Interactive and evaluative correlates of dialogue sequence: a simulation study applying the RIAS to turn taking structures.

Abstract

OBJECTIVE: This study explores novel characterizations of turn taking structure and its interaction and evaluative correlates. METHODS: The Roter Interaction Analysis System (RIAS) was applied to videotapes of 51 physicians with a simulated patient (SP) to create a variety of novel turn taking measures including turn frequency, rate of interactivity, density, duration, and statement pacing. RESULTS: Visits averaged 52 speaker turns with an interactivity rate of 3.9 turns per visit minute. For physicians, turn duration averaged 13.7 s with a turn density of 4.2 statements paced at one statement every 3 s. For the SP, turn duration was 3 s with a turn density of 1.4 statements paced at one statement every 2 s. More turns, briefer turn duration and faster physician pacing were significantly related to positive ratings of affective demeanor, interpersonal satisfaction and collaborative decision-making. These measures, and interactivity, were also associated with a RIAS-based patient-centeredness score and more overall patient talk. CONCLUSION: Turn taking structures can be characterized in novel ways lending depth and richness to our understanding of dialogue, relationships to the patient-centeredness of a visit, and evaluative judgments of physician performance. PRACTICE IMPLICATIONS: The study findings suggest specificity to the interviewing admonishment "talk less and listen more" by enhancing the interactivity of the dialogue and guarding against doctors tendency toward long monologues.