Mollie A. Ruben

“I Know Your Pain” Proximal and Distal Predictors of Pain Detection Accuracy

The aim of this research was to examine predictors of pain detection accuracy. In Study 1 (n = 160, undergraduates), the predictors were distal factors (empathy, emotion recognition, family history, and past experiences with pain), and in Study 2 (n = 104, undergraduates), the predictor was a proximal factor (an experimentally induced experience of pain). Results showed that having past and an immediate experience with pain as well as being more empathic were associated with higher pain detection accuracy scores. Men were more accurate at detecting pain than women in both studies. Our findings contribute to a growing literature on pain detection and empathy.

Training clinicians to accurately perceive their patients: Current state and future directions.

OBJECTIVEnTo review the literature on training clinicians person perception accuracy, or the ability to correctly judge patients states and traits. To present the importance of training this skill, share evidence it is a trainable skill, and suggest evidence-based recommendations for implementing training.nnnMETHODSnWe conducted a literature review on person perception training studies developed for or implemented with clinicians. We also summarized measures to evaluate training efficacy, barriers to implementation, and future research directions.nnnRESULTSnTraining studies exist to improve clinicians ability to perceive patients emotions, pain, distress, and depression. These varied in training approach, length of training, and study design. Ten of 13 studies showed training benefited person perception accuracy.nnnCONCLUSIONSnThe medical literature and previous meta-analysis on person perception training across contexts demonstrate that training person perception accuracy can be effective. Examples of effective trainings provide suggestions of best-practices for future efforts in this area.nnnPRACTICE IMPLICATIONSnMore evidence is needed to create and implement trainings which produce not only differences in accuracy but also in patient care and outcomes. Medical curriculum developers and researchers should collaborate to create effective person perception trainings for clinicians.

Reliability and Validity of Nonverbal Thin Slices in Social Interactions

Four studies investigated the reliability and validity of thin slices of nonverbal behavior from social interactions including (a) how well individual slices of a given behavior predict other slices in the same interaction; (b) how well a slice of a given behavior represents the entirety of that behavior within an interaction; (c) how long a slice is necessary to sufficiently represent the entirety of a behavior within an interaction; (d) which slices best capture the entirety of behavior, across different behaviors; and (e) which behaviors (of six measured behaviors) are best captured by slices. Notable findings included strong reliability and validity for thin slices of gaze and nods, and that a 1.5-min slice from the start of an interaction may adequately represent some behaviors. Results provide useful information to researchers making decisions about slice measurement of behavior.

The Test of Accurate Perception of Patients’ Affect (TAPPA): An ecologically valid tool for assessing interpersonal perception accuracy in clinicians

OBJECTIVEnA clinicians ability to infer patients thoughts and feelings is a critical component of high quality care. The goal of this article is to present a new test to measure this ability in clinicians, called the Test of Accurate Perception of Patients Affect (TAPPA).nnnMETHODSnAudiovisual clips were taken from patients actual medical visits. The patients reviewed the videotape after the visit to identify their thoughts and feelings during the visit. This information was used to extract short audiovisual clips for which the correct answer was the patients report of the thought or feeling associated with that clip. The TAPPA contains 48 audiovisual clips, each responded to in a multiple choice format.nnnRESULTSnThe TAPPA showed good psychometric properties (optimal mean and good variance, adequate internal consistency, and strong re-test reliability) and convergent validity with other tests of emotion recognition. In addition, the test showed predicted better performance by female than male participants.nnnCONCLUSIONnThe TAPPA promises to be a valuable tool for research and education on provider-patient relationships and quality of care.nnnPRACTICE IMPLICATIONSnA tool for testing clinicians understanding of patients thoughts and feelings may contribute to better quality of care and to improved selection and training.

Clinically relevant correlates of accurate perception of patients' thoughts and feelings.

The goal was to explore the clinical relevance of accurate understanding of patients’ thoughts and feelings. Between 2010 and 2012, four groups of participants (nursing students, medical students, internal medicine residents, and undergraduate students) took a test of accuracy in understanding the thoughts and feelings of patients who were videorecorded during their actual medical visits and who afterward reviewed their video to identify their thoughts and feelings as they occurred (Test of Accurate Perception of Patients’ Affect, or TAPPA). Participants’ accuracy scores were then correlated with participants’ attitudes toward patient-centered care, clinical course background, recall of clinical conversation, evaluations of clinical performance made by preceptors, evaluations of interpersonal skill made by standardized patients in clinical encounters, and independent coding of behavior in a clinical encounter. Accuracy in understanding patients’ thoughts and feelings was significantly correlated with nursing students’ clinical course experience, clinicians’ favorable attitudes to psychosocial discussion, standardized patients’ evaluations of medical students’ interpersonal skill, independent coding of medical students’ patient-centered behavior while taking a social history, and undergraduates’ more accurate recall of what an actor-physician said on video. Accuracy in perceiving patients’ thoughts and feelings can be objectively measured and is a skill relevant to clinical performance.

How women's sexual orientation guides accuracy of interpersonal judgements of other women

This research examines how womens sexual orientation guides the accuracy of judgements of other women. One hundred ten judges (67 straight and 43 lesbian women) watched videotapes of 9 targets (4 straight and 5 lesbian) and made judgements about the targets thoughts, emotions, personality, and sexual orientation. Accuracy scores were created for each judge by comparing judgements to criterion data gathered about targets. Straight judges were significantly more accurate at judging thoughts and marginally more accurate at judging emotions compared to lesbian judges. There were no significant differences in judging personality. Straight targets thoughts and personality were more easily assessed than lesbian targets while lesbians emotions were more easily judged than straight targets. Lesbian judges were more accurate at judging sexual orientation regardless of their tendency to categorize women as lesbian compared to straight judges. Findings support past research on the accurate perception of sexual orientation and contribute to understanding how sexual orientation guides person perception.

Measuring nonverbal behavior in clinical interactions: A pragmatic guide

OBJECTIVEnUnderstanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors.nnnMETHODSnBased on our experience conducting nonverbal behavior research in clinical interactions, we developed practical advice and strategies for coding nonverbal behavior in clinical communication, including a checklist of questions to consider for any nonverbal coding project.nnnRESULTSnWe provide suggestions for beginning the nonverbal coding process, operationalizing the coding approach, and conducting the coding.nnnCONCLUSIONnA key to decision-making around nonverbal behavior coding is establishing clear research questions and using these to guide the process.nnnPRACTICE IMPLICATIONSnThe field needs more coding of nonverbal behavior to better describe what happens in clinical interactions, to understand why nonverbal behaviors occur, and to determine the predictors and consequences of nonverbal behaviors in clinical interactions. A larger evidence base can inform better teaching practices and communication interventions.