Libert Yves, Merckaert Isabelle, Reynaert Christine, Delvaux Nicole, Marchal Serge, Etienne Anne-Marie, Boniver Jacques, Klastersky Jean, Scalliet Pierre, Slachmuylder Jean-Louis, Razavi Darius
Université Libre de Bruxelles, Belgium.
Psychooncology. 2007 Jun;16(6):553-62. doi: 10.1002/pon.1098.
Although it is widely recognised that educational interventions may be more effective for people with an 'internal' Locus of Control (who believe that life outcomes are controlled by their own characteristics or actions) compared to people with an 'external' Locus of Control (who believe that life outcomes are controlled by external forces such as luck, fate or others), no study has yet assessed the influence of physicians' Locus of Control (LOC) on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an 'internal' LOC would demonstrate communication skills acquisition to a greater degree than those with an 'external' LOC.
A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated in a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance.
In the two-person and three-person interviews, changes in the use of open directive questions were more important among physicians with an "internal" LOC compared with changes observed among physicians with an 'external' LOC (P=0.066 and P=0.004, respectively). In the three-person interview, changes in the use of directive questions, assessing functions and moderate feelings stated explicitly were more important among physicians with an 'internal' LOC compared with changes observed among physicians with an 'external' LOC (P= 0.001; P=0.002 and P=0.011 respectively).
This study shows that physicians' LOC is a psychological characteristic that could influence the efficacy of a communication skills training program. This evidence supports the idea that a psychological characteristic such as 'internal' LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.
尽管人们普遍认识到，与具有“外部”控制点（即认为生活结果受运气、命运或他人等外部力量控制）的人相比，教育干预措施可能对具有“内部”控制点（即认为生活结果受自身特征或行为控制）的人更有效，但尚无研究评估医生的控制点（LOC）对沟通技能学习的影响。本研究旨在检验以下假设：在沟通技能培训项目中，具有“内部”LOC的医生在沟通技能习得方面的表现要优于具有“外部”LOC的医生。
1999年1月至2001年4月期间进行了一项非随机纵向干预研究。来自比利时私人和机构执业的67名志愿医生参加了以学习者为中心、以技能为重点、以实践为导向的沟通技能培训项目。在培训前后的2次标准化模拟访谈（一次两人访谈和一次三人访谈）中评估沟通技能的变化。使用癌症研究运动研讨会评估手册评估沟通技能。使用Rotter I-E量表评估医生的LOC。使用组间时间重复测量方差比较医生在该量表上得分处于上三分之一和下三分之一的沟通技能变化情况。
在两人访谈和三人访谈中，与具有“外部”LOC的医生相比，具有“内部”LOC的医生在开放式指导性问题使用方面的变化更为显著（分别为P = 0.066和P = 0.004）。在三人访谈中，与具有“外部”LOC的医生相比，具有“内部”LOC的医生在指导性问题使用、评估功能和明确表达适度情感方面的变化更为显著（分别为P = 0.001；P = 0.002和P = 0.011）。
本研究表明，医生的LOC是一种可能影响沟通技能培训项目效果的心理特征。这一证据支持了这样一种观点，即诸如“内部”LOC这样的心理特征可能通过医生认为与患者的沟通可由医生自身控制的信念来促进沟通技能的习得。
