audio or video channels may be used in combination as the behavior would naturally appear, or the channels may be separated or manipulated in some way. The audio channel is sometimes altered by passage through an electronic bandpass filter that renders the literal content unintelligible but retains the vocal qualities that convey emotion. In some experiments the audio channel is completely silenced and only text, or silent video, is used. Typically, thin slice segments are rated by judges asked to assess the emotion or attribute conveyed in the communication [2]. In our previous study, trained observers rated rapport on three one-minute slices of medical student interaction during an OSCE with a standardized patient (SP) [10]. While the rapport ratings were based solely on the first minute, fifth minute, and ninth minute of the session, the ratings were related to interaction analysis based on the full OSCE session, coded with the Roter Interaction Analysis System (RIAS) [13]. We reported that medical students rated high on rapport were also rated as affectively Patient Education and Counseling 82 (2011) 410–419 ARTICLE INFO Article history: Received 31 July 2010 Received in revised form 28 November 2010 Accepted 29 November 2010 Keywords: Roter Interaction Analysis System (RIAS) Thin slice analysis Patient–provider communication Medical students Standardized patients Rapport ABSTRACT Objective: To explore the relationship between one-minute slices and full-session interaction and the predictive validity of the slices to ratings of affect and rapport. Methods: Third-year medical students (n = 253) were videotaped during an OSCE. All interaction was coded using the Roter Interaction Analysis System (RIAS) and samples were drawn at minutes 1, 5, and 9 and extracted from the coded database. The slices were related in multivariate analysis to full-session interaction, corrected for slice content, and correlated with affect ratings of participants and independently rated judgments of rapport. Results: One-minute slices explained 33% of full-session variance in student interaction and 30% of variance in standardized patient interaction. Slices were significantly correlated with affective ratings of participants and independent judgments of rapport in a similar pattern as full-session interaction analysis. Conclusions: One-minute slices of interaction can provide a meaningful degree of insight into OSCE session communication with both concurrent and predictive validity to ratings of session affect and rapport. Practice implications: Evidence of concurrent and predictive validity further supports use of this approach as a research tool that provides an efficient means of analyzing processes of care, examining variation in communication throughout a visit and predicting visit outcomes. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N. Broadway, Baltimore, MD, USA. Tel.: +1 410 955 6498; fax: +1 410 955 7241. E-mail address: droter@jhsph.edu (D.L. Roter). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.11.019