3.... .125... ......_“,1 .:.a......, . ‘ K A .. ... 71.1.2 .33. , «VCLJt? V .A l )1... .l 12‘11 . H . . a A935,: I: 313113. n <...... I . .5 ;..;..,..,..,..,... L1,. .. . v. i. ,rfi..lw; . 3 y; .,.IA‘W« .. , Ian v . 0 r .‘ . V ,. A4 1' I tag): 1 .J, :73? .Ilf ). 7 . . 3.3.. CL... L. .V c. «r 52’“: .lul . . lll'rlefl.‘ 3 .. lat: u:iy‘kmifiefiamksifiwmamfl. ‘9‘); p. I , :.. This is to certify that the thesis entitled EFFECTS OF MODELING AND DIFFERENTIATED PRACTICE UPON INTERVIEW SKILLS OF PARAPROFESSIONALS presented by Nancy A. Tyler has been accepted towards fulfillment of the requirements for Ph.D. _ Education degree 111 ' Major professor Ma 3 1974 Date y ’ 0-7339 ‘; BINDING BY “ HMS 8 SUN NS w‘ ‘BUUK BINDERY INC. st DSER ‘ mug SPRIIGPOR] MICHIBAI N fl rLo ABSTRACT EFFECTS OF MODELING AND DIFFERENTIATED PRACTICE UPON INTERVIEW SKILLS OF PARAPROFESSIONALS BY Nancy A. Tyler This research examined the effects of model, practice, and activation on the attainment and retention of initial interview skills in a training program for dental health paraprofessionals. To assess the results of the video modeling and differentiated practice procedures used in the interview skills training program, three companion studies vmre formulated. The companion studies were intended to {novide comparative measures of both the effect of modeling \da videotape and the efficiency of different types of :uactice in the mastery and generalization of initial non- \mrbal and verbal interview skills. Specifically, the objectives of this research were: 1. Study One: To assess the effect of a specific ammple of modeling vs. no modeling in the performance of rmndverbal and verbal interview skills. 2. Study Two: To compare differential practice hmatments in the mastery and retention of both verbal and rmn-verbal interview skills. , Nanc A. T ler C) Y y I}. Study Three: To investigate differences in the level<3f activation of the practice treatments and differences in activation level at the end of the interview performance. To meet the objectives of the research, a training program was developed with the intent of making systematic comparisons of the outcomes of the video modeling plus cues and differentiated practice procedures used in teaching initial non-verbal and verbal interview skills. Study One contrasted the effect of the modeling plus cues treatment with no treatment to test the power of the training model on both non—verbal and verbal interview skill performance. The basic design of this study was an experimental "post-test only" design recommended by Campbell and Stanley (1963). subjects were randomly assigned to the undeling treatment (M1) or the no model group (M2). The model treatment was administered via videotape in a group setting. Group interaction was not included in the model treabment; subjects simply viewed the video presentation on initial interview skills. After interview performance data vmre collected, and prior to the practice treatments, the rm model group (M2) viewed the identical model videotape so that all subjects were equivalent before the practice phase CW the researdh was administered. During the practice phase, Study Two, subjects were randomly assigned to the five practice treatments: dis- cximination, feedback and supervisor, teach another, IJ . 3 § Nancy A. Tyler combination, and control. All practice treatments were administered individually. Immediately following the practbce session, each subject completed a second interview which provided data for the comparative evaluation of the practice treatments. Three weeks following the treatment administration, a delayed-post measure was collected to assess the retention of interview skills across time. The basic design for Study Two was a 2 x 13 x 5 repeated measures design: that is, the design contained 2 times, 13 interview skills, and 5 levels of practice with S3 nested with practice but crossed with measures and times. Each cell contained an equal number of subjects (n = 7; total n - 35). The third phase, Study Three, of this investigation pmovided for the exploration of the activation properties of practice treatments, the relationship of activation to the attainment of interview skills, and subject differences in activation. Activation was defined as the degree of arousal or alertness as measured by the four factors of the Activation-Deactivation Adjective Check List. Data were collected twice: immediately after practice and prior to the second interview, and after the final delayed-post interview. The criterion measures used in this study were formulated tn examine both non-verbal and verbal interview skills. The mmm dependent variables comprising frequency and duration (flmervations and global ratings were included in each Nancy A. Tyler companion study. Interview data in the form of seven-minute \ddeotaped interviews were collected on three occasions: aflmr modeling, after practice, and three weeks following Inactice. Videotaped interview skill performance data were mflmequently rated by three independent judges for the (miterion measures. Reliability estimates were calculated flnrthe mean judges' ratings on each interview skill measure flu each set of interview data collected at the three (fifferent times. Reliability estimates ranged from .98 to .S&. Also, reliability estimates were obtained for the anal non-verbal and verbal scores at each of the three data collection times . It was hypothesized that subjects who received the Hmdel*would exhibit superior non-verbal and verbal inter- \dew skills to those who did not receive model instruction. It was also hypothesized that subjects receiving differential Emactice treatments would exhibit different performance levelsdelayed-post assessment times were statistically signifi- cant (a.= .05). The concept of activation appears to be an interesting one that may provide some understandings about learning sequences and treatments. EFFECTS OF MODELING AND DIFFERENTIATED PRACTICE UPON INTERVIEW SKILLS OF PARAPROFESSIONALS BY Nancy AT‘Tyler A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Counseling, Personnel Services and Educational Psychology 1974 ACKNOWLEDGMENTS The writer wishes to recognize and to express her sincere appreciation to the following peOple: To Dr. Norman Stewart, committee chairman and major advisor throughout my graduate study, who exhibited an mfiive interest in this research. He made many helpful suggestions, yet allowed me to extend myself and make the learning and meaning from this study mine. To Dr. Andrew C. Porter, committee member, who offered mqmrtise in research design and statistics. His encourage- ment for that which is meaningful and worthwhile in research stands as a challenge. To Dr. Herbert M. Burks, Jr., who encouraged me as a committee member and also assumed an active interest in my graduate program. . To Dr. James W. Nelson, committee member, whose interest ulthe community college and support as a representative :hmm the student personnel area were valued. To the administrators at Charles Stewart Mott Comm- Iunty College who encouraged me in this research. To the dental hygiene faculty and students of C. S. Mott Cbmmunity College whose interest, willing participation, and support made this set of studies possible. To the staff of the C. S. Mott Community College In— structional Media Center who provided the equipment and technical assistance necessary to implement the model, Practice, and data collection phases of this project. To my colleagues who served as judges, giving generously of their time and energy. Finally, to the many significant others who contributed “3 my background, growth, and motivation to achieve which reSulted in the accomplishments of this set of companion Studies. ii TABLE OF CONTENTS IJST OF TABLES . . . . . . . . . . . . . . . . LIST OF FIGURES O O O C O O O C O O O O O O 0 Chapter I. INTRODUCTION AND REVIEW OF LITERATURE Introduction . . . . . . . . . . . Purpose . . . . . . . . . . . . . . Review of Literature . . . . . . . Initial Interview Skills . . . Modeling . . . . . . . . . . . Video Simulation in Modeling . Microcounseling . . . . . . . . Practice Dimensions . . . . . . Generalization and Transfer . . Activation . . . . . . . . . . Summary . . . . . . . . . . . . . . II. EXPERIMENTAL DESIGN AND PROCEDURES . Overview . . . . . . . . . . . . . Model . . . . . . . . . . . . . . . Materials . . . . . . . . . . . Assistants . . . . . . . . . . Facilities and Apparatus . . . Treatment Procedures . . . . . Practice . . . . . . . . . . . . . Materials . . . . . . . . . . . Assistants . . . . . . . . . . Facilities and Apparatus . . . Treatment Procedures . . . . . Hypotheses . . . . . . . . . . . . Study One . . . . . . . . . . . Study Two . . . . . . . . . . . Sample . . . . . . . . . . . . . . Sample Characteristics . . . . Subject Assignment . . . . . . Interviewee POpulation . . . . iii Page vi ix H \DKDU'IH 10 18 23 28 30 32 35 35 4O 40 42 42 43 46 46 52 54 55 56 57 57 59 59 61 63 Chapter Measures and Data Collection Non-Verbal Measures . Verbal Measures . . Data Collection . Judges . . . . . Reliability . . . Activation Data . Feedback Data . . Design and Analyses . . Experimental Design Analysis of Data . II I 0 RESULTS 0 O O O O 0 O O O O O O O O O O O 0 Study One: Modeling . . . . . . . . . General Findings . . . Results of the Tests for Hypotheses Study Two: Practice . . . . . . . . . General Findings . . . . . . . . . Combined Effect of Practice over Time Results of the Tests for Hypotheses—- Combined Effect of Practice . . . Study Three: Activation . . . . . . . . Activation Level of Practice . . . . Activation Level Following Delayed- Post Interview . . . . . . . . . . Activation Changes for Subjects across Time . . . . . . . . . . . Relationship of Activation to Interview Skill Performance . . . IV. SUMMARY, DISCUSSION, AND IMPLICATIONS . . . Summary . . . . . . . . . . Limitations . . . . . . . . Discussion and Implications subject Variable . . . Dependent Variables . . Treatment Effects . . . Conclusion . . . . . . . . LISTOFREFERENCES................. iv Page 64 64 64 65 68 72 75 76 77 77 80 83 84 84 87 91 91 94 113 117 118 119 124 125 129 129 134 141 141 144 147 150 153 Ton-l . u a...“ l '1' ‘ l " on N a . -.'. on d 6 “ h l... ' M u l o I I! I1 . C v t\ 4 . 1 'V o '| I '0 \ ‘I ~ I w o m APPENDICES Page A. INITIAL INTERVIEW SKILLS . . . . . . . . . . . 162 B. BASIC MICROCOUNSELING MODEL . . . . . . . . . . 170 C. ACTIVATION-DEACTIVATION ADJECTIVE CHECK LIST . 172 D. VISUAL AIDS . . . . . . . . . . . . . . . . . . 177 E. MODEL VIDEOTAPE CONTENT . . . . . . . . . . . . 179 F. INSTRUCTIONS FOR ASSISTANTS . . . . . . . . . . 180 G. ANNOUNCEMENT TO CLASS OF TRAINEES . . . . . . . 183 H. SUBJECT ASSIGNMENT FORMS . . . . . . . . . . . 185 I. GENERAL INSTRUCTIONS FOR PRACTICE SESSIONS . . 186 J. DISCRIMINATION PRACTICE WRITTEN MATERIALS . . . 187 K. FEEDBACK AND SUPERVISOR PRACTICE'WRITTEN MATERIAm O O O O O I O C C C O C O O C O O O l 98 L. TEACH ANOTHER PRACTICE WRITTEN MATERIALS . . . 203 M. COMBINATION PRACTICE WRITTEN'MATERIALS . . . . 215 N. CONTROL GROUP PRACTICE WRITTEN MATERIALS . . . 227 O. SUPERVISOR'S INSTRUCTIONS FOR.PRACTICE SESSIONS O O C O C C O O O C O C O O C O C O 236 P. PHYSICAL FACILITIES: DENTAL CLINIC FLOOR PLAN 238 Q. NON-VERBAL AND VEREAL RATING SCALES . . . . . . 239 R. NON-VERBAL AND VERBAL EVENT RECORDER OUTPUT . . 241 3. INSTRUCTIONS FOR VIDEOTAPING INTERVIEWS . . . . 243 T. INSTRUCTIONS FOR INTERVIEW ASSISTANTs . . . . . 244 U. DENTAL HYGIENE STUDENT SURVEY . . . . . . . . . 248 V. INTERCORRELATIONS OF INTERVIEW SKILL ITEMS . . 252 TABLE 10. ll. 12. LIST OF TABLES Hoyt Reliability Coefficients for the Mean JUdge Ratings for Each NOn-Verbal and Verbal Measure at EaCh Testing Time . . . . . . . . Hoyt Reliability Coefficients for Total NOn—Verbal and verbal Measures at Each Testing Time 0 O O O O O O O O O O I O O O 0 Cell Means and Standard Deviations for Model and NO-Model Groups on Verbal and Non-Verbal Interview Skills, All Judges . . . . . . . . Analysis of Variance for Non-Verbal Interview Skills, Model vs. No-Model Comparison . . . . Analysis of Variance for Verbal Interview Skills, Model vs. NO-Model Comparison . . . . Cell Means and Standard Deviations for Total Verbal and NOn-Verbal Interview Skills for All Practice Groups on Immediate and Delayed—Post Observations . . . . . . . . . . Cell Means for verbal and Non-Verbal Items for All Practice Groups on Immediate and Delayed-P081: Observations 0 o o o o o o o o 0 Cell Means for the Effect of Practice on the Total NOn-Verbal Measure . . . . . . . . Cell Means for the Effect of Practice on the Total Verbal.Measure . . . . . . . . . . Cell Means for the Effect of Practice on NOn-Verbal Measures for Combined Immediate and Delayed—Post Observations . . . . . . . . Cell Means for the Effect of Practice on Verbal Measures for Combined Immediate and Delayed-Post Observations . . . . . . . . Analysis of Variance Test of Combined Total Non-Verbal Measure for Interaction between Practice Groups and Repeated Measures . . . . vi Page 73 75 85 88 90 92 95 97 99 101 102 103 we | u !l ‘ til i In TABLE 13. 14. 15. 16. 17. 18. 19. 20. 21. 22, 23, 24, 25 Analysis of Variance Test of Combined Total Non-Verbal Measure for Repeated Measures Main Effect for All Subjects Analysis of Variance Test of Combined Total NOn-Verbal Measure for Practice Groups Main Effect . . . . . . . . . Analysis of Variance Test of Combined Total Verbal Measure for Interaction between Practice Groups and Repeated Measures Analysis of Variance Test of Combined Total Verbal Measure for Repeated Measures Main Effect for All Subjects . . . . . . . . . . . Analysis of Variance Test of Combined Total Verbal Measure for Practice Groups Main Effect . . . Multivariate Test Item Measures for of Combined NOn—Verbal Interaction between Practice Groups and Repeated Measures . . . . Multivariate Test Item.Measures for Main Effect . . . Multivariate Test Item.Measures for Multivariate Test of Combined Non-Verbal Repeated Measures of Combined NOn—Verbal Practice Groups Main Effect of Combined verbal Item Measures for Interaction between Practice Groups and Combined Measures . . . . . . . . Multivariate Test of Combined Verbal Item Measures for Repeated.Measures Main Effect for All Subjects Multivariate Test of Combined Verbal Item Measures for All Practice Groups . . . . . . Weighted Scheffé Contrasts for Non-verbal Total Practice Groups Main Effect for Combined Practice Data . . . . . . . . . . . Cell Means for Activation-Deactivation Adjective Check List Factors for All Practice Groups Immediately Following Practice Treatment . . . . vii Page 103 104 105 105 106 107 108 109 110 111 112 115 120 TABLE 26. 27. 28.. 29. 30. 31. Analysis of Variance for Activation Factors for All Practice Treatments Assessed Immediately Following Practice . . . . . . Cell Means for Activation-Deactivation Adjective Check List Factors for All Practice Groups Following Delayed-Post Interview . . . . . . . . . . . . . . . . . Analysis of Variance for Activation Factors for All Practice Treatments Following the Delayed—Post Interview . . . . . . . . . . Activation Factor Cell Means for All gs . . Analysis of Variance for Activation Factors for Changes in Subjects from Practice through Delayed-Post Interview Times . . . Correlation of Activation Factors to Immediate Practice Assessment . . . . . . . viii Page 121 122 123 125 126 127 LIST OF FIGURES Sequence and Time Chart for Training Activities and Data Collection . . . . Effects of Modeling and Differentiated Practice Upon Interview Skills of Dental Hygienists . . . . . . . . . . Study One: Pictorial Representation of the Experimental Design to Test the Effect of Modeling . . . . . . . . . . Study Two: Pictorial Representation of the Experimental Design for Comparative Study Of Practice . . . . . . . . . . ix Page 38 62 78 79 ~z ”M. a... CHAPTER I INTRODUCTION AND REVIEW OF LITERATURE Introduction Counselor skills are too important to be confined to fluacounseling cubicle alone. Recent conceptions of the practicing counselor's role expand the activities to include serving as a counselor educator, as a trainer, and as a mnmultant in human relations skills (Ivey, 1971: Carkhuff, 1969a, 1969b, 1972). As counselors move into a larger mmmmnity to conduct training programs for paraprofessionals, teachers, and students, research questions and methods focus Ontme specific skills needed to be effective. Teaching beginning counselors and therapists "how to counsel" is one °fthe more complex issues facing counseling psychology (Knmflpltz, 1967: Matarazzo, Wiens, and Saslow, 1966: wrenn, 19m”. These issues are central in preparing counselors for their role in training others. In this study the concept of abr'Oad counselor role, training and serving as consultant indeveloping programs for health paraprofessionals, was imPlemented. In the develoPment of training programs, some counselor educators call for systematic efforts. The systems approach 1 '- - nut IO! emphasizes the creation of step-by-step programs both in counselor education and the efforts of counselors to assist others. Unfortunately, counselor education and counselor- directed programs have too often been less than systematic. In addition, personal convictions and preferences have Often tmen given priority over comparative investigations seeking to establish effective practice. Counselor training has rum generally been efficient or economical in the use and vaelopment of human resources (APA, 1972a, 1972b; Ivey, 1971; Vfinteley, 1969). Systematic programs that promise to deliver sumcific skills appear to be needed most. The present in- \mmtigation attempted to develop and analyze an interview fldlls training program in a comparative, systematic manner. Counselor research which can offer understandings for cmnmelor practice meet the criteria of relevance. As Knmmoltz recommends, the test of relevance consists of askhw one simple question and probing the answers: "What “"1-11 counselors do differently if the results of this research come out one way rather than another?" (Whiteley,l969, I” 191). Throughout the years counselor educators have relied on little empirical evidence and a variety of teach- ing methods. Lectures, demonstrations, role-playing, case Studies, and audio and videotapes have been commonly used “1.. .A. u. - «I» ‘ | .. . Iv ‘. a . ‘\ s in training. However, the need for comparative studies of these methods to build a base of empirical evidence still exists. The present study was a comparative investigation of modeling and different types of practice in training dental lmalth paraprofessionals in initial interview skills. This research was based upon the contention that counselors and cmumelor educators need to systematically investigate the nahue and comparative effectiveness of different teaching pnmedures and methods for training paraprofessionals. Whieley (1969), in a review of counselor education literature, shmles out the training process as being in particular need Qfsystematic study. Often studies avoid or neglect the Tmmtion of comparative effectiveness (Horan, 1972). The ismmaof what works, with whom, and under what conditions iSCflrcumvented. There is a need to train paraprofessionals ineffective interview and human relations skills so that thQiney grow personally, will relate effectively to others, andPerform competently on their jobs. In View of limited remMumes and budgets available for human development t"raining programs, comparative studies are needed to focus Upon methods of training. In the research undertaken here, a . . n effort was made to compare the effectiveness of Video modeling and the different types of practice that might enhance an interview skills training program for health paraprofessionals. One approach to researching specific skills in counselor education and interview training, microcounseling, was pio- rmered by Ivey and associates (Ivey, 1968). The principal amxof microcounseling is to provide prepracticum training tormrrow the gap between theory and actual practice. In pnfliminary studies, specific skills identified and specified amble important aspects of interviewing and relationships Unbe isolated. In essence, the microcounseling paradigm alkmm controlled and systematic study of the interview pro- cemain naturalistic settings. Microcounseling techniques Pnndde a framework, a structural or methodological approach, tojnterview training and research (Ivey, 1971). What are the basic dimensions of microcounseling? Em- MNmis on a single skill, feedback, modeling, and super- ‘dshxlare four essential elements (Ivey, 1971, p. 87). {Mm basic model allows for learning through video models, written materials, feedback by self-Observation and super- Visory comments. Basic components and alternative models allow for systematic, controlled research in training. To summarize, deveIOpments and extensions of the CO . . . unSelor role, Increased demands for systematic, comparative .1 ~11. - 4n..- nnvb'n. r- u an. n,. \..'. and accountable studies in counselor education research, and microcounseling components for paraprofessional training establish a foundation for the present investigation. From this foundation the present research focused on modeling and {mactice dimensions Characteristic of microcounseling and cther learning approaches. m A group of dental hygiene paraprofessionals at Charles sawert Mott Community College was selected for interview meining. The purpose was to investigate the comparative effimt of modeling and practice upon the attainment and rennmion of initial interview skills. This investigation wmsdivided into three companion studies. The companion studies were intended to measure both tMaeffect of modeling via videotape and the efficiency of dfiferent types of practice in the mastery and generalization °frmm~verbal and verbal interview skills. For organizational p‘J‘I'POSes and the investigations desired, each companion study ”fill be considered an independent one. More specifically, the objectives of this research Were; 1- Study One: To assess the effect of modeling vs. no modeling in the performance of non-verbal and verbal interview skills. 2. Study Two: To compare differential practice treat- ments on mastery and retention of both verbal and non-verbal interview skills. 3. Study Three: To investigate differences in the level of activation of the practice treatments and differences in activation level at the end of interview performance. Both non-verbal and verbal aspects of interview per- formance were deemed to be of importance. Initial interview mulls were defined from attending behaviors such as demon- MEating to the interviewee that the interviewer respects hunas a person and is interested in what he says (Ivey, 1971L. Evidence of skill in initial non-verbal attending or listening behaviors was observed in the initiation and mahuonance of eye contact and in the relaxed, natural Ewihuo and movements as the interviewer directly faced the30ther person. Initial verbal attending behaviors for interview trainees comprised offering invitations to talk (ITT) and encouragements to continue talking (ECT). This research was designed to test the proposition that modeling and practice methods used in the interview Q|-I... A “or. c n A. .— *u. «g. .‘ "‘IA _ -.v‘ u “ training program are differentially effective in increasing the use of both non—verbal and verbal initial interview tmhaviors. Non-verbal total scores were based on the following coservations: duration and frequency of breaks in eye camect; and global ratings of body posture, gesture, and rum-verbal attending behavior. Verbal total scores were cxmoosed of the frequency and quality of invitations to talk (ITT), encouragements to continue talking (ECT); and global ratings of quality and effectiveness in the use of invitations, encouragements and verbal attending behavior. Observations and ratings were made from seven—minute interviews made by dental health paraprofessionals involved in the interview skills training program. Assessment of the effect of modeling and comparisons of different modes of practice on mastery and retention <3f interview skills were of interest. The modeling and ‘2ues treatment was a videotape demonstration of positive E3nd negative student examples of initial interview skills. IPractice modes incorporated in this study included: 1. Discrimination Practice §s* viewed videotapes of a variety of inter— viewers and practiced by rating to discriminate the number and quality of others' interview skills. 2. Feedback and Supervisor Practice gs viewed their own performance with a super- visor, and talked about ways to improve their next performance. 3. Teach Another Practice gs taught another person the interview skills. After reviewing the skills from a written script, each S was provided with a practice individual to instruct in interview skills. 4. Combination Practice gs experienced a combination of discrimination, feedback with supervisor, and teaching another practice. 5. Control Group gs studied dental hygiene materials not related to the mastery of interview skills. Thus, the major purpose of this research centered on InOdeling and the differential effectiveness of practice modes 541 mastering and retaining initial interview skills. Additional benefit was gained by observing activation 143vel of practice mode and interview performance. The *Subjects will be abbreviated for this chapter and in tihe following chapters: Subject as S, and Subjects as gs. intent of this section of the research was to study the activation properties of practice treatments, the relation- ship of activation to the attainment of interview skills gmesented in training, and individual subject differences hiactivation. Activation was defined as the degree of arousal or alertness as measured by the Activation-Deactivation Adjective Check List factors. Review of Literature First, the review will report current developments in training that outline initial interview skills and related training programs. Then, relevant literature concerning modeling will be discussed in terms of social learning theory and techniques and the development of learning se- quences and training programs. Next, the review will focus on the practice dimension and the generalization and transfer of skills. Finally, a discussion of the concept of activation and the applicability of this line of inquiry will be under- taken. Initial Interview Skills In the writings of Ivey and his associates (1971), Extensive treatment is given to the identification and lO description of interview Skills. Many specific skills, each carefully documented, are an outgrowth of the microcounseling framework. Initial, or beginning interview skills, involve both non-verbal aspects and verbal behaviors intended to assist the trainee in attending to another (Ivey, 1971). These initial interview behaviors are deemed appropriate for the focus of this inquiry. Beginning interview skills incorporated as good attending behaviors which give evidence of listening are: (a) maintaining some type of consistent eye contact, (b) being physically relaxed with natural posture and movements--body directly facing the other person, (c) opening the interview with invitations to talk, (d) encouraging the patient to continue talking. Background information and descriptive formulations of these skills are contained in Appendix A. Mode ling Historically, a theoretical viewpoint of imitative learning was deve10ped by Miller and Dollard (1941) from social psychology, psychoanalytic, and instrumental con- ‘ditioning concepts. These theorists stated that the four factors essential to imitative learning are drive, cue, 11 response, and reward. The four factors operate in two different forms of imitative learning--matched-dependent kmhavior and empathic learning. Matched-dependent behavior pmoposes that an observer learns to match a model's response as a result of reinforcement which is experienced directly or vicariously. The imitator in cOpying behavior not only responds to cues from the model, but he also responds to cues cm sameness and difference produced by internal stimulation. Mowrer (1960) has described an identification process whereby cme person makes a response while rewarding another; later the rewarded person attempts behaviors exhibited by the model even though the model is no longer present. In the second form of imitation called empathic learning the model experiences the reinforcement. Imitation of the model's behavior follows from the observer vicariously experiencing reinforcement simultaneously with the modeled behavior. Bourdon (1969) and Bandura and Walters (1963) have demonstrated the implications of theories of imitation. Bandura, Ross,and Ross (1963) developed a social learning- imitation learning theory based on contiguity and mediational theory. This theory proposed that sensory images aroused by the model became structured through association by prox- imity. Reinforcement, however, to the model or to the 12 observer is not necessarily essential for learning to take place. Imitation learning research suggests that a behavioral change will occur when a trainee sees a model do something that is contrary to his own behavior (Bandura 1965a, 1965b: Bandura & Walters, 1963) . In an extensive review of the research on observational learning, Bandura (1969) concluded that the behavior of models often serves as discriminative cues for observers to facilitate learned responses. Thus, current literature concerning behavior change emphasizes modeling in developing and maintaining skills. Bandura (1969), Bandura and Walters (1963), Kagan, Krathwohl, and Farquhar (1965) and Whalen (1969) illustrate different kinds of modeling in creating immediate behavior change. Many counselor training and educational programs concerned With human relationship skills rely heavily on modeling Procedures. Krumboltz (1966) and Krumboltz and Hosford (1967) have additionally illustrated the applicability of modeling to counseling. Related research suggests further that the counselor is an effective model for behavioral change in the client (Kanfer, 1965; Krumboltz, 1965; Mowrer, 1966; Shoben, 1965). A tra- ditional approach to counselor training is for the trainer or supervisor to serve as a model (Bonney & Gazda, 1965: Driekurs 8‘ Sonstegard, 1966; Fraleigh s. Buchheimer, 1969; Ruble & Gray, 1967). Usually the counselor educator lectures about and demonstrates the skills of counseling to prospective trainees. 13 Models of desirable therapeutic behavior have been pmesented to counselor trainees via audiotape recordings (Carkhuff & Truax, 1965: Palmer, Fosmire, Breger, Straughan, & Patterson, 1963). Exposure to audio—recorded modeling cmnditions resulted in trainees’behavior changes in desired directions. Beaird and Standish (1964) trained counselors through audio-simulated experiences to discriminate between cognitive and affective client responses and to use counselor response leads to facilitate more affective client responses. Imrformance of the experimental group receiving audio simu— lation improved over time at a significantly greater rate than the control group that did not receive audio simulation training. In research on interpersonal skills and counselor effectiveness, Carkhuff (1969a, 1969b) has focused on the counselor-trainer as a critical source in learning. This research highlights the importance of the trainer as an effective model. Utilization of the counselor educator as a model (Eisenberg & Delaney, 1970) combined with apprOpriate lapplication of positive reinforcement techniques (Berliner, 1969) can facilitate change. Of especial interest here is ‘the Eisenberg and Delaney (1970) research conducted with 'three purposes: (a) to compare the effectiveness of modeling Funcedures with operant conditioning procedures in the aCquisition of counselor responses, (b) to investigate whether the manipulation of verbal reinforcement would l4 improve counselor behavior, and (c) to explore the effect of prestigious models. The use of modeling procedures seemed more effective in establishing responses than operant conditioning procedures. Verbal reinforcement of counselor response leads was not instrumental in shaping counselor trainee behavior. Eisenberg and Delaney concluded that a video—simulation procedure which involved the systematic presentation of a model significantly influenced the trainees's behavior...also, that... one way trainees learn to behave as counselors is by emulating their mentors (p. 18). Eigeo Simulation in Modeling The development of video technology has provided a nmans of furnishing a close approximation to real-life Situations. The recent literature abounds with statements 0f advocacy concerning video simulation methods in the training of skills. In recent years counselor education Programs have deve10ped and adapted videotaping procedures and technology in a variety of directions and with greater frequency (Delaney, 1969; Eisenberg & Delaney, 1970; Ivey, l971; Kagan, Krathwohl, et al., 1967; Miller, Morrill, Weston, Uhleman, 1970; Poling, 1968a, 1968b; Ryan, 1969). 1‘ typical application is the use of video recording in practicum supervision (Poling, 19683, 1968b; Ryan, 1969) where the trainee, with either actual or role-played client, i53 videotaped, and then critiqued by the supervisor. vid eo tapes offer both verbal and non-verbal performance 1§E3cords of interview skills and interaction. 15 Kagan and associates (1967) offer a variety of inno- vations with videotape; principally, an adaptation of video simulation and feedback, Interpersonal Process Recall (IPR). The IPR process involves videotape recording and then playing lack the videotape so that client and counselor can study their reactions. A further adaptation of the IPR metho- mflogy incorporates affect simulation (Kagan & Schauble, 1969) and videotapes of individual reactions to actors and actresses portraying intense emotions of rejection, pseudo— acceptance, seductiveness, guilt, or affection. Affect simulation appears to be an effective tool in combination “dth IPR (schauble, 1970) or as a treatment methodology by itself (Danish & Brodsky, 1970). An extension of the feedback mode has recently been deve10ped to increase the effectiveness of the IPR.process (Kagan, 1971). Physiological activity measures are recorded, v'ideotaped, and played back to the individual to enhance understanding of behavior. Kagan and associates offer unique applications of the videotape feedback procedures to cOunselor training programs. The continued studies and research add to the data supporting the use of video tech- nOlogy in training programs. 0f direct interest to the present investigation, is the research of Eisenberg and Delaney (1970) and Stone (1972). These investigators have applied video simulation in training c“Dunselors to acquire a specific verbal skill, counselor 16 tacting response leads. As previously cited, the Eisenberg and Delaney research is especially significant in supporting the use of videotape modeling procedures. Results of the Ifisenberg and Delaney study demonstrated that model pro— cmdures affected the trainee's use of these concrete response leads; but transfer effects were lacking. Stone (1972) con- trasted written, audio, video, and in vivo simulations in Eicomparative investigation focusing on the fidelity of Hmdeling. Manual simulations, written and audio, were cmnsidered to be low fidelity, and video and in vivo simu— lations to be high fidelity. The specific interview skill, huning response leads, was again featured. In the practice phase, manual and in vivo simulation methods were compared. The data of the Stone investigation support the effectiveness @fthe high fidelity model and high fidelity practice on the hunteterm measure. The low fidelity model, practice, and tmst groups were low in comparison with all other groups Mho performed about equally. The long—term measure data )delded contradictory results, especially the interaction of‘written forms of model simulation and practice. Poling (1968a) suggests theoretical reasons to support videotape being more effective in counselor training than audiotape because of the similarity' to the actual counseling situation. Yenawine and Arbuckle (1971) studied the question by contrasting the effects of audiotape and videotape record- ing techniques on counselor-trainee practicum experiences. 17 The nature of this pre-experimental investigation with small sample, design problems, and the confounding variable of mmmrvision do not provide conclusive answers. Ward, Kagan, and Krathwohl (1972) attempted to evaluate ‘Um use of Interpersonal Process Recall (IPR) with videotape, MSOpposed to more traditional methods. In comparing \ddeo-IPR, audio-IPR, and supervision using an audiotape of arhgular counseling session, the results did not demonstrate the effectiveness of any one treatment procedure. The re— Emarchers discussed problems in the use of a coached client, hnvinterrater reliability, lack of specificity in the txaining,and the confounding of supervision and treatment. These studies do not contribute definitive results Isgarding simulation methods or the use of videotape modeling Uxhniques most effective in attaining particular counseling hulls. As indicated, evidence is often lacking, incomplete, mkiambiguous. There remains a need to adOpt research nmdels which seek to define techniques, detail their limits cm applicability, and show their comparative effectiveness. hfiller (1972) writes of simulation and the use of instruc— tional objectives in counselor education. He provides definitions of interest: Simulation is a controlled representation of a real situation. The use of simulation provides the student with learning experiences leading up to the attainment of instructional objec— tives. Levels of simulation are used to intro- duce a programmed aspect into the sequence of learning experiences and serve as degrees of 18 approximation to actual counseling. The lowest level is theoretical and abstract: the highest level of simulation contains most of the ele- ments of the desired terminal behavior (p. 84). Four levels of simulation that could be used for each mnformance skill being taught in counselor education are pnmmsed by Miller: reading and listening, modeling, pnumice responses and role playing, and supervised exper- immm. Miller in discussing these levels of simulation mums that the use of videotape in modeling experiences Ru the trainee is extremely useful in developing counseling fldlls of all types. He states, "the use of videotape models Inidges the gap between theories and the actual practice of Cnunselor Skills (p. 85)." The present research is based on the contention that \fideo simulation will provide appropriate models for initial huhrview skills training and that video simulation would IHbvide controlled representation of the real situation. Mrocounseling Even more germane to the develOpment and intent of fins study are the concepts of microcounseling set forth by Ivey (1971). Stemming from the microteaching skills approach cm McDonald and Allen (1967) at the Stanford Center for Research and Development in Teaching, microcounseling is based on the focus of learning procedures which stress intense supervision, immediate feedback,and evaluation aided by videotape recordings (COOper, 1967). Essentially, 19 ndcrocounseling refers to a method of video instruction of cmunselors in the basic skills of counseling which can be achieved in a short period of time. Ivey (1971) stresses the consideration of microtraining techniques as a "structural or methodological approach" to interview training. Microcounseling is based on several essential prOpositions: focus on single skills, self— Cflmervation and confrontation, learning from observing \fideo models, and real interviewing. The basic micro- counseling model is outlined as a set of progressive steps (see Appendix B) allowing for actual videotaped interviews, reading written manuals describing specific skills, super- visory instruction, video models, feedback from video per- formance in the presence of a supervisor, and additional interview practice with feedback and evaluation. Basically, this methodological innovation allows variations for teaching interviewing skills in a wide area of diverse theoretical and practical frameworks. ‘With the adaptability 0f the microcounseling framework, it becomes a useful research tOol, permitting controlled studies. Ivey, Normington, Miller, Morrill, and Haase (1968) in a classic study combined the principles of videotape models and feedback to effectively train beginning counselors in the behavioral skills of attending behavior, reflection of feeling, and summarization of feeling. Ivey et al. defined attending behavior in terms of three highly reliable, easily 20 identifiable component behaviors--eye contact, relaxed pmstural position with appropriate gestures, and accurate \mrbal following behavior (p. 30). The validity of the specific skills taught via the microcounseling paradigm is attested to by the fact that every pretraining and post— txaining comparison of the client's reactions was positive amisignificant. Clients' reactions to interviewers was assessed by the Counselor Effectiveness Scale (Ivey, Miller, Morrill, & Normington, 1967), and a relationship question- rmire adapted from Truax and Carkhuff (1967). The counselors tuained in attending behavior were rated as being more effective. A growing body of literature continues to substantiate the validity of the microcounseling research paradigm. More— land, Phillips, Ivey, and Lockhart (1970) utilized micro- counseling to teach six interviewer skills to first-year clinical psychology graduate students. This study demon- strated that the effects of microcounseling training generalized from the instructional lab to actual interview situations with real patients. Haase and DiMattia (1970) demonstrated via microcounseling training that the skills of attending behavior, reflection of feeling, and expression of feeling can be attained by counseling paraprofessionals. In addition, Haase, DiMattia, and Guttman (1971) reported that these skills were sustained over a year's time. Para- professionals retained improved non-verbal communication 21 and ability to express feeling; although performance remained above original levels, verbal following and reflection-of— feeling statements decreased. Miller, Morrill, Ivey, Normington, and Uhlemann (1969) demonstrated that the skill of selective attending can be used to shape a client's verbal behavior toward talking about his attitudes toward tests. In another microcounseling variation, Higgins, Ivey, and Uhlemann (1970) trained college students in the interpersonal skills of direct, mutual communication, skills which are related to those em- Phasized in encounter groups. Research study compared three approaches to teaching this skill: (a) full treatment in the traditional microtraining paradigm, (b) programmed text and video models only with no supervision or video feedback, and (c) reading material only. The full-treatment group doubled the amount of direct mutual communication (100 per cent increase): group b increased 50 per cent; and group c did not change. Other studies report differing success in training a variety of clients. Haase, Forsyth, Julius, and Lee (1969) trained clients at a university counseling center in the skill of expression of feeling. Moreland, Phillips, Ivey, and Lockhart (1970) demonstrated the feasibility of defining skills to the degree that good and bad models can be made for an increasing variety of interviewer behaviors. Thus, 22 mnxotraining provides a framework wherein individual responses manmdels may be studied systematically. In controlled lab situations many of the possibilities ofthe microcounseling model emerge. Frankel (1970) examined fluaeffects of videotape models and videotape feedback in temfldng accurate reflection of feeling. A comparison group nxmived instructions only. Half of the experimental subjects nxmived feedback first and half viewed models first. View- hmrthe model first followed by self-observation produced Imue positive change in the subjects' skill to accurately reflect feeling. Hutchcraft (1970) presented interesting (hta on the role of models in microtraining. Group one \dewed a tape of a model counselor interviewing, followed kw a videotape of a supervisor reinforcing the model counselor. (koup two viewed only the model counselor tape; group three may the supervisor's tape, and a control group, none of Hm models. Each group conducted four interviews and received feedback from their training. The presentation of the supervisor model provided the most potent force for change. McDonald and Allen (1967), cited earlier, varied ndcrotraining methods with teachers and reported that smlf—viewing accompanied by supervisor comments was the nmst powerful aspect of the microtraining treatment. It Vms also found that the presence of a supervisor facilitated learning from the video modeling tapes. 23 McDonald and Allen reached the conclusion that the full complement of microtraining methods (feedback, modeling, supervision with cueing and discrimination) was the most effective way to impart skills. If the behavior is relatively simple, they suggest that simple instructions may be sufficient; however, as behavior becomes more complex, the importance of more extensive training seems to appear. Finally, on a more clinical basis, it is noted that some individuals seem to respond only to certain aspects of the microcounseling training program, while others seem to prefer the full treatment package (Ivey, pp. 123-24). In summary, the microcounseling paradigm provides a variety of modeling, practice, review, and reinforcement procedures all aimed at helping the trainee incorporate the skill of interest. Practice Dimensions Practice is necessarily critical in the development, mastery, and retention of skills in any learning sequence. In the review of variables governing retention, Bandura (1969) describes practice as the variable that effectively stabilizes and strengthens acquired responses. The level of observational learning can be enhanced through practice or overt rehearsal of modeled behaviors (Margolius & Shef- field, 1961). Practice, specifically, seems to be much overlooked in theories of imitation learning. However, reinforcement activities, which seem to be a component of practice, have received attention in the literature. Bellucci (1972) recently reviewed pertinent research and theory relating to microcounseling, imitation learning, 24 mfilbehavioral approaches to counselor education, and in fins discussion highlighted some related lines of inquiry ébaling with reinforcement. Millenson (1967) states that shmm behavior is lawful, it will be related to an individ- twl's history of reinforcement. Rotter (1966) has identified ‘a"control continuum of reinforcement" which simply stated says that the effect of reinforcement for an individual depends upon whether the individual perceives a causal relationship between his behavior and the reinforcement. Rotter posited two types of control, external and internal. Definitions describe external control as occurring "when a reinforcement is perceived by the subject as following some action of his own, but not being entirely contingent upon his action" (p. 1). Internal control is defined as occurring "when a person perceives that the event is con- tingent upon his own behavior or his own relatively per— manent characteristics" (p. l). Phares (1957, 1962) con- cluded that individuals in control (internal) of specific situations are more likely to exhibit perceptual behavior that can assist them in coping. Battle and Rotter (1963) found a significant relationship between internality and intelligence. In essence, these investigations seem to suggest that the acquisition, performance, and practice of skillful behaviors are related to individual perceptions of internal and external control of reinforcement. So differences in individual perception of internal and 25 external control of reinforcement could influence the effect- iveness of practice procedures. McDonald and Allen (1967) reported the delay of rein— flnrement phenomenon. In a microteaching situation the delayractice strategies. These different types of practice in Ei learning sequence stress the acquisition, mastery, and iretention of the modeled initial interview skills. It is the contention of the present study that the different 26 practice modes vary in their nature to obtain mastery and to generalize over time,and that there is a need for eval— uation of the differentiated practice strategies often lumped together and employed in microcounseling and other counselor training programs. Discrimination Practice. Carkhuff (1969a, 1969b) in interpersonal skills training stresses the importance of discriminating the quality of responses. This component is incorporated in pre— and post-evaluations on research scales, and used as an integral part of Carkhuff's group training procedure. In continuing practice sessions, each individual is trained in appropriate responding skills by discriminating and discussing his rating of each response offered. Dis- crimination practice assists each trainee in identifying skills, and in assessing the quality of skill performance. Orme (1970) concluded that differential effectiveness of different teaching models can be attributed to distinct cueing properties. Imitative learning can be facilitated, he stated, by increasing the distinctiveness of relevant nmdel stimuli. Orme stated that "training systems which seek to increase both the range and availability of sub- Skills within a given teaching strategy must systematically Tughlight salient cues in the initial phases of training" (p. 3). Discrimination practice increases the trainee's ability to spot and use cues appropriately. 27 feedback and Supervisor Practice. Stoller (1965) has stressed the necessity of "focused feedback" in therapeutic work with videotape. Focused feedback means that the super- visor focuses training only on a single dimension of the trainee's behavior. Not all behaviors are corrected at once. In feedback and supervisor practice, the trainee and supervisor view the trainee's interview and each in turn verbally evaluates one aspect of the trainee's initial interview behaviors. Each segment of the videotape is viewed to focus on the different skills being taught. Verbal feedback which is focused can reinforce the trainee's skill development. There is some evidence supporting the idea that verbal approval has great potential in reinforcing adult behavior (Krasner, 1958). Eisenberg and Delaney (1970), however, found that verbal reinforcement was not instrumental in shaping apprOpriate counselor behavior. Berliner (1969) summarized the issue in this manner: The absence or presence of someone in a super- visory role providing discrimination training and reinforcement does seem to be an important variable in the acquisition of complex teaching skills when training occurs with modeling and the videotape system (p. 31). Ierhaps, the combination of reinforcement and discrimination Emovides the necessary ingredient to make the feedback more effective. Teach Another Practice. Ivey and Rollin (in press) are currently exploring the microtraining framework as a useful 28 method of teaching interpersonal skills. The "do-use-teach" model of imparting behavioral skills asks the trainee to demonstrate his ability to engage in a selected behavior, develops his own way to use the behavior in his daily life, and then demonstrates his understanding of the skill by teaching it to someone else. As Ivey (1971) states, "the value of teaching others what you yourself have just learned appears to be a promising avenue for increasing self-learning and producing a multiplier effect" (p. 134). The differentiated types of practice-—discrimination, feedback and supervisor, teach another, combination, and control--wi11 be the treatments compared in this research study. Generalization and Transfer Certainly, generalization of learned responses provides the critical task for any training procedure (Greenspoon, 1962). Often, analyses of the effects of modeling lack data thich might support the transfer of learning. Thorndike's theory of transfer of training (Thorndike & Woodworth, 1901) suggests that the more identical the elements, the greater the transfer. Studies often assess only the immediate effects of learning, but neglect to check on treatment effects over time. The present investigation is planned to incorporate approaches in video simulation, emphasis on practice, and 29 the element of generalization to emphasize retention. Efforts will be made to approximate the typical real-life interview situation as closely as possible in order to provide for the greatest degree of generalization and retention over time. Guttman and Haase (1972) reported the generalization of counseling skills learned via microcounseling to actual counseling settings. Of particular interest to this study is the finding that across the three skills trained for-- attending behavior, reflection of feeling, and summarization of feeling--there were no significant differences between experimental and control groups on attending behavior skills. Greater learning and retention of skills in reflection of feeling and summarization of feeling were found for the ex— perimental counselor group experiencing microcounseling training. Attending behavior was rated on three five-point Likert-type rating scales for eye-contact, verbal following, and posture. Reflection of feeling was rated on a l4-point scale adapted from Ivey and others: summarization of feeling was rated on a five—point constant response scale adapted from Ivey and others. The results of this study are consistent thh others; not all skills behave in the same manner. Pos- ture and eye contact variables showed no differences as a result of training and no improvement across trials as reported in previous investigations with these variables (Ivey, Normington, Miller, Morrill, & Haase, 1968; Haase & IfiMattia, 1970). Explanations reported that eye contact and 30 a relaxed posture are social skills possessed by most counselors at this level. The researchers assumed that persons selected for counselor training programs already possessed rather SOphisticated levels of these two attend- ing skills. Thus, in this replication (Guttman & Haase. 1972) the microcounseling paradigm tested the generalization of training of specific behavioral skills in counseling to actual counseling settings. The skills did generalize but showed a loss of skill commensurate with what was expected in terms of an extinction curve. Ivey (1971) urged that research designs incorporate trend analysis design with repeated measures of a single treatment group, control or comparison designs, and multiple comparison groups. Ivey has reported that microcounseling research only recently reached the stage whereby adequate follow—up testing has been possible. Research by Haase, DiMattia, and Guttman (1970), Miller, Morrill, Ivey, Norm— ington, and Uhlemann (1969» and Moreland, Phillips, Ivey, and Lockhart (1970) illustrated that trainees retained skills over time. Hutchcraft (1970), however, noted a fairly rapid extinction of learned skills. Apparently, considerable additional work is called for in examining the retention and generalization of microtraining skills. Agtivation The concept of activation appears pertinent to investi- gations in counselor education seeking to understand the 31 nature of different learning and practice strategies. Invol— vement or activation concepts appear to be central to issues of motivation, learning, and mastery of skills. Many research— ers in the area of motivation and emotion have utilized such concepts as activation, arousal, or energy release to unify a vast amount of diverse data. The term "activation theory" is often given to theoretical conceptions that dichotomize behavior into direction and intensity and that view the intensity dimension as common to all states of motivation and emotion (Thayer, 1967). Activation as an experimental variable is prevalent in psychological research. Specifically, the research findings of interest relate that variations in activation affect performance in qualitatively different ways. The inverted U curve describes performance as a function of low, medium, and high levels of activation. Activation concepts and the inverted U performance curve are illustrated in research in vigilance and attention (Frankmann & Adams, 1962), human verbal learning (Spence, 1963), curiosity and other aspects of cognitive behavior (Berlyne, 1960), personality (Goldstein, 1964), sleep, and functional mental disorders (Duffy, 1962). Activation, usually assessed with psychOphysiological measuring apparatus and equipment, has been related to paper and pencil measurements (Thayer, 1967, 1970, 1971; Thayer & Cox, 1968: Thayer & Moore, 1972). (see Appendix C-- 32 AD—ACL, Activation-Deactivation Adjective Check List.) As counselor research seeks to assess what learning and practice treatments are best, for whom, and in what manner, the use of activation theory appears promising. An adjunct of the present study is an interest in applying the concept of activation to determine the motivating and involvement prOperties of the different practice treatments being com- pared, and the differences in individual levels of activation as assessed following both the practice and the delayed-post interviews. Summary The rationale for this research is based on the follow- ing needs: (a) the need for replication and comparative study of the effect of modeling vs. no modeling in the training of both non-verbal and verbal skills; (b) the lack of comparative findings of the efficiency of different types of practice involved in counselor and microcounseling training programs; and (c) the need to explore the concept of activa— tion as a means of describing the effect of the various treatments used in counseling. The decision to use the modeling and practice treatments was based on their extensive utilization in counselor and microcounseling training programs. Similar thinking was employed in the selection of dependent variables. Non—verbal and verbal initial interview skills were both deemed 33 appropriate in comparative tests of the use of modeling and practice treatments. Each of the skills incorporated can be defined Operationally and specifically for the purposes of measurement and training. The population of dental health paraprofessionals needs and uses interview skills consistently and routinely in its work. Yet, like many paraprofessional groups, they are not being trained in any systematic way in the people-relating skills expected of them. This group, like many others, can benefit from an expanded counselor role that seeks to extend the skills counselors and counselor educators use. A comparative approach was selected to allow for tests of relative effectiveness of each of the methods, and to assist in answering the critical questions in counselor education by pinpointing which method(s) works best with Mhich skill(s). There appears to be a need to investigate systematically whether behavioral skills following a micro- cmunseling format or adaptation do in fact generalize over time. As urged by Ivey (1971), Carkhuff (1969a, 1969b) and cmhers, follow—up data were collected to see if the training and practice treatments were effectively retained. This investigation was organized as a set of companion Studies. Each study was considered as a discrete unit: each designed so there would be no confounding effects mithe other studies. Each segment of the companion 34 set of studies is outlined in the following paragraphs. Study One. Study One was concerned with the effect of modeling vs. no modeling. The acquisition of initial inter- view skills and the effectiveness of the model in introducing non-verbal and verbal interview skillsvere the focus of this segment of the total investigation, Study Two. Study Two was designed to investigate the comparative effects of differentiated practice. The effi- ciency of different modes of practice in the mastery and generalization of interview skills was to be the focus of this portion of the total investigation. This part of the research incorporated immediate post and delayed-post measures of interview skill performance. Study Three. Study Three was considered to be explora- tOry in nature. Questions relating to the concept of acti— vation were of interest in this segment of the research. of particular significance were understandings which can be gained: (a) in regard to the level of activation of each of the practice treatments: (b) in the maintenance of the level of activation for practice treatments across time; and (c) in the relationship of an individual subject's level of activation when compared to mastery of interview Skills. No formal hypotheses were presented for this pilot Study. Post hoc data analysis procedures will be used to investigate the questions described above. CHAPTER II EXPERIMENTAL DESIGN AND PROCEDURES Overview The major purpose of this set of companion studies was to measure both the effect of modeling via videotape and the efficiency of different types of practice in the mastery and generalization of non-verbal and verbal initial inter- View skills of dental hygienists. To carry out this purpose, initial non-verbal and verbal interview skills were defined from attending behaviors (Ivey, 1971). Evidence of non-verbal attending or listening behaviors was observed in initiation and maintenance of eye contact, and in relaxed, natural Posture and movements as one directly faced the other person. Verbal attending behaviors comprised the skills of offering invitations to talk (ITT) and encouragements to continue talking (ECT). These total non-verbal and verbal initial interview skills formed the dependent variables in this Study. Model and practice were the treatment variables researched. In addition, the trainee's initial performance of non—verbal and verbal interview skills was evaluated as a covariable. This covariate was used to control for subject differences that might have existed prior to the practice 35 —H. __r V—a—w-w-~*—- v-o—vu" 36 treatment. The use of the covariate was planned for the immediate and delayed-post practice data. Activation level, as measured by the Adjective Check List, was studied in relation to the practice treatments, individual differences in activation factors, and interview performance. Activation level was defined as the psycho-physiological level of in— volvement as measured by the four factors of the Activation- Imactivation Adjective Check List. Thus, separate and combined effects of the modeling and practice variables on the performance of initial interview skills of dental hygienists were the major thrusts of the present investigation. Level of activation was explored to determine its relationship to practice. The Choice of modeling and practice treatments was based on learning theory and their extensive use in counselor education. The differentiated practice treatments were of Special interest in this investigation. The research was conducted with dental health para- Professionals enrolled in the first year of the two—year dental hygiene curriculum at Charles Stewart Mott Community College. All 38 students enrolled for the Spring semester 1973 were involved in the interview skills training program. Subjects were randomly assigned within each phase of the treatment procedure, i.e., model and practice. 37 For the model phase, the subjects were assigned to one of two groups, model and no model. The model group (M1) viewed a videotape before their first interview; the no model group (M2) did not see the model videotape before their first inter— tdew. After their first interview the no model group was per- ndtted to view the model videotape so that all gs would be equal as they entered the practice phase. The sequence, flow cm training activities, and data collection through the model and practice phases are illustrated in Figure 1. During the practice phase there were five practice treatments: discrimination practice, feedback and supervisor Practice, teach another practice, a combination practice with each of the first three elements, and a control practice group.‘ At the completion of one fifty-minute practice period for each type of practice, each subject completed an adjective Check list and their second interview. Both modeling and tYpes of practice treatments will be described in detail later. The delayed-post phase included a third interview and the completion of an adjective check list. Each of the three interviews provided measures of non-verbal and verbal inter- view Skills. Each item measure reflecting both non-verbal andver‘bal interview skills was scaled so that a high score indicated better performance than a low score. Only one non-verbal item, frequency of breaks in eye contact, had to be rescaled in order to meet this requirement. 38 GOAuUmHHoo mumn can mwflufl>fluo¢ mewcflmua so“ unmsu news can mucosvmm oecsao ooumauoonm see ”me H was oqh 3ma>nmucH wmmuompfl> umomipmamen 3ww>umusH Hound pawn xomno m>nuomn6a uumHHoo mama Hmuofi>m£mm m>flo momma pmnfl>oum muswflumm 3mfl>uwusH 3mw>umucH commuompw> no“ ucmficmflmnm mw.w>fl0 V m N ,4 cum 5 .h .b .h cheese ooumauoonm see.m m m .ssa 0.6 mama amu0w>m£mm m>fl0 momma ©m©fl>oum musmwumm 3mw>umucH H.m 3wfl>umusH new mmmuomca> umomuwumflmeEH N.® .H musmwm owsaau ooumauooum .umd uqu songs .noa pumaaoo m.m nam>mq moauomum m on pwsmwmmm >H50psmm mm H.m adamsoa>flpsH mowuumum umumM:HE©< .4 wufiuumnm pmumflucmummm«o Am Saslm Hfiumdv ”038 MDDBm H00 msmEmO owcflao HUU msmEmo mma.m OastU A.n: Ho oouss oonmanooum A.nn so ooum 1.:ne my manna .mum .om .umz mm a 5m .umz .soz .mm .umz .Hnm.mm .umz o.¢ o.m o.~ o.a mums Hasxm 3mn> manpowce> Hmuofl>mnmm luwusH aw w mafiampoz m>flo Hz sense N.~ no“ name .fll maafixm r momma ~.m mmsouo Imoflmmd 3ww>umucH , pmpfiwoum , .9358 .w T m 930 ~.H CH gamma H.v masseumm .msa Eoum mmmao 3mw>umucH H.m pmcmflmflm on uses m2 asouw 3ma>umucH a Eoocmm mm H.m swocsmtsa H.H mo umchmEmm on and was» on womuOmpfl> mm Ham ou Hmpoz usmmmum IOmow> WW Ham proz usmmmum hpsum soapouucH mensweoz Aomumm sonnet "mzo sosem ~—-- ’7‘- 4—m- op.-. .._"er 39 In each of the three testing interviews the criterion measures for non—verbal and verbal interview skills were assessed in the same manner. Non-verbal total scores were based on the sum of the following observations of each seven—minute interview: duration of eye contact, the number of breaks in eye contact; and global ratings on four-point scales of body posture, gesture, and non—verbal attending behavior. Verbal total scores were comprised of the sum of observations during each seven-minute interview: the number of good invitations to talk (G-ITT), the number of poor invitations to talk (P-ITT), the number of encouragements to continue talking (ECT): and global ratings on four-point scales of quality and effectiveness in the use of invitations, quality and effectiveness in the use of encouragements, and Verbal attending behavior. As mentioned previously this research was conceived as a Set of companion studies. Prior to frequency counts and ratings, all interview tapes were randomized across time and treatment groups. Hoyt reliability estimates across the three judges' observations and global ratings were computed for each of the non-verbal and verbal items in each study. In addition, inter- nal consistency reliability coefficients were computed for the total non-verbal and verbal measures. Data within Study One were processed through the use of multivariate and univariate analyses. Data for Study Two were subjected to repeated measures multivariate analysis of variance analyses. Both multivariate 40 and univariate analyses were used so that any differences in interview skill items could be identified as well as differences in total non-verbal and verbal interview skill nwasures. The data for Study Three were processed through analysis of variance techniques. Also, the activation data vmre correlated with total non-verbal and verbal criterion measures . Model Materials For the modeling phase, Study One, a fifty-minute video presentation was prepared by the researcher. Based on the Skills defined by Ivey (1971), this film detailed the concept 0f attending behavior,anuioutlined and demonstrated the verbal and non-verbal skills contained in this interview training Program. Additional cues for offering effective invitations to talk were provided. The materials on offering invitations to talk go beyond the original formulations by Ivey (1971). Descriptive background information that was adapted and incorporated in the audio portion of the tape is included inAppendix A. 'When background information was included in the audio portion of the videotape, visual aids in the form of posters were presented on the accompanying video segments (Appendix D). After this background, example models were taped. 41 In making the model videotape advanced dental hygiene students were used as models. These models were peers, but more experienced than the SS viewing the tape. Developed in the clinic situation, with a variety of senior students and actual patients, the model materials illustrated pros and cmns of the interview skills. It was assumed that the variety ct examples and models, filmed in the dental setting, increased 'dm authenticity of the simulation so that the materials were realistic and life-like. Video materials, scripts, and model— ing examples were prepared so that effective learning of skills could be achieved. One third of the model videotape was devoted to the non-verbal interview skills; approximately equal thirds 0f the tape illustrated verbal skills of invitations to talk (ITT) and encouragements to continue talking (ECT). Non-verbal models were a minute in length and visual only, with no audio. Six examples of a minute's length were ineluded. Verbal model examples were audio and video and purposely either 30 seconds or one minute in length. The 1ehgth of the example depended on the skill being illustrated. AGain, multiple examples were incorporated; a total of ten 30 second and nine one—minute verbal examples were included. Basides the variety of hygienist models, dental hygiene faculty introduced various sections of the model videotape. A complete outline of the content of the fifty-minute model 'Videotape is provided in Appendix E. Two minutes were 42 devoted to the introduction of the training program by the Director of Dental Health Programs and a member of the dental education faculty. As Ivey (1971) recommended in his discussion of micro- counseling presentations, the skills presented were explic— itly illustrated. Even though microcounseling approaches generally include only one skill, i.e., attending behavior, invitations to talk, or encouragements, Ivey has stated that it.might be apprOpriate to include these initial skills together (p. 148-149). All of the initial interview skills presented in this modeling experience were deemed by Ivey to be within the parameters that could be easily perceived, comprehended, and digested in a beginning training session. ESSistants Only one general assistant was available with the researcher to greet gs, take roll, and help with the arrangements for the presentation of the model videotape (See Appendix F). No video technicians were present for the mOdel videotape presentation. The television playback eguipmentwas positioned in advance and ready for Operation by the researcher. icilities and Apparatus One classroom in the College Center of Charles Stewart Mott Community College served as the facility for the model 43 treatment. This classroom with two television monitors, 20 Spaces for seating, and large tables created a spacious, quiet area for comfortable viewing of the model videotape. The same room and arrangement were used for the no model group after the model test interview was completed (prior to the practice sessions). Shibaden Model FPC—lOOO vidicon color camera with EIAJ Type 1 videotape format was used to create the videotape for the model presentation. This half-inch equipment yields good video and audio quality reproduction. For purposes of this study, the model presentation was replayed in black and white. The videotape model taping facility was compat- ible with Sony playback equipment. Treatment Procedures Obtainingiand Scheduling Subjects. The interview skills training program deve10ped for this study was presented to the director and faculty of the dental hygiene curriculum. With their approval and direction, the cooperation of the entire first-year, second-semester class was solicited. Of greatest concern was the additional time requirement, which required a commitment of an extra hour for each s and a rearrangement of individual lab and study time during clinic hours. The entire class group was extremely cooperative in agreeing to participate in the interview skills program. An announcement was made, previous to assignment and 44 participation, regarding the experimental nature of the training program (see Appendix G). Subjects were aware that the training program was being evaluated for the im- provement of instruction and being considered for inclusion in the total curriculum. Since gs were appraised of the experimental nature of this learning situation, the problem of external validity should be raised. Campbell and Stanley (1963) describe the importance of the artificiality of experimental settings and a gs awareness of participation in an experiment. In order to reduce the effects of reactive arrangements, the experi— mental procedures need to be similar' to the kinds of experiences §s have already encountered. An effort was made to structure the model experience as a classroom experience: practice experiences were adapted to the clinic and lab arrangements that existed. A detailed and careful explanation of the sample and experimental procedures provide the reader with knowledge about how this papulation might compare with some population to which he might wish to generalize (Cornfield & Tukey, 1956). Model Videotape Presentation. After the group of Se ‘waa informed of the interview skills training program, and agreement to participate had been secured, an arrangement was made to excuse half the group from a regularly scheduled lecture. A randomly assigned group was scheduled in this manner for the model presentation. Assignment times were 45 distributed a day in advance to each individual (see Appendix H) at the end of a regularly scheduled lecture. For the model group, lecture was excused and they attended the presentation of the videotape demonstrating initial interview skills. The no model group attended their next regularly scheduled lecture class which contained in- formation unrelated to interview skills. Following the presentation of the model, all gs completed their first interview. At the end of the first week, the no model group was scheduled for the model presentation and the model group attended the lecture they had missed. In this way, the total group of §s had completed the model experience before the practice phase of the experiment was scheduled. For the model presentation, the procedures for all gs were exactly the same. With the modeling experience recorded on videotape, the same materials could easily be presented to the two different groups and still allow for the test of the effect of the model. For each of the model demonstrations, gs were given room times and assignments in advance. An assistant checked attendance, and the videotape was played by the researcher. The same classroom and set-up with two television monitors was employed for each presentation. The researcher was present in the rear of the classroom during the model presentation. The total time for the administration of the videotape model treatment procedure was 50 minutes. 46 Practice Materials For the practice phase, Study Two, detailed materials were prepared and selected by the researcher for each of the five levels of practice. All practice materials were tried and modified before they were finally prepared for adminis— tration to the subjects. A large envelope was assembled for each §_for the scheduled practice session. Every large envelope had a set of general instructions taped to the out- Side (see Appendix I). The general instructions directed each subject that everything was provided in the envelope and practice room, that the _S_ was to follow the instructions .inside the envelope carefully, and was to return the materials 'to an assistant at the end of the 504minute practice period. ZIn order to structure the practice sessions uniformly, a "Practice Instructions Checklist" was constructed for each of the five levels. This checklist listed step-by—step numbered instructions for each activity, estimated time for each activity, and provided a space for the §_to check that activity when it was completed. In essence, the "Practice Instructions Checklist" amounted to a very complete lesson Iflan for each practice session. From this common format, the different materials were created for each of the types of practice: discrimination, feedback and supervisor, teach another, combination, and control groups. 47 Discrimination Practice. The purpose of discrimination practice was to create an awareness of the interview skills and to aid the subjects in distinguishing the degree to which the skills exist in a model. Basically, this type of practice was designed so that the majority of the time was directed toward viewing videotape model excerpts and rating the non-verbal and verbal excerpts. The "Discrimination Practice Handout" included in the packet of materials ex- plained to each §_that before mastery of interview skills could be achieved one must first be able to discriminate or be aware of them when they are present. Discrimination was defined as being able "to make a distinction, to sep- arate one from another, to distinguish, or to differentiate." The two kinds of discrimination pointed out to each § included, (a) becoming more keenly aware of the presence of a particular skill, and (b) noting the degree to which the interviewing behavior exists. Materials organized for each subject to accomplish the two kinds of discrimination in this type of practice session included the following: 1. Practice Instructions Checklist (activity list lesson plan) 2. Discrimination Practice Handout 3. Discrimination Rating Form 4. Reaction Sheet 5. Discrimination Videotape 48 Appendix J contains the written materials created for dis- crimination practice sessions. The videotape examples of interview skills were selected and copied from the model videotape. During the 50-minute practice session gs watched, rated, and made discriminations on 26 examples. Feedback and Supervisor Practice. This type of practice session was devised so that the § meeting with a dental hygiene supervisor could review her first performance on videotape to make her own observations and obtain comments from the supervisor. This practice was constructed so that the session involved: (a) observation of self-performance, (b) analyzing and discussing what the § wanted to change in the next interview, (c) receiving comments and suggestions from the dental supervisor, and (d) reviewing the suggestions and comments as preparation for the second interview experience. The Opportunity was created for the §_to view her own interview performance three different times, with the seven— minute tape subdivided into two, two, and three-minute seg— ments. The instructions for viewing prescribed the different approaches for each of the three viewings. The first time, the g was to view the tape with the supervisor and share her comments with the supervisor discussing what she observed that she wished to change. The second time, the supervisor pro— vided feedback to the s, For the third observation, the hygienist reviewed the supervisor's feedback and repeated the suggestions that had been discussed. To assist the §_and the W. 49 supervisor a "viewing log" form was provided for written comments during each of the segments of the three observations. Thus, materials created for this feedback and supervisor practice session filled 50 minutes and included: 1. Practice Instructions Checklist (activity list lesson plan) 2. Instructions for Viewing 3. Viewing Logs (for.§ and supervisor) 4. Videotape copy of SS first interview. The kinds of materials used in this practice are contained in Appendix K. Teach Another Practice. If an individual can effectively use a skill, tell another about it, and show another person the skill so that the other learns it, the practice of this skill by the learner instructing increases the likelihood of skill mastery by the instructor. The "Teach Another" practice session was based on this idea. From the funda- mental do-use-teach approach of mastering skills, this set of practice materials was arranged. §s were told that the practice session was to involve individualized tutoring, explaining the interview skills to another individual, demon— strating the interview skills to another, answering questions asked by the other, and assisting in every way possible so that the other could identify, label, and use the initial iinterview skills. Based on the adage, "If you wish to 1earn something, to master it, try to teach it to someone 50 else," materials for the §_included a teaching guide sug— gesting activities and time allowances. Over 40 minutes of the 50-minute session were detailed on this teaching guide. The S was instructed to explain, present ideas, demonstrate, illustrate, discuss, and ask questions of the other. To assist the §_in the teaching process, a set of six posters was provided (Appendix D) identical to those utilized in the model videotape. In order to check the §fs teaching performance a short quiz was included in the materials: the § administered these eight questions to the individual being taught at the end of the practice session. The quiz was included as a motivational device for the g, In summary, the materials established for this practice (see Appendix L) included: 1. Practice Instructions Checklist (activity list lesson plan) 2. Teaching Guide 3. Summary Guide on Attending Behaviors 4. Set of Six Posters 5. Interview Skills Information Test (for the trainee working with the S). Combination Practice. The design of the materials for the combination practice was based on the elements of each of the first three types of practice——discrimination, feed— back and supervisor, and teach another. Approximately equal times were allotted for a dozen discrimination ratings, feedback and analysis of the S's first interview, and 51 individualized tutoring of another. The structure of the materials for this 50 minute practice was identical to the first three practice conditions, but in mini form. Thus, the S's set of materials included the following: 1. Practice Instructions Checklist (activity list lesson plan) 2. Discrimination Practice Handout 3. Mini Discrimination Rating Form 4. Discrimination Videotape (model examples) 5. Instructions for Viewing 6. Viewing Logs (for §_and supervisor) 7. Videotape copy of SS first interview. 8. Mini Teaching Guide 9. Set of Six Posters The written materials for the combination practice are found in Appendix M. Control Practice. The control §s were provided with an activity of interest to dental hygienists, but not related to interview skills. A set of commercially prepared audio cassettes and accompanying booklets with pictured and written materials on dental plaque diseases was secured for the control Se. The gs were asked to listen to three short tape cassettes, answer some brief questions on each, and complete an evaluation form on each cassette. Two sets of tapes of equivalent content were available to be randomly assigned to the control group. Appendix N contains samples of the 52 written materials prepared for this group. The cassettes, a set of self-learning audio visual education materials, were available through the Preventive Dentistry Section of the Dental Health Center, San Francisco, California. The content did not involve any reference to interview skills. In total, gs for each level of practice received a packet of written materials and pencils from an assistant. As prescribed, some of the materials contained videotapes. The other assistants, facilities, and apparatus incorporated into the practice sessions will be discussed in the following sections. Assistants Practice General Assistant. One general assistant was available with the researcher to greet gs, take roll, pass out materials, collect and check-in materials for the practice sessions. Appendix F contains a list of the duties and instructions to the model and practice general assistants. Video Monitor Technicians. During the practice sessions that contained discrimination practice, the practice that involved entirely discrimination tasks and the first segment of the combination practice, a video monitor technician was necessary. The §_was not expected to operate the television equipment, only to view the videotape provided and complete the appropriate observational and rating activities. 53 These technicians were instrumental in setting up the facilities for the practice sessions. Also, technicians were available to load tapes on the monitor for playback for the feedback and supervisory sessions. This was com— pleted in advance of the practice session. Once the feed- back practice was underway, the supervisor operated the television monitor as necessary. Practice Personnel. Practice personnel were involved in three of the types of practice included in this research. The feedback and supervisor practice sessions utilized each of the four different clinical dental hygiene staff. The staff were assigned to practice sessions as available from the clinic and so that as much as possible each faculty member was involved equally with 50 minute and 15 minute feedback sessions. Supervisors experienced three hours of inservice training prior to implementation of the pro- gram: one hour of additional training was provided by the researcher so that each supervisor would be experienced in delivering the practice format (see Appendix 0). All four female staff members were experienced dental hygienists and clinical supervisors. The two dentists on the faculty were involved in administrative and lab responsibilities and not available for the feedback sessions. To complete the practice personnel, each subject assigned to teach another practice had a different person to train in initial interview skills. volunteers for the §s completing 54 this type of practice were solicited from the one-year dental assistants program. Thus, the candidates working with the teach another treatment could be described as motivated, interested, health occupations college students. Facilities and Apparatus Five small rooms or offices at the Mott Children's Clinic Dental facility of Charles Stewart Mott Community College were used for practice sessions. These practice rooms were similar in size, but varied in arrangement and decor. These were the only spaces available. Although not totally equiva— lent, efforts were made to set up the rooms similarly for practice sessions. Ideally, totally equivalent office space for all practice sessions would have been desired. This was not possible. It was assumed, however, that the effects of the facilities were minimal. A quiet, private room with necessary equipment and materials was provided in all cases. Appendix P illustrates the floor plan of the Dental Clinic facility. Sony AV series video recorders with 19 inch monitors were utilized for the playback of interview and discrimination materials. For purposes of the practice sessions requiring videotape materials, second generation c0pies were provided of discrimination models and subject interviews. Original seven-minute interview videotapes were set aside for data analysis. 55 Treatment Procedures Following the presentation of the modeling phase, all §s were involved in the practice treatments. Again, gs received time and room assignments in advance. The practice sessions were added into the clinic experience. Each § completed these activites during what had been allotted as individual study time. Practice treatments were all designed to take place in one hour's time, actually a 50 minute class period. All treatments were administered individually. I§s reported to the assistant at the time designated on their assignment notice. After receiving an envelOpe of materials from the assistant, each § proceeded to the assigned room for her practice session. Practice treatment content varied for each of the five levels of practice described previously. Practice treatments involving discrimination, feedback,and supervision and the combination necessarily involved the use of a television monitor and playback unit with prepared video materials. These were provided in the practice room. Practice treat- ments involving feedback and supervision, teaching another, and the combination included another individual. A dental hygiene instructor was involved in the feedback practice treatment; teaching another practice involved a volunteer for the §_to train in interview skills. The combination practice included both instructor and volunteer for each g 4 56 experiencing the practice treatment. The supervisors and volunteers were scheduled to arrive at the assigned practice rooms as needed for the various treatments. After completion of the practice treatment, the §_returned to the assistant and checked in the envelope of materials. The practice session was followed immediately by a second videotaped interview. Subjects were scheduled for practice so that five reported and completed different practice treatments; a second group arrived for practice for the next hour while the first group completed its interviews. Practice treatments were pre— pared uniformly and administered in an individual setting. Hypotheses The overall purpose of this set of companion studies was to measure the acquisition of initial interview skills modeled via video simulation and practiced differentially. For pur- poses of clarity, the different phases of this study were considered to be separate, but companion pieces of research. Study One was concerned with the effect of modeling vs. no modeling on the acquisition of initial interview skills. Study Two was designed to investigate the efficiency of different modes of practice in the mastery and retention of skills. Study Two included both immediate and delayed-post tests. Study Three focused on the relationship of activation to practice treatments, individual differences, and interview performance. Formal hypotheses were developed for Study One and Study Two of the companion investigations. 57 StudyVOne Study One was designed to provide a means of evaluating the effect of the model plus cues presentation. Modeling and video simulation have been advocated in counseling literature. Ivey (1971) and others have adapted modeling in the microcounseling approach to meet the needs of a variety of subjects. A comparison of the effect of the prepared modeling simulation to a control was desired to determine the potency of the model treatment in training dental hygienists in both initial non-verbal and verbal interview skills. To test the expectation that the model treatment would make a difference, the following directional hypotheses were formulated: l. 1§s who receive the model instruction tape will exhibit superior non-verbal interview skills to those who do not receive model instruction. 2. Se who receive the model instruction tape will exhibit superior verbal interview skills to those who do not receive model instruction. Study Two Different types of learning practice procedures are prevalent in the counselor education literature. Single types of practice experiences often exist when a variety of studies are reviewed. Also, differential kinds of practice are often coupled with a variety of learning models, or used in a multiple fashion which confounds types of practice. 58 There seemed to be a lack of comparative investigations con- trasting the efficiency of different kinds of practice. Therefore, the hypotheses for the practice treatments reflect a needed comparative analysis. The following general hypo— theses were formulated: 1. SS who receive differential practice treatments will exhibit different performance levels of non-verbal interview skills. a. 83 who receive combination practice treat- ment (P4) or teach practice treatment (P3) will exhibit superior non-verbal inter- view skills to those who receive feedback practice treatment (P ) or discrimination practice treatment (P1). (P4 + P3 > P2 + P1) §s who receive feedback practice or dis— crimination practice treatments (P2 and P) will exhibit superior non—verbal interview skills to those who receive the control practice treatment (P5 ). (P2 4" P1 ) P5) gs who receive differential practice treatments will exhibit different performance levels of verbal interview skills. a. 53 who receive combination practice treat- ment (P P) or teach practice treatment (P3) will exhibit superior verbal interview skills to those who receive feedback practice treatment (P ) or discrimination practice treatment (P1). (P4 + P3 > P2 + P1) Ss who receive feedback practice or dis- crimination practice treatments (P2 and P1) will exhibit superior verbal interview skills to those who receive the control practice treatment. 59 Sample A sample of 38 Se was obtained from the second—semester, first—year dental hygiene program at Charles Stewart Mott Community College. This group of gs comprised the total membership of the 1973 Spring semester freshman class; all members of the class were females. A careful delineation of the sample and sampling procedure follows in order to permit the reader to judge how this pOpulation compared with pOpu- lations to which he might wish to generalize (Cornfield & Tukey, 1956). Sample Characteristics 1. 2. Sex: 38 females. Age: range = 19-37 years; mean = 22.7 years: median = 20 years. Marital status: 10 married, 26 single, 1 divorced, and l widowed. Class standing at Charles Stewart Mott Community College: second semester of a four-semester associate degree program in dental hygiene. Academic standing: All students must obtain a 2.5 average, complete 80 hours experience in a dentist's office, and take the Dental Hygiene Aptitude Test before being considered for selection in the degree program. Employment: All students are full—time students. Some of the subjects maintain limited, part—time employment in addition to their full-time college study. Clinic Experience: All subjects in the second semester of their first year are expected to spend 4 hours a week for 15 weeks in actual clinic work under supervision. All subjects 60 were engaged in interviewing and patient care at the time the interview skills training program was initiated. For purposes of this study students enrolled in the Health Occupations Division, Dental Hygiene program at Charles Stewart Mott Community College, Flint, Michigan, provided a group of paraprofessionals interested in interview training skills. Students routinely interview, instruct patients in dental hygiene procedures, and perform dental cleaning and charting activities. In general, trainees seek to motivate and reinforce co-operative patient behavior toward appropriate individual dental care. This first—year class had no specific training in interview skills. Although class discussion high- lights the necessity for relating with patients and the importance of motivating them to engage in appropriate hygiene procedures, no systematic skill training program existed in the area of interview behaviors. Each student is expected during the course of the second semester to complete between 10 and 15 patient interview, instructional, and cleaning sequences in the dental clinic program. In the course of these expected patient interviews each trainee must begin to relate to a variety of individuals seeking dental hygiene care. For these reasons both students and faculty were interested in the interview skills training program and actively supported the program. 61 Subject Assignment The procedural steps in the random assignment of Se are presented in Figure 2. In the modeling phase, Study One, gs were randomly assigned to one of two groups, model (M1) or no model (M2). Because of artifical scheduling require- ments dividing the class into Tuesday and Thursday sections, random assignment was completed by section A and section B (two random halves for each section). There was no planned difference between sections other than the sequencing created by the two times offered in the scheduling of clinic times: only 20 students could be handled in the clinic at one time period. In the practice phase, Study Two, gs were randomly assigned to one of five levels of practice treat- ment. All interviews were conducted on Tuesday and Thursday at the three times indicated in Figure 2, phases 3, 6, and 7. For examples of the individual assignment forms prepared for each § see Appendix H. For Study One, data for all 38 subjects were collected. In Study Two, the subject pool was reduced by one subject because she did not complete an interview. Covariate analysis included all available completed data, n = 37. Multivariate and univariate analyses of variance for Study Two included a total of 35 subjects, seven subjects for each level of practice. Two additional subjects were dropped prior to analysis of data to obtain an equal cell size of seven for each practice treatment. Three subjects failed to complete mumacmamhm Henson mo maafixm 3oe>umucH comb mofiuomum owumflucmuwwmwa ocm maflawooz mo muowmmm .N musmwm .mquEummuu mowuomum ou uoHum umflxw anode awn» noncommmmwo assow>eosw MOM amonom ou mumaum>oo mm owns sceum>nmnno m manna + .5 one m mommcm umuwm qusnom mo :ofluumaaoo mama "mouse hosum .uswEummuu mofluomum 0» mm mm mo ucchmfimmm Ecosmm "039 upsum as .m msoum .NZ on w one 4 msoum .Hz 0» m ”Amomusna “m msoum .mz on m osm « msoum .Hz on m uxmomwse unsceuosuumCe HmooE on WW no ucwficmflmmm Eoocmm "mso hosum « 62 m mouse“ A lummxm ma u c m. mw m. Mu: m m. Mu: enougwum W (t P (. v Hmooz o. It a manomom m a m a + o o o nmsouze msouw 3 G .4 I 3 .m. W .m. m .m. w. a a e a 3 mm a s m OHm>mQ I M I ma I a u p u e u M 31.38 m d M“ m m M“ W 1 o 1 m z I 33535 A S A d A O m. a m... .o. m. u M N M 3 HA M «0 ma I G W % fiasco: mcwsnmoq < “ *QSOHMV «aonuumum Modem u omega 0 ounce m omega 0 mmmnm m women m manna H ounce 036 MDDBm NZO NODBm mmwosum sawcmmsoo 63 the adjective check lists; resulting in complete data for 35 of the 38 subjects for the analysis of the activation data. Interviewee POpulation Patients available for dental hygiene trainees to inter- view during phases 3, 6, and 7 consisted of children and adults from the general population in the local geographic area. For purposes of this training experience only adult individuals seeking dental hygiene care at the Mott Clinic were involved. Only adult patients were asked to participate because of the limited time schedule, television equipment, and the additional complications anticipated in involving children. Willing adults from the waiting rooms in the dental clinic were solicited to be interviewed by the gs. The individuals being interviewed were from the population served by the clinic--both sexes, adults ranging from college students to senior citizens, different socio-economic levels, racial and cultural backgrounds were included. Patients agreeing to be interviewed were paired in the order of their arrival so that the patients were random to treat- ment conditions. No one individual was interviewed more than one time. Student assistants kept records of each person's name so that a complete list of all those who volunteered for interviews was available. Very few adults declined as they were visiting the clinic and had time as they waited to seek dental care for themselves or their children. 64 Measures and Data Collection Both total non-verbal and verbal measures were used to compare outcomes. Each set of non-verbal and verbal measures included interview skill items composed of frequency counts, duration, and global ratings based on observed data. The same measures were applied to the model, practice, and generalization effects. Non-Verbal Measures Items included in the total non-verbal measure of initial interview skills were developed from the assessment of the videotaped interview data. Observational items of duration of eye contact and number of breaks in eye contact were combined with three judges' global ratings of body posture, gesture, and general non-verbal attending behavior. Both observational and subjective rating items seemed important in the assessment of total non-verbal interview skills. Examples of the four-point non-verbal rating scales used for body posture, gesture, and non-verbal attending behavior are provided in Appendix 0. Verbal Measures Items incorporated in the total verbal measure of initial interview'skills were developed in a similar manner from videotaped interview data. Observational items of the frequency of the number of good (open) and pOOr (closed) 65 invitations to talk, and the frequency of encouragements to continue talking along with three judges' global ratings of the effectiveness of invitations, encouragements, and general verbal attending formed the total verbal outcome measure. Appendix 0 also contains an illustration of the four-point, verbal rating scales developed for global ratings. Again, both the frequency and duration as well as the global types of items were viewed as contributing important elements to the assessment of total interview skill performance. Data Collection Raw data in the form of videotaped interviews were collected on three different occasions: after modeling, after practice, and as a delayed-post measure three weeks after practice. Each §_was asked to complete a seven- minute interview with a volunteer interviewee. Instructions for videotaping interviews were the same for all three interviews (see Appendix S). Subjects were accustomed to the use of television as an instructional tool. They were also aware that video- recording of interviews was expected in the diet interview sequence planned for the second year of the dental hygiene curriculum. These interviews, however, were the first experience scheduled in their training program. 66 Facilities and Apparatus. For collection of data, one dental surgery unit was converted into a television studio for the videotaping of interviews. This large area with controlled access also furnished an anteroom where videotape technician, assistant, and equipment could be stationed out-of—sight from the interviewing process. Sony AVC 3210 cameras and AV series video recorders with 19" monitors were utilized for recording § interviews. The same studio facility at the clinic was employed for videotaping the model materials and interviews. The posi- tioning of dental equipment, chair, and props was as similar to the clinic stations as possible. Identical arrangement of dental equipment and wide-angle camera set-up was main- tained for all subject interviews. Sufficient black and white television equipment was available for all phases of the study. The complete cooper- ation of the college Instructional Media Center for materials preparation and equipment was required and received. The advisement, cooperation, and competence of the Instructional Media Center Director and staff of Charles Stewart Mott Community College enabled the implementation of this study. An additional piece of equipment, a 20 channel Esterline Angus Event Counter was employed in the data collection aspects of this research. Assistants. To execute the interview experience and collect the data, a general assistant, videotape assistant, 67 and videotape technician were needed. The general assistant checked Off gs as they reported for their interview exper- ience, asked the §Dt0 read the instructions for videotaping her interview, recorded names of patients and completed general clerical tasks. This general assistant worked closely with both the videotape assistant and technician that were actually carrying out the duty Of videotaping the interviews. The videotape assistant timed the interviews, ushered subjects and people in and out of the studio facility: the videotape technician was responsible for the technical and mechanical functioning of the videotaping operation. Responsibilities and materials used by these assistants are presented in Appendix T. From the seven-minute videotape excerpts, judges com- pleted frequency and duration counts as well as global ratings that provided the data for the dependent variables in both Study One and Two. The Esterline Angus Event Counter was employed to Obtain frequency and duration counts and to provide the specific record for data analysis. Non-verbal total scores included items based on eye contact duration and the number of breaks in eye contact. The amount Of eye contact duration was measured from the Observational records recorded by the three judges, these totals were transformed to represent the number Of seconds Of eye contact duration during the seven-minute period. The number Of breaks in eye contact was tallied from the same Observational record 68 and reversed so that the smaller or minimum frequency Of breaks was recorded negatively (y = 100 - x). Thus, all scales on the non-verbal and verbal items reflected a higher score as being more desirable. The four—point global rating scales were set in the same way so that a higher score reflected better performance. Verbal skills data also were developed from the video— tape excerpts, so that Observational records of judges con— tained frequencies Of the extent Of use Of verbal interview skills (ITT and ECT). Again, the Esterline Angus Event Counter was used tO facilitate data collection. The three four-point global rating scales were constructed in the same manner as the non—verbal so that a higher score reflected better performance. Judges Two sets Of three judges each were selected and trained by the researcher to make assessments Of non—verbal and verbal interview skills performance. All judges were employed in counseling or psychology fields. Judges from the counsel- ing discipline all had master's degrees, graduate course work beyond the master's degree, and experience in counseling; Of the two judges from the psychology discipline one had com- pleted a doctorate and the other was working on the advanced degree, both had psychology teaching experience. Two females and one male were included in each set of judges. One Of the females in each set represented the counseling discipline 69 and one the psychology discipline. Thus, all the judges were considered to be competent professionals with similar train— ing and experience. The three judges making non-verbal assessments were trained by the researcher tO record the duration and fre- quency Of breaks in eye contact, and then at the end Of the seven—minute segment Of interview performance to make the three global ratings for the §_On body posture, gesture, and non-verbal attending. Their training consisted of the follow- ing sequence of experiences. 1. Introduction to attending behavior. 2. Observation of the model videotape (non-verbal portion). 3. Explanation and discussion of non-verbal skills. 4. Demonstration Of the Esterline Angus Event Recorder. 5. Try-out of recording equipment. 6. Practice in Observing eye contact and breaks in contact. 7. Discussion and further practice. 8. Presentation of global rating scales. 9. Observation Of models. 10. Practice rating and discussion. Steps 6 through 10 in the training sequence were repeated until all the judges and the researcher agreed that the ratings were similar. Training was continued until doubts and concerns on how to rate a specific example Of behavior were removed through continued discussion and practice. 70 The researcher carefully presented a variety Of interview excerpts deve10ped in tryouts Of various rating systems to insure the competence Of the judges to handle the required discriminations. Model tape excerpts and five interviews not included in the practice treatment data analysis provided materials for the judges. All judges' ratings Of non-verbal interview performance were made from videotapes with no audio background. This procedure focused attention on the necessary Observations and removed the audio component as a source Of contamination. The three judges making verbal assessments were trained by the researcher to record the frequency Of good (Open) invitations (G-ITT) and poor (closed) invitations (P—ITT) to talk, and the frequency Of encouragements tO continue talking (ECT). At the end Of the seven-minute interview performance segment, the judges were also trained to make the three global ratings for the g on use Of ITT, use Of ECT. and verbal attending. The training consisted of the following sequence Of experiences. 1. Introduction to attending behavior. 2. Observation Of the model videotape (verbal portion). 3. Explanation and discussion Of verbal skills. 4. Visual presentation Of verbal skills (posters) and discussion. 5. Demonstration of the Esterline Angus Event Recorder. 6. Try-out of recording equipment. 7. Practice in listening and rating ITT and ECT. 71 8. Discrimination discussion and further practice. 9. Presentation Of global rating scales. 10. Practice in global ratings and continued discussion. Again, steps 7 through 10 were continued until the judges and the researcher agreed that the ratings were similar. As previously stated, the training sequence was repeated until doubts and concerns on how to rate a specific example of behavior were removed. All judges' ratings of verbal interview performance were made from the audio portion Of the videotapes with no pic- tures. This procedure focused attention on the necessary listening and removed the video component as a source Of contamination. In both the non-verbal and verbal rating procedures, each of the three judges was furnished with an independent work station which contained a videotape monitor for viewing or listening, a table and chair, an appropriate rating board for the event recorder, and global rating materials. The rating stations were positioned in one room and the recording equipment, tapes, and videotape recorder partitioned in an adjoining room. Videotapes for all three sets of interviews (model, practice, and delayed—post phases) were first collected and then randomly ordered and presented to the raters. The judges Observed or listened to each interview, made appropriate responses on the event recording equipment, and then rated 72 the SS on the global rating scales. Examples Of the event recorder output are illustrated in Appendix R. Reliability Using an analysis Of variance technique developed by Hoyt (1941), rater reliability was estimated on each Of the items contained in the non-verbal and verbal measures. The ANOVA was calculated on a Control Data 6500 computer using a program developed by Jennrich (1961). This procedure yielded estimates Of reliability Of the mean judges' ratings on each of the items composing the total non-verbal and verbal scores at each Of the three data collection phases. Results are reported in Table 1. The subject pool used in estimating the judge reliability contained all 38 subjects Of the model and delayed-post inter- view data. The lack of one subject's interview data for the practice phase resulted in 37 subjects for the reliability coefficients reported for the immediate practice interview data. As Obvious from the coefficients reported in Table 1, frequency and duration data resulted in much higher coeffi- cients than the judges' global ratings. Only on one fre- quency item (G-ITT) did the reliability (.75, .73, and .63) appear to be lower. Apparently, the judges found it more difficult tO consistently determine gOOd quality Of an invitation than poor quality. In essence, the judges were 73 Table 1 Hoyt Reliability Coefficients for the Mean Judge Ratings For Each Non-Verbal and Verbal Measure at Each Testing Time Model Practice Delayed-Post IntervieW’Skill Measures Interview Interview Interview Data Data Data Non-verbal Items Eye Contact Duration .96 .96 .96 Breaks in Eye Contact .84 .89 .88 Body Posture Rating .64 .76 .55 Gesture Rating .63 .77 .72 Hen-Verbal Attending Global Rating .75 .82 .74 Verbal Items Good Invitations .75 .73 .63 Poor Invitations .90 .91 .84 Encouragements .95 .95 .98 Use Of ITT Rating .80 .63 .73 Use of ECT Rating .75 .61 .77 Verbal Attending Global Rating .81 .62 .72 74 not only distinguishing the frequency Of invitations and encouragements as they listened, but also discriminating whether the verbal content reflected a poor attempt or good attempt by the §s in Offering an invitation tO talk. Other than the one exception, the difference in Obser— vational and global item reliability appears to be substan- tial. It can also be noted from Table 1 that the consis- tency Of the reliability coefficients across the model, prac- tice, and delayed-post testing phases of the data remained more similar for the frequency and duration data than the global rating items. Regardless of the differences in reli- ability Of frequency and duration vs. global rating items, and the greater variance in reliability Of the global rating items, the reliability coefficients were well within the generally acceptable range for such data. In addition to the mean judges' ratings on model, practice, and delayed-post interview items, the internal consistency reliability of non-verbal and verbal total scores (a simple sum Of the variables in Table l) at each Of the three phases (times) was estimated. These total non—verbal and verbal reliability estimates were Obtained by the Hoyt analysis Of variance technique. Results are reported in Table 2 . 75 Table 2 Hoyt Reliability Coefficients for Total Non-Verbal And Verbal Measures at Each Testing Time Interview Skill Model Practice Delayed-Post Measures Interview Interview Interview Data Data Data Total Non-Verbal .23 .26 .37 Total Verbal .53 .41 .33 Total score reliabilities were lower than the item reliability estimates (Table 1) based on the mean judge ratings. Since total reliability estimates were affected by the correlations Of all non-verbal or verbal items to each other, differences in reliability estimates were expected, i.e., the first set Of reliabilities addressed the question Of inter-judge agreement while the second set of reliabilities addressed the question Of inter-item agree- ment. Activatiop_pata In addition to the videotape performance record, Activation-Deactivation Adjective Check List data were Obtained. Immediately following the practice treatment and after the last videotape performance record, activation data were gathered. These data provided four factor levels Of activation information. The four factors, or subscales, of the Activation-Deactivation Adjective Check List were 76 derived from analyses Of student self-ratings to a group Of activation-descriptive and mood-descriptive adjectives (Thayer, 1967). The following are brief descriptions of the properties Of each Of the four factors: 1. High Activation adjectives (clutched-up, jittery, intense, stirred-up, fearful) are most represen- tative of feelings associated with anxiety or stress. 2. General Activation adjectives (lively, active, full-of—pep, energetic, peppy, vigorous, activated) represent moderate activation feelings which do not particularly describe feelings associated with anxiety or high stress: adjectives probably represent a middle range Of activation feelings. 3. General Deactivation adjectives (at-rest, still, quiet, leisurely, quiescent, calm, placid) prob- ably best discriminate feelings associated with high anxiety and stress or the Opposite feelings to those states. This factor has been the least stable Of the factors; interpretation of this factor score must be made with caution. 4. Deactivation Sleep adjectives (sleepy: tired, drowsy) are probably not sensitive to stimulus conditions inducing stress or high anxiety. Scores on the factor best represent the middle tO low range Of activation feelings. Feedbackvpata After the study had been completed, the researcher met with all gs during a scheduled meeting hour. During this time, an Offer was made for those gs who had not had an Opportunity to view their interview performance to make arrangements to see the videotapes of their interviews. Any questions regarding the nature Of the experiment were answered and discussed. z. II. 77 Additionally, this opportunity provided time for struc— tured feedback in the form Of a student survey (see Appendix U). Although not planned in the initial proposal, the infor- mation collected through the student survey provided informal information for the dental hygiene faculty as well as the researcher. Design and Analyses lgxperimental Design As mentioned before, the organization of this research was conceived as a set Of separate companion studies. There- fore, the experimental designs used followed the basic out- line designated for Study One and Study Two. The design model for Study One is illustrated pictorially in Figure 3. This study used a "post-test only" design which is strongly suggested by Campbell and Stanley (1963) for educational and psychological research. Random assignment of Se to the model treatment and no model groups permitted absence Of pre-test measures. The 38 SS were divided equally between the model and no model groups. Six non-verbal and seven verbal interview skill variables were incorporated in the design. A representation Of the experimental design for Study Two is illustrated in Figure 4. Study Two included the same non—verbal and verbal dependent variables as Study One. Interview'skills (13) by times (2), with levels Of practice(5) 78 M1 M2 81 ooooooo $19 SZOOOOOOOoS38 V1 I2 Non- I4 Verbal 15 Total Non- Verbal V2 I7 ‘Verbal Total Verbal ‘7 Model Prior to First Videotape Experience No Model Prior to First Videotape Experience Subjects, Dental Hygiene Students Non—Verbal Interview Skills 'Verbal Interview Skills Non-Verbal Interview Item Measures Verbal Interview Item Measures < H II II II II II II II Figure 3. STUDY ONE: Pictorial Representation of the Experimental Design to Test the Effect Of Modeling 79 P P P1 P2 P3 4 5 81.7 S8.14 S15-21 S22-28 S29.-35 V2 O Total Discrimination Practice Feedback and Supervisor Practice Teach Another Practice Combination Practice Control Group Subjects, Dental Hygiene Students Immediate-Post Test Delayed-Post Test Non—Verbal Interview Skills Verbal Interview Skills Non-Verbal Interview Item Measures Verbal Interview Item Measures U) IIIIIIIIIIIIIIIIIIIIIIII I1-5 I6-11 Figure 4. STUDY TWO: Pictorial Representation of the Experimental Design for Comparative Study of Practice 80 with gs nested within practice but crossed with times and skills formed the basic matrix. Only 35 §s were included in the analysis procedure: each practice level had equal cell size. Analysis Of pata Data were keypunched and verified at the Michigan State University Computer Center. The various statistical analyses were calculated for Study One and Two on a Control Data 6500 computer; Study Three analyses were calculated on the Control Data 6500 and 3600 computers. An analysis Of variance pro- gram developed by Jeremy Finn (1968) formed the base for the analysis Of data in Study One and Study Two. As outlined before, the companion nature Of the studies included in this research provided an approach to the design and analysis Of data. Three different phases were considered in developing the analysis. 1. Study One: The analysis of non-verbal and verbal performance Of interview skills for those receiv- ing model and no model instruction. 2. Study Two: A total analysis Of non-verbal and verbal performance Of interview skills for those receiving different practice treatments (P1...P5) at two points in time. 3. Study Three: Activation dimensions were to be analyzed post hoc tO gain understandings of the 81 nature of activation factors in relation to the practice treatments, individual differences, and the performance Of interview skills. Following the design for Study One, the data were sub- jected to multivariate and univariate analyses of variance. Thus, the data collected were analyzed using analysis Of variance techniques for a one-way design with 13 dependent variables (six non—verbal and seven verbal). The model hypotheses were stated in a directional manner since the direction reflected the expected results. However, since the results were Of interest even if in the non-predicted direction, the model data were analyzed in a non-directional fashion (at the .05 level instead of the .10 level). Data analysis for Study Two proceeded with repeated measures multivariate analysis Of variance for the combined practice data. The use Of a covariate, the SS initial interview performance, was evaluated. Appropriate contrasts of practice treatment results were calculated based on the analyses Of non-verbal and verbal total scores. The sub- hypotheses ordering the different practice procedures reflected the best guess regarding the properties of the practice treatments. Since the results were Of interest even if in the non-predicted direction, tests were made in a non-directional fashion (.05 level of error instead Of .10 level Of error). 82 As noted earlier, no formal hypotheses were prepared for Study Three. Data analysis was completed on a post hoc basis to gain understandings Of exploratory questions of interest. First, an investigation Of the activation effect of practice treatments was studied. An analysis of variance technique for a two factor (5 x 4) experiment was utilized-- practice treatments by activation dimensions, with groups Of subjects nested within practice treatments. Secondly, the individual changes in activation from practice to last interview'were examined. A repeated measures analysis Of variance technique for a two factor (4 x 2) experiment was utilized--activation dimensions by time of measure, with all subjects crossed with activation factors and times. Finally, the relationship of activation dimensions to per- formance was investigated. Correlations were computed for activation dimensions and total non-verbal and verbal inter- view skills. The outcomes Of these data analysis procedures are reported in Chapter III. CHAPTER I I I RESULTS The results of this investigation were based upon mea- sures of both non-verbal and verbal initial interview skills. Total scores for both non-verbal and verbal interview skills were obtained from frequency and duration counts and global ratings. Therefore, the results reported will include analyses of the composite non-verbal and verbal criterion measures as rated by three judges. Also, analyses of the non-verbal and verbal item data used to develop the composite measures will be reported. Together, composite and item data will provide a complete, comprehensive and comparative view of the non- verbal and verbal initial interview skills. Because of the organizational structure Of the companion studies, results will be presented separately for each study. Multivariate and univariate analyses Of variance were used in Study One to test the effect Of the model videotape. Study Two incorporated repeated measures multivariate analysis of variance techniques to investigate the combined effect of the different types Of practice over time. Planned contrasts were calculated as required. For all hypotheses the .05 probability of a Type I error (alpha) with appropriate 83 84 degrees Of freedom was used. Analysis of variance results and correlations were completed for Study Three. Study One: Modeling General Findipgs The effects of the model videotape can be Observed in terms of the result means for model and nO-model groups. The means for each item and total non-verbal and verbal means are recorded in Table 3*. The range Of values for *In the tables presented in this chapter, the follow- ing abbreviations will be used for the initial interview skills. Non-Verbal Interview Skills: Eye Contact Eye Contact Duration Breaks Frequency of Breaks in Eye Contact Posture = Global Rating of Relaxed Posture Gesture = Global Rating of Natural Gestures Non-verbal = Global Rating Of NOn-Verbal Attending Total Non-Verbal Score (All Non-Verbal Interview Skills) Total NOn-Verbal Verbal Interview Skills: G - ITT = Good Invitations to Talk P - ITT = Poor Invitations to Talk ECT = Encouragements to Continue Talking ITT Rating = Global Rating Of Effectiveness for Invitations to Talk ECT Rating = Global Rating Of Effectiveness for Encouragements to Continue Talking Global Rating of Verbal Attending Total Verbal Score (All Verbal Interview Skills) Verbal Rating Total Verbal 85 .Ax I 00H u xv monoom um3oH ca mcfiuasmmu memun Eseflxme nuHS Esssflusoo spy on» omuowamwu mxmwun mo Hones: Seances on» umnu an omEMOMmcmuu mm3 woven nose hp omens mm uomusoo no one m>auflmom can apnea: Om GOeuomHHo on» mswmuo>wn was an mxmoun mo museseouma m.voa h.mv m.om m.bm m.bHH Hmnum> Hmuoe meaumm Hmnuw> mesons eon mcaumm SSH m Bum v 89H I m H 99H I 0 Hmnum>ncoz Hence 0 m Hmnuw>lcoz H m whgumww m .5 NHSHmOQ 0 new «nxnmum m OMOH uomusou emu OQCW Ama Gmmz av HQQOZIOZ smmz meuH Haaxm 3ww>umusH memoso Has .mHHAXm 3mH>MousH Hmnuo>lsoz one amnum> co mmsouo Hwoozroz one Hmooz How m manna nSOwusw>wQ ousosmum one name: HHOO 86 each Of the interview skill items reported in Table 3 is indicated below: 1. Eye Contact: 0 - 1260 Eye contact was reported as seconds of eye contact duration summed across three judges (60 seconds x 7 minutes x 3 judges = 1260 seconds maximum eye contact). Breaks: 0 - 300 Breaks in eye contact were based on the frequency of shifts in eye contact summed across three judges. The number of breaks as rated by each judge were transformed by reversing the direction so that the minimum number of breaks reflected the higher and positive end of the continuum (y = 100 - x). All Non-Verbal and Verbal Ratings: 3 - 12 Ratings for global items (posture, gesture, non- verbal attending, effectiveness Of ITT and ECT, verbal attending) were based on a 1—4 point scale summed across the three judges. Invitations and Encouragements: 0 -60 (estimate) Verbal Observations (G-ITT, P-ITT, and ECT) were based on the frequency Of verbal invitations and encouragements summed across the three judges. Cell means for the model group were higher for both total non-verbal and verbal measures than for the nO-model group. Higher means were recorded for the model group on all item measures except the verbal item encouragements to continue talking. Intercorrelations for all interview skill items are reported in Appendix V. With the background Of these general findings in mind, the hypotheses dealing with the effect of the model videotape are reported. .411 f. I ‘_ ig-I—l-hh—i-Q—w. ‘{ ~ ,1- l - “Em 87 Results Of the Tests for Hypotheses Hypothesis 1 was planned to test the effect of model instruction on non-verbal interview skills. A multivariate and a univariate analysis of variance procedure were used to test Hypothesis 1. The results Of the analyses are shown in Table 4. The model hypotheses were stated in a directional manner because the direction reflected the expected results. How- ever, since the results were Of interest even if in the non- predicted direction, the model data were analyzed in a non- directional fashion (at the .05 level instead Of the .10 level). Thus, the .05 probability Of a Type I error was used to test both the multivariate statistic (F = .44, df 5, 32) for all non-verbal interview skill items and the total non-verbal univariate statistic (F = .43, df 1, 36). The .05 level of error was partitioned for the five non-verbal measures and each measure was tested at the .01 level. Partitioning of the level of error was deemed appropriate to control for the over-all Type I error (Whitla, 1973). None Of the results were significant. The differences in the means between the groups were in the predicted direction; however, the differences were not substantial enough to be statistically significant. Hypothesis 1 was not supported. It stated: §s who receive model instruction will exhibit superior non-verbal interview skills to those who do not receive model instruction. 88 Table 4 Analysis Of Variance for Non-Verbal Interview Skills Model (n = H 19) vs. NO-Model (n = 19) Comparison Multivariate F = .44 with 5, Non-Verbal Mean Square Mean Square Univariate F Items Between Within 1, 36 df Eye Contact 13566.42 23633.93 .57 Breaks 360.24 513.85 .70 Posture 3.79 3.03 1.25 Gesture 1.68 3.43 .49 Non-Verbal 6.74 3.29 2.05 Total Non-Verbal 19964.24 29571.75 .42 89 Iiypothesis 2 was structured to test the effect Of model instruction on verbal interview skills. Again, a multi- variate and a univariate analysis Of variance procedure were used to test the effect of the model treatment. Viewing the model videotape did facilitate statistically significant differences in the performance Of total verbal interview ..- -‘_'H 1 skills. The results of the analyses are illustrated in Table 5. Both the multivariate statistic (F = 3.43, df 6, 31) I I E 1 I 1. for the interview skill item measures and the univariate Statistic (F = 4.18, df l, 36) for the total verbal measure were significant beyond the .05 probability level. The .05 1evel of error was partitioned for the six verbal item mea- sUres and each measure was tested at the .008 level. Only One verbal item was significant (F = 11.73, df 1, 36) at the -008 probability level. The one significant interview item involved attempts to Offer invitations tO talk although Poor in quality (P-ITT). Even though P-ITT was the only Statistically significant item, large between group differences Were also Obtained for successful invitations (G-ITT) and the global rating Of the effectiveness Of Offering invitations to talk. Encouragements to continue talking, and the two 910bal ratings for effectiveness Of encouragements and global verbal attending had only trivial group mean differ- ences. With the exception Of encouragements, the differences in means reported were in the expected direction as seen in Table 3. 90 Table 5 Analysis Of Variance for Verbal Interview Skills Model (n = 19) vs, NO-Model (n = 19) Comparison Multivariate F = 3.43 with 6, 31 df* ‘Verbal Mean Square Mean Square Univariate F Items Between Within 1, 36 df G - ITT 501.16 70.78 7.08 P - ITT 3006.42 256.36 11.73 ** ECT .95 591.18 .01 ITT Rating 19.18 3.16 6.08 ECT Rating .66 4.03 .16 verbal Rating 3.18 3.49 .91 Total Verbal 6925.50 1656.97 4.18 * _k *Significant beyond the .05 level. **Significant at the .008 level. 91 Thus, Hypothesis 2 was supported. It stated: §s who receive model instruction will exhibit superior verbal interview skills to those who do not receive model instruction. Next, the results for Study Two are reported. The second Companion study included investigations of the effects Of F different practice over time. Study Two: Practice General Findings The results Obtained from the first interview assessment were predicted to be highly correlated in a positive way with the same dependent variables used to assess interview skills ‘performance after practice. In order to determine the lin- ear association between initial and practice assessments, an analysis Of covariance (ANCOVA) was computed. Low correla- tions were found for all items except two (gesture rating and ECT Observation) indicating that the use Of initial performance data as a covariate was not helpful in gaining a more powerful significance test. Because the unadjusted and the analysis of covariance adjusted means would not differ meaningfully, the covariance procedure was dropped in order to simplify the analysis and interpretation Of the results. The effects Of the different practice procedures can be Observed in terms Of the means for each Of the five practice groups. The means and standard deviations for each practice group for total immediate and delayed Obser- vations are recorded in Table 6. 92 mm.¢~ Hm.v>H hm.ma vm.hmm .Q.m an.om hm.noma mm.am «H.0Nma can: Houucou ~m.mm mm.mma em.mm hm.ova .n.m Ah.mHH oo.oova m¢.maa an.mmma :mmz sOaumsMQEOU vo.¢¢ mn.¢mH om.mm mo.m¢H .n.m uwsuocs mv.Hoa vH.Hm~H mv.nHH ah.hmma new: sense mm.me mm.mm om.mo mm.em .Q.m xumnommm nm.mma mv.mmva hm.o~H hm.mmaa smmz soma>smmsm mo.nv mm.HHH mm.Hm mo.ama .Q.m oo.mHH va.mvma oo.moa HS.>HMH cow: co«umcfi8«somwn Hmnuo> Hmnum>ucoz Hmnum> Hmnuo>usoz Hmuoe HmsOB Hmuoe Hmuoa mmsouo Oswuomum umom newsflmn anon sunflomefin neodum>uomno unomnowhmaoa can wumaoOsEH so museum mowuomum Ada HON mHHme 36a>uousH Hmnum>lsoz one Hmnuo> dance How 6 manna mCOaumw>mQ osmosmum can name: HHmU 93 Non-verbal cell means generally drop slightly from the immediate to the delayed-post observation. An exception is the mean for the non-verbal total score for combination practice. Verbal cell means increase slightly from the bu{ immediate to the delayed-post observation for discrimination and supervisor-feedback practice. The teach another practice group drops slightly on the verbal mean from immediate to ~43! Qu-ln --”\. . ."‘ delayed Observations. Both combination and control practice ! group verbal means remain almost identical from immediate to L- delayed-post Observations. For immediate and delayed Obser- ‘vations on both non-verbal and verbal means, the supervisor- feedback practice ranks first and the control group last. Ranks for the other practice groups vary with the non-verbal or verbal skill and the Observation. It is also interesting to compare these data in Table 6 ‘with the prior levels of skill performance reflected by the Insane reported in Table 3 (model assessment time). Across non—verbal total means, all practice treatment means in- Creased from the model to the immediate assessment time. {The practice control group mean for non-verbal total (1226.1) ‘Dn the immediate post test was less than the model (1302.5) 'and no-model means (1256.7). Across time, the non-verbal 'total means regressed for discrimination and teach another Irractice, but increased beyond the model means for super— visor-feedback and combination practice. 94 Verbal total means from model to immediate assessment, increased for supervisor-feedback practice, reflected no change for teach another and combination practice, and de- creased for discrimination practice. At the immediate and delayed-post assessments, the control group verbal means (91.3 and 90.7) were less than the model (117.8) and equal to the nO-model mean (90.8) . Delayed-post verbal means increased for discrimination (119.0) and supervisor-feedback (129.6) practice from the model (117.8) assessment time and decreased for teach another (101.4) and combination (115.7) practice groups. A more detailed picture Of the effects Of the different practice procedures can be Obtained by a review Of the cell means Of each interview skill item across immediate and delayed-post Observations. This information is presented in Table 7. With these general findings in mind, the results Of the Practice treatments will be developed further. Results Of the repeated measures multivariate analysis Of variance for the combined effect Of practice over time will be presented rlext . £9_mbined Effect of Practice over Time A multivariate multiple repeated measures analysis Of variance was completed to assess the combined effect Of the Practice treatments. Combined scores for all practice groups I f- I 95 cohum>uwmno umomaowmmaon coflum>uwmno mumecoeeH 6.66 6.666 6.666 6.666 6.666 6.66 6.666 6.666 6.666 6.666 66666> 66666 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 666666 66666> 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 666666 son 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 666666 966 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 966 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 6.66 666 I 6 6.6 6.66 6.6 6.66 6.66 6.6 6.66 6.66 6.66 6.66 666 I 6 u Hmflu m> 6.6666 6.6666 6.6666 6.6666 6.6666 6.6666 6.6666 6.6666 6.6666 6.6666 66666>Iaoz 66666 6.6 6.66 6.6 6.6 6.6 6.6 6.66 6.6 6.6 6.6 66666>Iaoz 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6666666 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6.6 6666666 6.666 6.666 6.666 6.666 6.666 6.666 6.666 6.666 6.666 6.666 666666 6.6666 6.6666 6.666 6.6666 6.666 6.666 6.6666 6.6666 6.6666 6.6666 6666666 666 u HmQHm>ICOZ some 6666 some 6666 codes menu noomh Inca soflum Menu locum 16:6 meuH flows lawn load HOmw> IEMHU Hon» lawn Ioc¢ Homw> lawuo Hawxm 1:00 1600 comma Inwasm I660 1:00 IEOU comma Iuomsm than 3ow>umucH ch«uM>uonno unomloommawn can sunflowEEH so nmsouo moduomum Has no“ mEmuH Hmnuo>lsoz ocm Hmnuo> 60m 6:662 HHmU 6 66666 96 flor non-verbal and verbal totals were Obtained from standard- ized immediate-post data added to standardized delayed-post data (.707 immediate post + .707 delayed post = standardized ccnnbined mean). This procedure was adOpted to adjust for clifferences in variance existing for immediate and delayed observations. Using the combined data with the multivariate and univariate analyses Of variance procedures provided results to determine the over-all effect Of the differentiated practice treatments. Results are reported separately for norrdverbal and verbal interview skills. First, the total scx>re data are presented. Second, the item data are reported. fifinird, the analysis of variance data are included. Total Non-Verbal Measure. In Table 8 the cell means fibr the total non-verbal measure are shown. Unadjusted data were included for the immediate—post and delayed-post assess- ments. The change across time score illustrated in the next to last column of Table 8 was based on the difference of Standardized means (standardized delayed—post minus the Standardized immediate-post mean). The change across time mean was used to test for differential retention across Practice groups. Then, the standardized immediate and delayed-post measures were combined. The combined repeated “masures were used to Obtain the cell means which were employed in the analysis Of the total across time effect Of the practice treatments. t, u‘:f’&_fl7a-r.hn‘— “(u-w: .Awuoom powwohmosmum u 660m seawawo 606. + umom muwamEEw 606.V sumo umomlommemo can synapses“ ooNHoumosmum so comma mum mamas omGHQEOU owufloumocmum .Amswu mmouum Omsmno u umom 666606856 606. I 660% peasant 606.V memos owufloumocmum on» :6 660cmuwmwao any so comma mum memos Oahu mmouom mmsmno N 97 6 66.6666 66.66 66.6666 66.6666 6666666 66.6666 66.6 66.6666 6646666 66666666666 ma.6HmH 66.66: va.amma 66.6mma nonuosm £0669 66.6666 66.6- 66.6666 66.6666 x6666666 6666>66666 66.6666 66.66- 66.6666 66.6666 66666666666666 6669 N omswneoo mowed umom umom omuaoumocmum wmcmru oohmaoo ouMHoOEEH oowuomnm nuance: Hmnuo>lsoz Hmuoa ecu so moauomum mo uumumm one now acme: Haou 6 66666 98 As illustrated by the data in Table 8, cell means for non-verbal total interview skills vary for the different practice groups. The combined mean for each practice group provides a way Of ranking the effect Of the practice treat— ments across time. The supervisor-feedback practice group ranks first, the combination practice next, teach another and discrimination practice rank third and fourth with similar cell means, and the control group ranks last. Changes from immediate tO delayed-post illustrate differences in practice groups. Three practice groups-- discrimination, supervisor-feedback, and teach another-- decreased across time. Combination and control groups improved on the total non-verbal measure across time. Total Verbal Measure. In Table 9 cell means for each 0f the practice groups on the total verbal measure are re— Ported. Again, unadjusted immediate and delayed cell means, change across time scores, and standardized combined means are included. When combined cell means are reviewed, the Bupervisor-feedback practice group ranks first, the combin— ation group second. discrimination and teach another groups next, and the control group last. Only one practice group nIsan decreased appreciably over time, teach another practice. Combination and control groups remained nearly the same. Vory slight decreases are reported. Discrimination and Supervisor-feedback practice cell means gained on the total Verbal measure. .Aouoom powwoumocmum u 660m commaoo 606. + 660m wumwooEEH 606.V memo anon-omhmaoo can sunfloofififl nonwoumocmum so comma mum 6:665 owswneoo powwoumosmumm .AoEHu 660606 omsmno u 660m 666600256 606. I 660m peasant 606.V memos ownaoumosmum 6:6 c6 mwocouwwmwo any so oomph mum 6:668 6866 660606 omsmnu 99 6 66.666 66.- 66.66 66.66 6666666 66.666 66.- 66.666 66.666 66666666666 66.666 66.66- 66.666 66.666 6666666 66666 66.666 66.6 66.666 66.666 x6666666 6666>66mam 66.666 66.6 66.666 66.666 66666666666666 H6869 N oosHQEOU mmouoc anon anon beefioumosmum omsmcu boxcamn wumHooEEH moauomum whammmz_amnuw> 66908 on» so wofluomum m0 uommwm on» now same: 6660 m manna 100 gnterview Skill Item Measures. Cell means for the non- verbal item measures are presented in Table 10. The means for each non-verbal interview skill item illustrate the effect of the practice treatment and indicate how each item contributes to the combined non-verbal total score. For the frequency and duration of eye contact items the supervisor- feedback and combination practice groups rank first and second. For the global ratings of posture, gesture, and non-verbal attending, the combination practice group ranks first. The Supervisor-feedback practice group ranks second for the gesture and non-verbal attending ratings and third for the Posture rating. Rank orders for the other practice groups are varied for each of the non-verbal items. In Table 11 the cell means for the verbal item measures are presented. The rank order of the levels of practice varies for each of the different interview skill items. A similarity is observed in the control group which ranks fifth, or last, for all observational types of verbal items (G-I'r'r, P-ITT. and ecr). After this review of the item measures and the way in Mhich they contribute to the combined total non-verbal and verbal measures, the analysis of variance results based on ‘flhese total non-verbal and verbal measures of interview Bkills will be presented. 101 wo.m®ha NN.NH H¢.HH mm.HH Ho.va oo.mmMH Houucou N©.Hhma v¢.¢a mm.ma mv.ma hm.oom ¢m.m®ma coflu6cwnfioo mH.onH Hm.HH om.OH HH.HH fim.hmm Nm.m¢¢H umnuocm £0669 mv.mmom mo.ma NO.NH NB.HH mh.Hom mm.vmoa xomflommm Homfi>uwmsm hh.¢HmH HO.HH HH.HH Hm.HH mm.o¢m ©¢.o¢¢a COHu6CHEHHomflm 6666-6666-6602 6666-6666-6696 6.6966660 6.6656066 6666665 uomucoo 35 66609 memuH 666xm 366>umucH 66Qum>ncoz 6066066m 6co6u6>666no umomupmh6amn UC6 mu6flpmfiEH pmGHQEou you 66 66669 66656662 66966>Icoz co mofiuomum wo uommmm 636 60m 6:662 aamo 102 6m.mm6 06.06 60.06 06.6 66.66 0m.0m M6.~6 6066:00 66.006 NN.N6 mm.~6 m0.m6 mm.mo 06.6m 66.mm co6u6c6nfiou mm.¢m6 00.06 06.6 06.6 mo.mm mm.mm 60.06 umnuoca £0668 66.066 00.06 00.6 00.6 66.66 0m.0m 66.66 #0660666 uo66>66msm 6m.mm6 m6.66 Nw.66 N6.66 m6.mm 66.6m 6N.VN co6u6c6E66066Q 6c6u6m mc6u6m mc666m 66666> 66666> 90m 986 Bum 896-6 996-0 66609 66666 666xm 366>kucH 66666> 606u066m 6co6u6>66660 6606-0666660 0:6 666606856 06:6QEOU 606 66656662 66666> no 60660666 mo 606mmm 63p 606 6:66: 6660 66 66666 103 ANOVA Results for Non-Verbal Total Scores. An analysis of variance procedure (ANOVA) was used to test for differen- tial retention on the non-verbal total means across the five practice treatments. Results are shown in Tables 12, 13, and 14. Table 12 Analysis of Variance Test of Combined Total Non-Verbal Measure for Interaction between Practice Groups and Repeated Measures _¥ E TOtal Score Mean Square Mean Square Univariate F Between Within 4, 3O df Non-Verbal 12647.89 13931.75 .91 AS documented in Table 12, the F statistic (F = .91, df 4, 30) for practice groups with repeated measures interaction was not significant. There was no differential retention across smactice groups. The data for the test of repeated measures Rain effect for all subjects were incorporated in Table 13. Table 13 Analysis of Variance Test of Combined Total Non-Verbal Measure for Repeated Measures Main Effect for All Subjects y .6.— Total Score Mean Square Mean Square Univariate F Between Within 1, 3O df Non-Verbal 12485.16 13931.75 .90 104 Again, the F statistic (F = .90, df l, 30) was not significant. The average total non-verbal score across practice groups did ncrt.change from the immediate to the delayed-post tests. The statistics used in the test of the main effect of practice are provided in Table 14. Table 14 thaalysis of Variance Test of Combined Total Non-Verbal Measure for Practice Groups Main Effect —¥ —._ katal Score Mean Square Mean Square Univariate F Between Within 4, 30 df NOnPVerbal 89158.37 30919.64 2.88* *Significant beyond the .05 level. The F statistic (F = 2.88, df 4, 30) was significant at the .05 level. There was a significant difference in the cell “mans for the total non-verbal measure based on the different types of practice. The different practice procedures do make a difference in the total non—verbal measure of interview skill performance. Next, information for the verbal total measure will be included. ANOVA Results for Verbal Total Scores. Analysis of variance techniques were used to test the effect of differences in the verbal total means for the five practice treatments. Results are shown in Tables 15, 16, and 17. 105 As documented in Table 15, the F statistic (F = .59, df 4, 30) for practice groups with repeated measures inter- action was not significant. Table 15 Analysis of Variance Test of Combined Total Verbal Measure for Interaction between Practice Groups and Repeated Measures Total Score Mean Square Mean Square Univariate F Between Within 4, 30 df Verbal 470.34 800.52 .59 There was no differential rate of retention across practice groups, The test for the repeated measures main effect for all subjects was completed next. Data for this test are presented in Table 16. Table 16 Analysis of Variance Test of Combined Total Verbal Measure for Repeated Measures Main Effect for All Subjects \\5-_——-—-——_-_r 1L 4* _S_-— f Tc3ta1 Score Mean Square Mean Square Univariate F Between Within 1, 30 df \ Verbal 25.19 800.52 .03 106 Again, the F statistic (F = .03, df l, 30) was not signifi- cant. There was no repeated measures main effect for the total verbal measure. The statistics used in the test of the main effect across both testing times of the practice treatments for the total verbal measure are presented in Table 17. Table 17 Analysis of Variance Test of Combined Total Verbal Measure for Practice Groups Main Effect __ g Total Score Mean Square Mean Square Univariate F Between Within 4, 30 df Verbal 2194.54 2133.56 1.03 The F statistic (F = 1.03, df 4, 30) was not significant at the .05 level. There was no significant difference in the cell means for the total verbal measure across the five different types of practice. The different practice pro- cedures did not make a statistical difference in the total Verbal measure of interview skill performance. Information 1relating to the interview skill items will be presented next. ANOVA Results for Non-Verbal Item Measures. Cell means for the non-verbal item measures were presented earlier in the data for Table 10. These cell means were used in the 107 multivariate and univariate analyses of variance tests to establish the effect of Results of the analysis Tables 18, 19, and 20. Statistics for the between practice groups in Table 18 . Multivariate Test of £01? Interaction between H H practice on the non-verbal items. of variance tests are reported in multivariate test of interaction and repeated measures are included Table 18 Combined Non—Verbal Item Measures Practice Groups and Repeated Measures Multivariate F .66 with 20, 87.18 df Non-Verbal Mean Square Mean Square Univariate F Items Between Within 4, 30 df Eye Contact 9974.62 11193.78 .89 Breaks 295.93 403.42 .73 Posture .91 2.24 .41 Gesture .59 1.49 .40 NOla—Verbal 3 . 77 2 . 17 1 . 74 \ The multivariate F statistic (F = .66, df 20, 87.18) was not 8ignificant. The .05 level of error was partitioned for the fiVB non-verbal items and each item was tested at the .01 level. None of the univariate tests for the non-verbal items were 108 significant. There was no significant interaction effect due to differential rate of retention across practice groups. The data for the test of non—verbal item repeated mea- sures main effect for all subjects are included in Table 19. Table 19 Multivariate Test of Combined Non-Verbal Item Measures for Repeated Measures Main Effect Multivariate F = .98 with 5, 26 df Non-Verbal Mean Square Mean Square Univariate F Items Between Within 5, 26 df Eye Contact 11009.30 11193.78 .98 Breaks .13 403.42 .0003 Posture 8.23 2.24 3.67 Gesture .91 1.49 I .61 N°n~Verba1 6.91 2.17 3.18 \ A I1C3n-significant F statistic (F = .98, df 5, 26) was found as a result of the multivariate test. Examination of the uniNariate test data reported in Table 19 indicated that no non‘verbal items were statistically significant. Again, the '05 level of error was partitioned for the five non-verbal 1.tems and each item was tested at the .01 level. 109 Data for the analysis of variance tests of all non-verbal item measures across times for practice groups main effect are reported in Table 20. Table 20 Multivariate Test of Combined Non-Verbal Item Measures for Practice Groups Main Effect Multivariate F = 1.09 with 40, 81.48 df Non-Verbal Mean Square Mean Square Univariate F Items Between Within 4, 30 df Eye Contact 66610.08 23606.64 2.82 Breaks 1243.57 774.84 1.60 Posture 5.88 2.94 2.00 Gesture 9.32 5.96 1.56 Non-Verbal 13.51 3.11 4.35** \ **Significant at the .01 level. The multivariate F statistic (F = 1.38, df 40, 81.48) was net significant. In univariate tests for each item measure, however, one item was statistically significant. Again, the '05 level of error was partitioned for the five non-verbal items and each item was tested at the .01 level. The over—all rating for non-verbal attending was judged significant at the '01 probability level for the univariate test (F = 4.35, df 4' 30). The significance of the non—verbal attending item fl «.4 C) ’1’ 110 was inconsistent with the earlier finding for the total measure 0 ANOVA Results for Verbal Item Measures. Cell means for verbal item measures were presented earlier in the data for Table 11. These cell means were used in the multivariate and univariate analyses of variance tests to establish the effect of practice on verbal interview skill items. Results of the analysis of variance tests are reported in Tables 21, 22' and 23. Statistics for the multivariate test of interaction between practice groups and repeated measures are included in Table 21. Table 21 Multivariate Test of Combined Verbal Item Measures for Interaction between Practice Groups and Combined Measures § Multivariate F = .44 with 24, 88.42 df Verbal Mean Square Mean Square Univariate F terns Between Within 4, 30 df \ G - Ilny 40.22 40.13 1.00 P 7 ITT 56.25 140.42 .40 ECT 82.00 469.00 .17 ITT Rating 1.61 2.26 .71 ECT Rating .79 2.71 .29 Verbal Rating 1.62 2.58 .63 k 111 The multivariate F statistic (F = .44, df 24, 88.42) was not significant at the .05 level of probability. Neither was there a significant interaction effect due to particular combinations of practice with the repeated measures for verbal items. Data for the test of verbal item repeated measures main effect for all subjects are presented in Table 22. Table 22 Multivariate Test of Combined Verbal Item Measures for Repeated Measures Main Effect for All Subjects KM. __-' Multivariate F = .58 with 6, 25 df Verbal Mean Square Mean Square Univariate F Items Between Within 1, 3O df G - I'l‘T 26.41 40.13 .66 P -- ITT 7.55 140.42 .05 ECT 110.60 469.00 .24 I'I'T Rating .36 2.26 .16 ECT Rating 1.43 2.71 .53 Verbal Rating 1.73 2.58 .67 \ A noIl-significant F statistic (F = -58- (if 6. 25) was found as a result of the multivariate test. Neither was there any Significant single item effect. 112 Data for the analysis of variance tests of all verbal item measures for practice groups main effect are reported in Table 23. Table 23 Multivariate Test of Combined Verbal Item Measures for All Practice Groups Multivariate F = 1.26 with 28, 75.23 df Verbal Mean Square Mean Square Univariate F Items Between Within 4, 3O df G - ITT 163.40 72.90 2.24 P - ITT 570.61 300.01 1.90 ECT 512.82 975.06 .53 ITT Rating 9.46 2.77 3.41 ECT Rating 11.94 2.35 5.08** Verbal Rating 8.10 2.87 2.82 **Significant at .008 level. The multivariate F statistic (F = 1.26, df 48, 75.23) was not significant. The .05 level of error was partitioned for the six verbal items and each item was tested at the .008 level. In univariate tests for each item measure, one item was statistically significant. The rating for the effective- ness of encouragements to continue talking (ECT) was judged Significant at the .008 probability level in a univariate test (F = 5.08, df 4, 30). The global test was consistent 113 with earlier results which overlooked the ECT item effect. It is now time to return to the hypotheses for Study Two and interpret the results for the combined effect of practice over time. Results of the Tests for flypotheses--Combined Effect of Practice Multivariate and univariate analyses of variance were used in Study Two to test the effect of practice on inter- view skills. Univariate tests were used to test the total non-verbal and verbal scores. A repeated measures multivar- iate analysis of variance procedure was utilized to test the combined (across time) practice item data. In addition, univariate tests were provided for each non-verbal and verbal interview skill item. The .05 probability of a Type I error was used to test both multivariate and total score univariate statistics. The .05 level of error was partitioned for the five non-verbal measures (tested at the .01 level) and the six verbal item measures (tested at the .008 level). Hypothesis 1. Hypothesis 1 was established to test the effect of the practice treatments on non-verbal interview skills. The combined total non-verbal measure for practice group main effect was significant (F = 2.88, df 4, 30). The multivariate test for combined non—verbal items for practice group main effect was not judged statistically significant, a1though the univariate test for the non-verbal attending 114 rating was significant at the .01 level (F = 4.35, df 4, 30). All tests for interaction between practice groups and repeated measures and for repeated measures main effect were not significant. Thus, hypothesis 1 was partially supported. It stated: §s who receive differential practice treatments will exhibit different performance levels of non-verbal interview skills. In addition to the general hypothesis, the order of the practice treatments was predicted. To test for the order of practice treatments, appr0priate contrasts were calculated for the total non-verbal measure. Contrasts. The significant main effect of practice for the combined non-verbal interview skills total measure was investigated by means of pairwise and complex Scheffé con- trasts. Four pairwise contrasts and three complex contrasts were formed to study the differences in the total non-verbal interview skill measure for each of the practice treatments. Appropriate degrees of freedom and the .05 probability of a Type I error (alpha) were used. Pairwise contrasts were established for each practice group in comparison with the control group. These four pairwise contrasts yielded two significant results. More non—verbal interview skills were evidenced as a result of the feedback and supervision (P2) and the combination (P4) ‘practice treatments. Information relating to the pairwise contrasts was set up in Table 24. .66.6 n 66 66 .6 606 6666> 66066660 .66>66 66. 6:6 oco666 6660666c6664 115 66. 66.6666 66.6666 66.66 66 - 66 6 66.66 66.6666 66.66666 66.666 66 - 66 66. 66.6666 66.6666 66.66 66 - 66 4 66.66 66.6666 66.66666 66.666 66 - 66 6 6 4 66.6 66.6666 66.66666 66.666 6 - 66 + 66 66. 66.6666 66.666 66.66- -|I6III.- 11161- . . . . 6 6 6 66 6 66 6666 66 6666 66 666 6 - 66 + 66 + 66 + 66 66 66.6 60666 66666600 6666> 66666600 6066> 6 666506 :66: 666006 :66: 66666600 6660 60660666 06c6neou 606 uommwm c662 6&5060 60660666 666oe 66666>-coz 6o6 mummuucoo_6666606 66666663 em 06669 116 Complex Scheffé contrasts were arranged to test the relationships of the practice groups as stated in the hypotheses (P4 + P3,) P2 + P1 and P2 + P1 > PS). The complex contrast comparing all practice treatments to the control group was statistically significant (F = 5.51, df 4, 30). Also, the complex contrast comparing discrimination practice (P1) and the supervision-feedback practice (P2) to the control group (P5) was judged significant (F = 5.43, df 4, 30)- The third complex contrast reported in Table 24 supported one of the two sub-hypotheses regarding the ordering of the practice treatments. Thus, all modes of practice contributed more than the control group to initial non-verbal interview skill perfor- mance. The supervisor feedback and combination practice modes were the stronger practice treatments. One sub- hypothesis which predicted the ordering of the practice treatments for non-verbal interview skills was supported. It stated: §s who receive feedback practice or discrimination practice treatments (P and P ) will exhibit super- ior non-verbal interview skil s to those who receive the control practice treatment (P5). (P2 + P1,> P5) Contrasts were also calculated in the same manner for the one non-verbal interview skill judged significant (non- verbal attending rating). Two pairwise Scheffé contrasts were significant. Combination practice (F = 11.11. df 4, 30) and discrimination practice (F = 3.29, df 4, 30) 117 were supported as being stronger than the control group for this one non-verbal item. Hypothesis 2. Hypothesis 2 was structured to test the effect of the practice treatments on verbal interview skills. Neither the univariate tests of the total verbal score nor the multivariate tests were judged to be statistically significant. Although the multivariate test lacked signifi- cance, one item appeared to differ; the encouragements to continue talking (ECT) rating was found in a univariate test to be statistically significant (F = 5.08, df 4, 30) for the combined test for verbal items for all practice groups. Again, pairwise and complex Scheffé contrasts were established for the one verbal interview skill item (ECT). Two pairwise contrasts were statistically significant when practice treatments were compared to the control group. As noted with the one non-verbal item, combination practice (F = 14.68, df 4, 30) and discrimination practice (F = 4.36, df 4, 3o)‘were supported as being stronger than the control group for this one verbal item. Hypothesis 2 was not supported. It stated: gs who receive differential practice treatments will exhibit different performance levels of verbal interview skills. StudygThree: Activation As stated earlier the concept of activation appears pertinent to investigations in counselor education. As 118 counselor research explores possibilities for assessing what learning and practice treatments are best, for whom, and in what manner, the use of the Activation-Deactivation Check List would seem to be promising as a means of assessing the activation properties of treatments and subject performance. The Activation-Deactivation Adjective Check List (Appendix C), a paper and pencil measurement of psych0physiological levels of activation, provides a means of securing four factor scores reflecting different states of activation. In Study Three, no formal hypotheses were proposed for the investigation of activation. However, several questions of interest for exploratory post hoc analysis were considered. The following areas of study were outlined: 1. no activation factors differ for each of the practice treatments? (immediately following practice and after the delayed-post interview) 2. D0 activation factors or levels Change across all gs from practice level to delayed-post measures? 3. What is the relationship of activation to the criterion measures of total non-verbal and verbal interview skills? Data were collected to relate to these questions of interest. Activation Level of Practice Activation and involvement properties of each of the modes of practice employed were of primary interest. Data 119 relevant to this question are presented in Tables 25 and 26. The cell means for each of the four factors of activation for eaCh practice group are included in the information for Table 25. Cell means vary somewhat for the different modes of practice when each activation factor was observed. The lower cell means for the deactivation sleep factor were based on a smaller number of items used to calculate the score for this one factor (see Appendix C). Similar numbers of items were used in calculations for the other three factors--high acti- vation, general activation, and general deactivation. Multivariate and univariate analyses of variance tech- niques were utilized to test for differences in activation factors. Results of this test are reported in Table 26. No statistically significant results were found. The activation or involvement properties as assessed by the Check list appear to be similar across the five practice groups. All levels of practice seem to be equally activating following the completion of the practice session. Activation Level Following Delayed-20st Interview Are activation levels different for each of the practice modes when assessments are made at the end of the interview skills training program? Data included in Tables 27 and 28 are provided to answer this question. Cell means for each of the four factors of activation for all practice groups as 120 60 u CV @0066 6066000 :6 0 6:0 606 6660 6c6666z+ 66.66 66.66 66.66 66.66 66066666 666 666oe 606066 co6u6>6uom 00.6 06.66 66.66 66.66 +6066c00 00.0 66.66 00.06 66.06 co6u6c66500 00.6 66.06 00.66 66.06 66nuoc< £0669 66.0 66.06 66.66 00.66 60690666 6066>66msm 66.0 6N.66 66.66 66.66 60666665660660 .HOuUMh HOUUMM 660900.66 HOUUMW An. " CV @6660 00666>660660 co6u6>660¢ co6u6>660< 00666>660660 6666060 6666060 £66m 6&0060 60660666 em u 0 600566669 60660666 666306606 66066606856 6&0060 60660666 66¢ 606 6606066 6666 300:0 0>6u0660< co6u6>6606601c0666>6uum 606 6:66: 6660 mm mHQMB 121 Table 26 Analysis of Variance for Activation Factors for All Practice Treatments Assessed Immediately Following Practice Multivariate F = .67 with 16, 80.07 df Activation Mean Square Mean Square Univariate F Factors Between Within 4, 29 df High Activation 33.98 21.00 1.62 General Activation 23.34 44.23 .53 General Deactivation 13-13 19-09 -69 Deactivation Sleep 10-40 11.73 .89 60 u CV @5060 6060000 06 m 000 606 0600 006mm6z+ 122 o¢.6~ am.om mm.mm 06.0m mummflnsm 660 Hmuoe 60600m 00660>660< mm.m 00.06 mm.m6 mm.66 +606ucoo 06.0 00.56 65.6N 0~.N6 00660069800 mv.m 00.56 06.06 06.06 6wnuoc¢ £0008 6>.v 00.06 00.06 0m.66 #009000m 6006>6mmsm mm.m v6.06 0~.h6 6b.m6 00660065660060 60600m 6060mm 606000 606000 As u :0 @0060 00660>660000 00660>660< 00660>6600 00660>660000 6060000 6060000 £06m 005060 0066006m 0m u c 306>6mucH umomncwmm6ma 00630660m 0&5060 00660060 660 606 060600m 6066 600:0 0>6600n00 00660>6600monco660>6600 606 00002 6600 Fm 06308 123 Table 28 Analysis of Variance for Activation Factors for All Practice Treatments Following the Delayed-Post Interview Multivariate F = .59 with 16, 80.07 df Activation Mean Square Mean Square Univariate F Factors Between Within 4, 29 df High Activation 10.89 38.14 .29 General Activation 20.98 37.69 .56 General Deactivation 34.87 33.80 1.03 Deactivation Sleep 6.66 12.11 .55 124 assessed at the end of the interview training program are included in Table 27. There were variations in the means that can be observed for each of the practice modes on the four levels of activation. When visual contrasts are made with the cell means following practice (Table 25 and Table 27), a consistent decrease in high activation factor scores and deactivation sleep factor scores is detected from immediate post to delayed-post observations. Very slight changes in the general activation and general deactivation levels are noticed when cell means are compared across both times. Multivariate and univariate analyses of variance tech- niques were selected to test for differences by practice groups for activation levels at the end of the interview training program. Results for this test are included in Table 28. No statistically significant differences were noted. Activation levels appear to be similar for practice groups at the end of the interview skills training program. Activation Changes for Subjects Across Time Another area of inquiry was raised concerning individual subject changes in activation across time from practice to the delayed-post interview. Cell means for all subjects are reported in the data for Table 29. 125 Table 29 Activation Factor Cell Means for All §s+ t Immediate-Post Delayed-Post Assessment Assessment Activation Factors Following Following Last Practice Interview n = 35 n = 37 High Activation 14.03 11.73 General Activation 17.03 17.76 General Deactivation 14.71 16.11 Deactivation Sleep 6.83 4.51 +A11 available data included from the total of 38 gs. To test for differences in cell means a multivariate analysis of variance technique was used. Results of this test are included in the information for Table 30. Statis- tically significant results were reported for changes in all subjects' activation factors from immediate to delayed-post interview times. The fourth activation factor, described as the sleep factor, contributed most to this finding. Although not statistically significant, the high activation factor score also appeared to add to the significant results reported in Table 30. The adjective check list would seem to be sen- sitive to group changes in individual subjects' levels of activation. Relationship of Activation to Interview Skill Performance The final line of inquiry in this exploration of acti- vation level relates the concept of activation to interview 126 Table 30 Analysis of Variance for Activation Factors for Changes in Subjects from Practice Through Delayed-Post Interview Times Multivariate F = 3.36 with 4, 26 df* Activation Mean Square Mean Square Univariate F Factors Between Within 1, 29 df High Activation 165.44 16.91 4.34 General Activation 16.94 35.79 .45 General Deactivation 21.44 16.74 .63 Deactivation Sleep 92.24 5.73 7.62 ** *Significant beyond the .05 level **Significant beyond the .0125 level 127 skill performance. This analysis was limited to the total non-verbal and verbal measures. Only activation factors as assessed immediately following practice and prior to entering the second interview were correlated to interview skills. Correlations were not included for the second set of acti- vation data since activation level was assessed after all tasks in the interview training program were completed. This relationship of activation level to final interview performance would not seem to be the most meaningful compari— son for the above reason. Data indicating the relationship of activation level to non-verbal and verbal interview performance are included in Table 31. Table 31 Correlation of Activation Factors to Immediate Practice Assessment n = 35 Total High General General Deactivation Interview Activation Activation Deactivation Sleep Factor Skills Factor Factor Factor Non-Verbal .00 -.21 .06 -.04 Verbal -.09 .29* -.01 -.36* *Significant at the .05 level (Edwards, 1960, p. 362). Two significant relationships appeared in terms of verbal interview skill performance. General activation level was 128 positively correlated to good verbal interview performance (r = .29); and the deactivation sleep activation factor was negatively correlated with verbal interview performance (r = -.36). Although the data are not directly comparable, it is interesting to note that the general activation factor correlated quite differently with non-verbal and verbal skills. A significant relationship existed between verbal skills and general activation and a distinctly negative (non-significant) relationship existed between non-verbal interview performance and the general activation factor. In conclusion, the concept of activation looks to be an interesting one that may provide some understandings about the learning sequences and treatments used in counselor training programs. In addition, the relationship of general activation and deactivation sleep factors to individual subject differences on performance may provide a specific means of assessing by activation factor scores the effect of training programs and the involvement or impact of these programs on individual subjects. CHAPTER IV SUMMARY, DISCUSSION, AND IMPLICATIONS Summary This research examined the effects of model, practice, and activation on the attainment and retention of initial interview skills in a training program for dental health paraprofessionals. To assess the results of the video model- ing and differentiated practice procedures used in the inter- view skills training program, three companion studies were formulated. The companion studies were intended to provide comparative measures of both the effect of modeling via videotape and the efficiency of different types of practice in the mastery and generalization of initial non-verbal and verbal interview skills. Specifically, the objectives of this research were: 1. Study One: To assess the effect of a specific example of modeling vs. no modeling in the performance of non-verbal and verbal interview skills. 2. Study Two: To compare differential practice treatments in the mastery and retention of both verbal and non-verbal interview skills. 129 130 3. Study Three: To investigate differences in the level of activation of the practice treatments and differences in activation level at the end of the interview performance. To meet the objectives of the research, a training program was developed with the intent of making systematic comparisons of the outcomes of the video modeling plus cues and differentiated practice procedures used in teaching initial non-verbal and verbal interview skills. Study One contrasted the effect of the modeling plus cues treatment with no treatment to test the power of the training model on both non-verbal and verbal interview skill performance. The basic design of this study was an experimental "post-test only" design recommended by Campbell and Stanley (1963). Subjects were randomly assigned to the modeling treatment (M1) or the no model group (M2). The model treatment was administered via videotape in a group setting. Group interaction was not included in the model treatment: subjects simply viewed the video presentation on initial interview skills. After interview performance data were collected, and prior to the practice treatments, the no model group (M2) viewed the identical model videotape so that all subjects were equivalent before the practice phase of the research was administered. During the practice phase, Study Two, subjects were randomly assigned to the five practice treatments: discrimination, feedback and supervisor, teach another, 131 combination, and control. All practice treatments were administered individually. Immediately following the practice session, each subject completed a second interview which provided data for the comparative evaluation of the practice treatments. Three weeks following the treatment administration, a delayed-post measure was collected to assess the retention of interview skills across time. The basic design for Study Two was a 2 x 13 x 5 repeated measures design: that is, the design contained 2 times, 13 interview skills, and 5 levels of practice with §s nested with practice but crossed with measures and times. Each cell contained an equal number of subjects (n = 7; total n = 35). The third phase, Study Three, of this investigation provided for the exploration of the activation pr0perties of practice treatments, the relationship of activation to the attainment of interview skills, and subject differences in activation. Activation was defined as the degree of arousal or alertness as measured by the four factors of the Activation-Deactivation Adjective Check List. Data were collected twice: immediately after practice and prior to the second interview, and after the final delayed-post interview. The criterion measures used in this study were formulated to examine both non-verbal and verbal interview skills. The same dependent variables comprising frequency and duration observations and global ratings were included in each 132 companion study. Interview data in the form of seven-minute videotaped interviews were collected on three occasions: after modeling, after practice, and three weeks following practice. videotaped interview skill performance data were subsequently rated by three independent judges for the criterion measures. Reliability estimates were calculated for the mean judges' ratings on each interview skill measure for each set of interview data collected at the three different times. Reliability estimates ranged from .98 to .55. Also, reliability estimates were obtained for the total non-verbal and verbal scores at each of the three data collection times. It was hypothesized that subjects Who received the model would exhibit superior non-verbal and verbal inter- view skills to those who did not receive model instruction. It was also hypothesized that subjects receiving differential practice treatments would exhibit different performance levels of non-verbal and verbal skills. Further, in regard to the hypothesized effects concerning the practice treat- ments, the practice treatment groups were predicted to order themselves in terms of performance of interview skills as follows: a. Combination or teach practice superior to feedback or discrimination practice b. Feedback and discrimination practice superior to control group. 133 No formal hypotheses were proposed for the investigation of activation; questions were deve10ped for post hoc analysis. The data were analyzed for Study One with multivariate and univariate analyses of variance. Data for Study Two were analyzed with repeated measures multivariate analysis of variance for the combined (across time) practice results. The initial interview data were investigated as a covariate for the practice study results, but when the covariate results failed to improve the analysis, this procedure was dropped. A statistically significant (0 = .05) effect was found for verbal interview skills due to presenting the model treatment. Significant effects were found for the multi- variate test of all verbal items (a = .05), for the total verbal score (a = .05), and for the univariate test for the verbal invitations to talk (P—ITT, a = .05). Thus, the model videotape treatment did make a difference in the acqui- sition of initial verbal interview skills. Results for the non-verbal variables were not significant. For the combined practice data (across time), a statis- tically significant (a,= .05) result was found for the total non-verbal measure. This result was not supported by the multivariate test for all non-verbal items; however, one item (non—verbal attending rating) was judged significant 0n the univariate test (a:= .05). Results for the verbal variables were basically not significant. Although the 134 multivariate test for all verbal items failed to be statis- tically significant, one item (ECT rating) achieved statis- tical significance (0 = .05). Contrasts calculated for the non—verbal total results reflected the significance of all practice treatments compared to the control group. The feedback-supervision and combination practice treatments ‘were the stronger treatments. Post hoc analysis of the activation data yielded significant correlations for the general activation and deactivation sleep factors with verbal interview skill performance. The verbal total measure was positively correlated (r .29) with general activation and negatively correlated (r = -.36) with the deactivation sleep factor. In addition, multivariate analysis of variance results for changes in all subjects' levels of activation from practice to delayed-post assessment times were statistically signifi- cant (a = .05). The concept of activation appears to be an interesting one that may provide some understandings about learning sequences and treatments. Limitations Before pursuing the positive conclusions and implications of this investigation, it is appropriate to review some of its limitations in order to qualify inferences and to suggest possible refinements for future research. In Study One, the "post-test only design" (Campbell & Stanley, 1963) controls well for variables which might 135 confound the experimental treatment effects. A possible threat to external validity was the reactive effect of the experimental arrangements which might preclude generalization about the treatment effects upon persons being exposed to the training program in non-experimental settings. The presentation of the model plus cues treatment was incorpor— ated in an ordinary manner like other class learning exper- iences, but the announcement concerning the "experimental nature" of the experience may have created expectations and attitudes that are not identical to persons in non- experimental settings. Expectations on the part of the dental faculty that each subject would participate and the subjects' awareness of faculty expectations may have affected the students' involvement and participation. In the preparation of the model videotape treatment materials, a variety of student peer models were selected from the second-year senior hygienists. Although there was no intentional selection bias, it was possible that certain models viewed in the treatment might have been acquaintances of the subjects and therefore could have limited external validity; The model materials were carefully delineated (see Chapter II) to allow the reader to assess how comparable the "models" in the model treatment are to those to which he might wish to generalize. An additional factor limiting the validity of the model treatment might have been the length of the presentation and 136 the amount of material introduced at one time. There was reason to believe (Ivey, 1971, p. 148-149) the number of initial skills presented was appr0priate for a beginning group seeking interview training. However, the length and interview skills included in the model treatment need to be remembered in reviewing the results of this study. Strictly speaking, the results of this model treatment cannot be generalized beyond the specific modeling materials developed for this investigation. A random sample of dental paraprofessionals was not possible. Again, the results cannot be generalized beyond the sample in this study. The sample and sampling procedure were outlined in Chapter II. All subjects who were members of the class participated: this allows for broader general- ization than if a number refused to participate. Overall, the sample was considered representative of dental hygienists pursuing associate degree programs in community colleges. Another sample limitation was the number of subjects. As occurs so frequently in preliminary investigations such as this, a larger number of §§ would have been preferred. In Study Two, some of the same limitations cited pre- viously were relevant. Limitations of the sample population ‘were similar: a larger number of Se within each cell would have been preferred for the practice treatments. Again, the experimental nature of this investigation may have created expectations and attitudes that would not be idential to others in non-experimental settings. 137 Also, treatments were assigned to different settings including small offices, conference rooms, and labs. Since equal facilities were not available, the researcher did not control for this extraneous variable, and it remains as a possible source of systematic error. Future research might control the setting in order to be assured that the treatment effect was not the result of the specific attributes of the setting. The practice personnel used in three treatments-- feedback-supervisor, teach another, and combination practice-- were not the same. These are possible confounding variables. Though the researcher attempted to establish the equivalence of practice personnel on the basis of the standardization of the content and their similar experiences, the use of the same individuals across the practice treatments remains the best assurance that the treatment effect was not the result of the specific attributes of the individual involved in the practice session. The limited number of faculty available for the feedback- supervision practice sessions and that portion of the com- bination practice involving feedback raises a question regarding the validity of the assumption that the repli- cations were independent. All available supervisory personnel were assigned to an equivalent number of 50-minute and lS-minute practice sessions. Thus, the researcher attempted to establish the equivalence of the feedback and 138 supervision experience on the basis of equal assignment, training, and standardization of the practice content. However, the use of a different individual supervisor for each subject remains the best assurance of independence. Efforts were made to control for equivalent practice treatments by structuring the time and activities for each practice. However, practice treatments were administered in different individual settings and this might raise ques- tions of equivalence. Detailed materials are provided in the appendix for each practice treatment. In essence, results of the practice treatments cannot be generalized beyond the specific practice materials and procedures generated for this investigation. A limitation of the practice treatments may be that each practice session was only 50 minutes. Chapter II and the appendix materials provide the reader with the information to assess how com- parable the practice treatments are to those to which he might wish to generalize. Also, the specific dental hygiene paraprofessional train- ing program and the specific patient interview setting are delineated for the reader to evaluate how comparable the characteristics of the interview skills program in this study are to others. Ideally, the delayed-post assessment would have been the actual clinic interview setting. This was impossible because of the physical arrangements (one large room.with 139 20 dental stations) that existed. Even though the setting 'was representative for the dental hygienists‘clinical inter- view, the characteristics of the dental sample should be reviewed carefully before the reader generalizes to other practicum settings and training programs. The rating material and criteria used appeared to be reliable. The application of the criteria and observational discrimination by the judges seemed to be easier to make for the frequency and duration counts than for the global ratings. The use of the Esterline Angus Event Recorder appeared to assist the judges in recording frequency and duration data. The judges were described so that the reader can assess their comparability to other populations of raters. Limitations inherent in the use of ratings need to be discussed. "The use of ratings rests on the assumption that the human observer is a good instrument of quantitative observation, that he is capable of some degree of precision and some degree of objectivity (Guilford, 1954, p. 278)." While confidence is placed in quantitative human judgments, the weaknesses resulting from the many sources of personal bias in those judgments should be acknowledged. Guilford (1954) has discussed in some detail the sources of rater errors. These sources may be summarized and briefly described as follows (Guilford, 1954): (a) error of leniency-- the tendency for a rater to rate too high or too low for whatever reasons; (b) error of central tendency--judges 140 hesitate to make extreme judgments and tend to displace individuals in the direction of the mean of the total group; (c) halo effect—-a tendency to direct the rating of any trait towards the general impression of the subject rated and to that extent to make the ratings of some traits less valid; also, to introduce a spurious amount of positive correlation between traits that are rated; (6) logical error--judges are likely to give similar ratings for traits that seem logically related in the minds of the judges: (e) contrast error—-a tendency for a rater to rate others in the opposite direction from himself in a trait; (f) proximity error--spurious correlation is introduced, adja- cent traits on a rating form tend to intercorrelate higher than remote ones, the degree of actual similarity being presumably equal. One of the better methods for improving ratings is to train raters carefully. As cited in Chapter II, the training sessions for all judges were planned in detail. A step-by- step program was used to provide information, demonstration, practice, and discussion. Steps were repeated as necessary to provide appmpriate experience with the rating materials until both judges and the researcher were in agreement. The problems of rating bias and constant errors of judgment are possible limitations of the present research. 141 Finally, a limitation of this research is the lack of information to establish a level of "meaningful significance" (Thoresen, 1969). Educational—economic research needs to be conducted in order to establish the cost-efficiency of producing videotape models vs. other in vivo modeling pro— cedures. Cost data would also be desired for each of the practice modes to determine if the results of the feedback- supervisor practice warrants this more expensive practice procedure. Discussion and Implications The discussion and implications of this set of com- panion studies must be interpreted in terms of the p0pulation, procedures, materials, treatments, and criterion measures included in this investigation. The range of generalization in terms of these factors is to be determined by the reader. Subject Variable One interest of this research was the use of dental hygienists' initial interview performance as a covariate to increase precision of the practice data. Low correlations were found indicating that the use of initial performance data as a covariate for the immediate effect of practice was not helpful in gaining a more powerful significance test. Because the unadjusted and the analysis of covariance adjusted means did not differ meaningfully, the covariance procedure was dropped in order to simplify the analysis 142 and interpretation of the results. Several possibilities exist to explain these low correlations. The dental para- professional group had some previous experience and emphasis in greeting people and relating to others in the dental clinic. Therefore, the range of initial individual differ— ences may not have been as extreme as found in other subject groups. Also, the initial interview performance for one half of the subjects followed the model experience so that it would have been affected by the model treatment. In this sense it was not entirely a measure of initial individ— ual differences. Of general interest to those exploring initial differences as a covariate would be the finding that the two interview skill items that appeared to be the strongest covariates were the gesture rating and the encouragements to continue talking (ECT) observation. There is a need for future research to identify possible predictors of train- ing outcomes. Future research should examine many different subject characteristics and subject learning styles. For example, it would be helpful to know what subjects learn best from videotape presentations and what subjects learn best from practice experiences. Subject profiles detailing the personality characteristics, learning styles, interpersonal competencies, and modes and ways of processing information would be useful in prescribing the learning and training sequences for individuals and unique subject groups. 143 In terms of subjective impressions, the more shy, quiet and introverted subjects seemed to appreciate the specifics of the interivew skill training program. These subjects seemed to feel they could more easily approach an interview comfortably and effectively at the end of the training sequence. On the other hand, a few extremely extroverted subjects who had learned to rely on their per- sonal charm found the concrete criteria of skill performance a bit more uncomfortable. Future research might select these variables for more intensive study not only in terms of individual change, but also in terms of the type of training program or sequence that might be more effective for different individuals. Another general characteristic of the subjects involved in this research was the cohesiveness of a group that works closely and often daily with each other and.with their faculty. Continued interaction in lab and lecture class experiences, and the familiarity with evaluation and expected feedback in clinic supervision provide a kind of unique subject group. This kind of group may be found in health occupations and counselor training programs. Research may be needed with populations where this type of cohesion and interaction are not present. All of these subject and population qualities present interesting ideas and potential for future investigations. 144 Dependent Variables The reliability of the mean judges' ratings (Chapter II) suggests that raters can use the initial interview skill categories to make consistent observational and global ratings from videotaped interview data. As might be expected, ob- servational items can be discriminated more reliably than the global or more subjective non-verbal and verbal interview skill items. The use of the Esterline Angus Event Recorder enhances data collection as it allows judgments to be recorded with mechanical and technical ease so that a judge can attend more intently to the interview; A variety of studies may be replicated or generated to establish the usefulness of this method of data collection. The present investigation incorporated both observational and global ratings based on the assumption that each type of data contributed necessary information relevant to interview skill performance. Additional research might pursue this line of inquiry as well as extending the assessment of interview skill outcomes to those individuals being inter- viewed. When specific observational criteria like eye con- tact are used, the qualitative aspect may be overlooked. A review of the data collected in this study added to the researcher's assumption that both kinds of data are essential. For example, a judge viewing videotapes may rate a subject as using eye contact and directly facing another, but not be able to respond to the quality of the non-verbal skill 145 in terms of the communication of warmth, listening, and interest instead of a stare, blank look, or disconcerting expression. The effectiveness of a subject's interview repertoire needs to include both quantitative and qualitative responses. The assessment of performance ought to include the total nature of effective performance. Future research might seek to add dimensions of the appropriateness of use of different skills. This suggests that more efforts are needed to identify the kinds, qualities, and classes of subject responses which will either facilitate or retard the interviewing or counseling process. Researching the possible consequences of different responses at different stages in the interviewing or counseling process seems to be called for in future studies. Another qualitative distinction that was included in the verbal interview skills was a rating of both closed or poor attempts to offer an invitation to talk in contrast to a good, Open, invitation to talk. As judges rated a verbal response as an invitation to talk, they distinguished the characteristics of the invitation (P-ITT or G-ITT) and then assessed the global effectiveness of the invitations offered. Results of the model treatment indicated signifi- cant results (Chapter III) in the verbal interview skills. The data indicated that the limited exposure to the model increased the number of invitations attempted, but because of the limited time the invitations were not of good quality. 146 Subjects may grasp the idea of the verbal interview skill of offering invitations, but need other training experiences to achieve mastery of the skill. Further research might establish the levels of achievement that might be attained with different amounts of training time and with different training practice procedures. Another area for research might entail efforts to determine which variables, non-verbal and verbal, appear to affect the outcomes of interviews with different types of patients or clients. Whether non-verbal or verbal variables are more critical, and to what degree, might be raised with different types of patient or client types and values. Undoubtedly, the length of interview time and the interview segment selected for assessment may affect the variables studied. In this investigation the length of the interviews, seven minutes, might have affected the dependent variables. Some subjects were more effective initially, and perhaps would have achieved more effective global ratings if their interview had lasted only five minutes. In general, some subjects seemed to be unable to maintain the initial level of interview skill performance. Other research might center on the effect of the length of the interview or the segments selected for evaluation of subject performance. 147 Finally, the introduction of the concept of activation (Study Three) was an attempt to isolate a specific variable that could be quickly and easily assessed that would provide a possibility for understanding the nature and properties of training program treatments and the characteristics of individual subject's involvement or response. Activation, as assessed by the Activation—Deactivation Adjective Check List, would seem to provide an encouraging possibility for research. If differing activation levels are correlated with performance of different types and classes of skills as the findings of this study suggest, then this opens questions about preferred modes of training. Treatments and training materials that achieve different levels of the general activation factor may be developed to provide more efficient mastery of verbal skills. Understandings of the activation properties and characteristics of effective trainee and counselor performance for different kinds of interview skills and response classes might suggest further research problems where the activation variables could assist in determining what treatments are effective in what ways for whom. Treatment Effects The data for Study One indicate that dental paraprofes- sionals can be trained through videotape modeling to use initial verbal interview skills. Reasons for the lack of effect on non-verbal interview skills may stem from the 148 more developed level of skill already present in the subjects or may relate to the need for other treatments to affect non-verbal skills. Other researchers (Ivey, Normington, Miller, Morrill, & Haase, 1968; Haase & DiMattia, 1970) have noted changes in verbal skills with varied results in the non-verbal skill area. Continued research on model and practice variables with other skill and response cate- gories (such as responding, summarizing, confronting, empathic, interpretative, and clarification) may provide additional understanding of the interrelationship of verbal and non-verbal interview skills. This study supports the effectiveness of a modeling plus cues videotaped presentation that includes both positive and negative examples of the initial interview skills. Other refinements in the modeling treatment might be recommended in contrasting the effects of good or positive models, negative models, both types of examples, along with comparisons of models alone, cues alone, and models and cues. As cited earlier in this discussion, research is needed on the effectiveness of modeling and other training procedures that might enhance the appropriate use and timing of when to use the interview skills. A review of the model findings (Study One, Chapter III), also suggests that although the model treatment resulted in changes in verbal skills, encouragements to continue talking as an initial skill were not affected as strongly as 149 invitations to talk. Two reasons may be helpful in gaining an understanding of this result. First, with both non-verbal skills and invitations to talk being presented first in the model videotape, subjects may have worked to master these skills first and overlooked encouragements. Secondly, encouragement to continue talking (ECT) was presented as a verbal skill, but analysis of the results might raise ques- tions regarding the nature of ECT. This item appeared to differ from the other verbal items in the multivariate test for the combined practice data (Table 22). This finding, and the subjective Opinions of the judges as they were rating, would lead the researcher to view encouragements to continue talking as being a skill containing equal verbal and non-verbal qualities. Verbal encouragements without the non-verbal element (head nods, encouraging expression, and physical attending) lack the qualitative effectiveness needed in this interview skill. Additional inquiry might seek to support or refute this view. As partially supported in the findings of this investi- gation, the practice procedures appear to enhance non—verbal performance. The different kinds of practice appear to have identical qualities and strengths for initial mastery. However, the feedback—supervision and combination practice appeared to be stronger practice modes for the retention of skills across time. Further research on the differentiated nature of the practice procedures used in this research is recommended. 150 Efforts were made in this set of companion studies to provide the good examples of each type of practice. Based on the experience gained in the preparation of materials and the implementation of the practice sessions, the researcher could recommend other refinements. Discrimination practice could be established so that each subject after making a discrimination rating had information to check for comparison. A larger number of more complex examples might have been desirable to increase the discriminations required. The control group was provided with dental oriented materials not related to interview skills. However, the content gained in the control session may have enabled the subjects to feel more at ease in interviewing because they had information and content that could have been included in their interview. In this sense, a control practice group that had no exposure to the model and no practice activity at all would have been more desirable. Under this circum- stance, the practice outcomes might have been more substantial. Conclusion In the discussion and implications of this research, the central themes have been (a) the training of dental health paraprofessionals and others by counselors, (b) the modeling and practice procedures used to develop and imple— ment a training program, and (c) the comparative assessment over time of the skills developed in training. The role of 151 the counselor as educator, trainer, and consultant was extended to create the programs, train the faculty who also participated in the interview skills training sequence, and implement and evaluate the training of students. An emphasis was also placed on the exploration of the concept of activation as a specific means of identifying one possibility for determining the effect of treatments and procedures. Basically, this interest stemmed from the need to find means of specifying what works with whom and in what way. In the past, counselor educators have been criticized for the artificial and theoretical dichotomies used in counseling research. Introducing meaning and rigor into research and practice has been the focus of three major directions in counseling education. Krumboltz suggested the test of relevance--recommending that answers to questions of what makes a difference in counselor practice are critical (Whiteley, 1969, p. 191). Ivey, in stressing microcounseling procedures, pointed out the need to identify particular, specific skills (Ivey, 1971). Carkhuff (1969a, 1969b) spelled out the importance of training others and of training as a preferred mode of treatment. This investigation attempted to demonstrate a practical, comparative study of training procedures that might be appropriate to counselor trainees and many other groups. 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Washington, D. C.: American Personnel and Guidance Association, 1962. Yenawine, G., & Arbuckle, D. S. Study of the use of videotape and audiotape as techniques in counselor education. Journal of Counseling Psychology, 1971, 25, 1-6. APPENDICES APPENDIX A INITIAL INTERVIEW SKILLS Background Information for the Dental Hygienist APPENDIX.A INITIAL INTERVIEW SKILLS Background Information for the Dental Hygienist An important aspect of establishing a relationship with a patient is being aware of, and responsive to, the communi- cations of that individual and communicating this attentive- ness. The communication of attentiveness is a potent rein- forcer in your interaction with a patient. Attention plays an essential role in establishing a relationship and in motivating your patient. Skinner in Science and Human Behavior (1953, p. 78) discusses attention as follows: The attention of people is reinforcing be- cause it is a necessary condition for other reinforcements for them. In general, only people who are attending to us reinforce our behavior. Thus, attention or attending behaviors communicated to your patient are a means of establishing relationships, being responsive, motivating and reinforcing. Individuals give attention to one another by a variety of means. Attending behaviors can be both non-verbal and verbal. In essence, attending behaviors can be defined as simple listening. When you communicate attentiveness to a patient, they might describe the experience as--“She really listens to what I say...She seems to be interested in me." When you attend to another, your verbal and non-verbal behaviors consistently communicate very clearly that you are listening. How do we learn to communicate simple listening or attentiveness? Rarely do we define what specific behaviors are involved in listening. Too often interviewer trainers or instructors say, "listen," without spelling out what the act of listening really is. Yet, all successful interviewers, dental hygienists, teachers, nurses, and counselors use basic attending skills and "communicate" that they listen. Good listeners give evidence through their verbal and non—verbal responses that communication is not only welcome, but 162 163 received and responded to in a manner that encourages more. In this way attending or listening behaviors are common to good listeners. Specifically, good attending behavior gives evidence of listening by: 1. Maintaining some type of consistent eye contact, 2. Being physically relaxed with natural posture and movements--our body directly facing the other person, our facial expression inviting and encouraging, 3. Opening the interview with invitations to talk, 4. Encouraging the patient to continue talking. Both non-verbal and verbal elements of our attending behaviors are necessary to communicate and give evidence of listening. Think about the times when you have felt someone listened to you. were you aware of the specific behaviors they engaged in that communicated "attending" or "listening"? Can you recall a moment when you felt someone listened? Think about the non-verbal and verbal behavioral skills the good listener practices. Attending behaviors not only make us feel like we are being listened to, but they can be specifically defined, observed, learned, and practiced. Summary Attention and the accompanying constructs of attending behavior provide a comprehensive framework of skills for the beginning interviewer. Professionals of varying orientations and areas of expertise may be distinguished by the issues of content and feeling to which they attend and thus rein- force. In other words, all effective professionals use attending skills in relating to people, but professionals in different fields may "attend" to different feelings or content as their tasks and situations vary. As such, attend- ing behaviors do not suggest that one type of interviewing is more effective than another. Attending behaviors simply illustrate an important or essential denominator used in a variety of interviewing approaches. 164 Non-Verbal Attending Behaviors Good attending behavior demonstrates to patients that you respect them as persons and that you are interested in what they say. By utilizing attending behavior to enhance the patient's self-respect and to establish a secure atmos- phere, the dental hygienist facilitates free expression from the patient. Attending behavior can be used to moti- vate your patient. The following are two non-verbal types of activities which best characterize gqod attending behavior: 1. The dental hygienist should initiate and maintain eye contact with the patient. However, eye con- tact can be overdone. A varied use of eye contact is most effective, as staring fixedly or with undue intensity usually makes a patient uneasy. If you are going to listen to someone, look at them. 2. The dental hygienist should be physically relaxed with natural facial expression, posture, and movements--directly facing the other person. If you are comfortable, you are better able to listen to the person with whom you are talking. Also, if you are relaxed physically, your posture and movements will be natural, thus enhancing your own sense of well-being. This sense of comfortable- ness better enables you to attend to and to commu- nicate with the patient. Of equal importance is the necessity to directhrplace your body in a position that faces the other person. The rotation or placement of your body signals to another non-verbally that you are indeed "attending". Facial expression can be of especial importance to the dental hygienist. Throughout the patient's visit, his keen sense of awareness may make him doubly aware of your facial expressiveness. 165 Verbal Attending Behaviors The following descriptions illustrate two verbal types of activities that characterize good attending by focusing on the patient and structuring your comments to provide opportunities for the patient to be involved. 1. OPENING THE INTERVIEW WITH INVITATIONS TO TALK The initial task of the dental hygienist is to find out how the patient sees his situation. Most useful in deter- mining this is the technique of providing limited structure through the use of an open invitation to talk. An open invitation to talk may be best understood when compared with a closed approach to interviewing. For example, Open: Could you tell me how you care for your teeth? or How do you feel about using dental floss? Closed: Do you brush your teeth each morning? Do you have dental floss? It may be observed that the open comments provide room for the patient to express his real self without the imposed categories of the dental hygienist. An open comment allows the patient an opportunity to explore himself with the support of the hygienist. A closed invitation to talk, on the other hand, often emphasizes factual content as opposed to feelings, demonstrates a lack of interest in what the patient has to say, and frequently attacks or puts the pat— ient in his place. Closed questions can usualiy be answered with a_yes or no. Crucial to open-ended questions is the concept of who is to lead the interview; While the dental hygienist does ask questions while using this skill, the questions are centered around concerns of the patient rather than around concerns of the dental hygienist for the patient. Questions should be designed to help the patient clarify his own prob— lems, rather than provide information only for the dental hygienist. A typical problem with closed questions is that 166 the dental hygienist leads the patient to topics of interest to the hygienist alone. Too often a hygienist projects her own theoretical orientation onto the information she is trying to gather and imposes artificial structure too early. If the dental hygienist relies on closed questions to struct- ure her interview, she is often forced to concentrate so hard on thinking up the next question that she fails to lis- ten to and attend to the patient. Open invitations to talk are extremely useful in a number of different situations. The following are some examples: a. They heip begin an interview. How have things gone since the last time we talked together? Tell me how you care for your teeth? b. They help get the patient to elaborate on a point. Could you tell me more about that? How do you feel when you skip brushing? c. Theyuhelp elicit examples of specific behavior so that the dental hygienist is better able to understand what the patient is describing. Will you give me a specific example? Can you show me how you use a toothbrush? d. They help focus theupatient's attention on his feelings. What are you feeling as you're telling me this? How did you feel then? Go through the examples above again, study them carefully, write some possible closed-ended questions in each case above in the spaces on the attached sheets. Then change your closed questions to open questions. 167 In summary, the purpose of this verbal skill is to assist you in initiating an open invitation so that the patient can maximize his verbal involvement. In essence, a good invitation to talk allows the patient to gain a lot of mileage--not just a one word yes-no response. Basically there are two types of verbal responses the patient can give: (a) mileage responses, and (b) yes-no responses. So the good open invitation to talk on your part elicits more information from the patient. When you allow the patient the opportunity to respond with mileage responses and fewer yes-no types of answers, he becomes involved and feels that you are attending to him verbally. Here is another important way to distinguish the quality of the open invitation to talk that you offer. If you begin with the following words--is, are, was, were, does, did, has, and have--you usually ask for the patient to respond with simple "yes" and "no" answers. For example, all of the following questions can be answered with a "yes" or “no": Imagine how you would respond to each example. . Is there something with which I can help you? . was it painful? . Are you interested in returning in six months? . were you concerned with what the dentist might think? . Does that feel comfortable? . Did you call for an appointment? . Has it bothered you in the last week? . Have you determined where the tooth hurts? QOU‘I .82-unor- A better way to word the previous examples allows for the patient to respond in other than "yes-no" varieties. By beginning the open invitation differently--How, I wonder, What, When, Tell me, Where--the patient is asked to respond in a manner that permits a lot of information from his point of view. Consider the following possibilities and imagine the kind of response you would give to each example: . How can I help you? . I wonder how painful it was. . How interested are you in returning in six months? What concern did you have with your dentist's thoughts? How does that feel? Can you describe how that feels? When did you call for an appointment? Tell me, when was the last time it bothered you? Where does it hurt? (1)6an bWNI-fl 168 It seems obvious that whether the hygienist is aware of her invitation to talk or not, she can in fact limit or encourage the patient through the kind of invitation she offers. Too often we limit without knowing or realizing. Once mastered, once the dental hygienist can choose to use this skill, she can in fact verbally attend to the patient or if necessary limit the amount of information and involve- ment of the patient. The hygienist needs to master the verbal skill of offering open invitations to talk so that she can elicit mileage rather than "yes-no" responses from patients. 2. ENCOURAGING THE PATIENT TO CONTINUE TALKING Once the patient has been helped by the dental hygienist's attention and open-ended questions to begin telling his story, the dental hygienist's task is to facilitate his continuing to talk. The hygienist really needs to say very little in order to encourage a patient to continue talking, elaborating, and explaining. Simple "um-hmm's," repetitions of one or two words from what he just said, one-word questions, such as "Then?" are often sufficient. The word “minimal" refers both to how much the dental hygienist says, which can be very little, and to the amount of direction or intervention she imposes on the content and flow of the interview. This technique presupposes that the dental hygienist has tuned in to what the patient is discussing. Minimal encouragement to talk would follow directly from what the patient has just said. When used correctly, the patient, although maintaining control of the interview in that he is talking about what he wants to discuss, is forced to elabor- ate, explain, and to take .an in-depth look at his problem. Often the dental hygienist will want and need to talk more and to more actively direct or focus the content of what the patient is saying. Minimal response elicits more detail from the patient as comfortable communication con- tinues. Whether a minimal response follows an open question or a very specific question, this type of reply leads to a patient's continuing to talk. More examples of the type of comments described by the title "minimal encouragement to talk" are the following: a. "Oh?" "So?" "Then?" "And?" b. The repetition of one or two key words. 169 0. "Tell me more." d. "How did you feel about that?" e. "Give me an example." f. "What does that mean to you?" 9. "Umm—hummm." Too many dental hygienists are unaware of the power and importance of minimal encouragement. As such, they are un- aware of how they may unconsciously influence the direction of interviewing and instructing sessions. If a dental hygienist understands minimal encouragement responses there will be more exploration and self-awareness on the part of the patient. APPENDIX B BASIC MICROCOUNSELING MODEL APPENDIX B BASIC MICROCOUNSELING MODEL While many variations are possible, most research and methodology in microcounseling has been conducted in a situa- tion in which the trainee goes through the following pro- gressive steps: 1. The trainee receives instructions to enter a room where he will interview a client. Depending on the situation, the topic may or may not be defined. Similar instructions are given to the volunteer client, with the exception that he is told he is about to be interviewed. A five-minute diagnostic session (with the trainee interviewing the client) is then videotaped. The client leaves the room and completes an eval- uation form or may be interviewed by a second supervisor. These data are then available for the supervisory session with the trainee. The trainee reads a written manual describing the specific skill to be learned in this session. The supervisor talks with him about the session and about the manual. Video models of an expert demonstrating the specific skill are shown. There may be a positive and a negative model of the skill. The trainee is shown his initial interview and discusses this with his supervisor. He is asked to identify examples where he engaged in or failed to apply the specific skill in question. The supervisor and trainee review the skill together and plan for the next counseling session. The trainee reinterviews the same client for five minutes. 170 171 9. Feedback and evaluation on the final session are made available to the trainee. Many alternatives and additions to this basic framework are possible. Perhaps most important among them is the re- cycling of the entire process; here, the trainee at step nine simply repeats steps three through eight, thus obtaining extra practice and reinforcement of the skill in question. The nine-step training process, including two five-minute interviews, takes approximately one hour; recycling the process brings training to a two-hour period, a time which seems to be maximum for participation. If the skill is not learned at this point, trainees are asked to return for further sessions. (Ivey, 1971, pp. 6-7.) APPENDIX C ACTIVATION-DEACTIVATION ADJECTIVE CHECK LIST APPENDIX C MAJOR FACTORS OF THE ACTIVATION-DEACTIVATION ADJECTIVE CHECK LIST (AD-AOL) Thayer, Robert E. Measurement of activation through self- report. Psychological Reports, 1967, 20, 663-678. The following activation dimensions have been used in a number of studies. The adjectives are listed in the order of their loadings in the above factor-analytic study. General Activation High Activation lively clutched up active jittery full of pep stirred up energetic fearful peppy intense vigorous activated General Deactivation peactivation-gleep at rest sleepy still tired leisurely drowsy quiescent quiet calm placid Each adjective is scored on a 4-point scale (4 = definitely feel, through 1 = definitely do not feel). Factor scores re summations or means of adjective scores within the factor. While the shave groups of adjectives have been used in various studies, more or less adjectives could be used depending upon the demands of individual studies (see factor matrix, Pp. 666- 667; Thayer, 1967). 1 Scoring templates may be easily made from card- board sheets cut to the dimensions of the AD—ACL. After holes have been cut corresponding to the factor adjectives, the appropriate scores may be placed above the four response alternatives. 172 .173 Name Date and Time (Please include A.M. or P.M.) Each of the words on the next sheet describes feelings or mood. Please use the list to describe your feelings at this moment. If the word definitely describes how you feel at the moment you read it, circle the double check (//) to the right of the word. For example, if the word is, relaxed, and you are definitely fe ling relaxed at the moment, circle the double // as follows: relaxed / l ? no. This means you definitely feel relaxed at the moment. If the word only slightly applies to your elings at the moment, Circle the single check as follows: relaxed // ? no. This means you feel slightiy relaxed at the moment. If the word is not clear to you or you cannot decide whether or not it applies to your feelings at the moment, circle the question mark as follows: relaxed // / (2) no. This means you cannot decide whether you are relaxed or not. If you clearly decide the word does not apply to your feelings at the moment, circle the no as follows: relaxed // / ? This means you are definitely not relaxed at the moment. Work rapidly. Your first reaction is best. Work down the first column, then go on to the next. Please mark all words. This should take only a few minutes. -Now please turn the page and begin working- 174- definitely feel feel slightly cannot decide definitely do not feel J . 55570:: ; JJ J ? (5:) : carefree JJ J serious // / peppy J/ J pleased JJ J placid // J leisurely JJ J sleepy JJ J ? ? no ? no 7 no ? no no jittery JJ J ? no intense JJ J ? no grouchy JJ J ? no energetic JJ J ? no egotistic JJ J ? no calm JJ J ? no suspicious JJ J ? no tired JJ J ? no regretful JJ J ? no stirred—up JJ J ? no warm-hearted JJ J ? no vigorous JJ J ? no engaged-in-thought JJ J ? no at rest JJ J ? no elated JJ J ? no drowsy JJ J ? no witty JJ J ? no anxious JJ J ? no aroused JJ J ? no fearful JJ J ? no lively JJ J ? no still JJ J ? no self-centered JJ J ? no wide-awake JJ J ? no skeptical JJ J ? no activated JJ J ? no sad JJ J ? no full-of-pep JJ J ? no affectionate JJ J ? no quiet JJ J ? no concentrating JJ J ? no sluggish JJ { ? no overjoyed JJ J ? no quick (J J ? no nonchalant if J ? no quiescent ;. J ? no clutched-up .J J ? no wakeful JJ J ? no rebellious J. J ? no active JJ ; ? no blue JJ J ? no defiant JJ J ? no tense JJ J 2 no 175 June 18, 1973 Dr. Robert Thayer Department of Psychology California State University Long Beach, Calif. 90840 Dear Dr. Thayer: Thank you for your assistance with the Activation—Deactivation Adjective Check List. I have included the check list as a measure in my dissertation. My study is concerned with the effects of modeling and differentiated practice in the attain- ment and retention of interview skills. Of special interest to me were the activation properties of the practice treatments and possible changes in activation at different phases in the learning sequence. Two adminis- trations of the check list were included--one immediately following the five levels of practice treatment, and one following a delayed-post measure of interview performance. Scores tabulated for the high activation factor included the adjectives anxious and tense. Tabulations for the sleep factor were calculated in two ways: a three-item group (drowsy, sleepy. tired) and a six-item group (drowsy, sleepyo tired, sluggish, and wide-awake and wakeful, inversely scored). Both calculations of the sleep factor render the same significant results. In both cases there were differences in activation from practice treatment to the post measure of performance. There were no differences in activation for the different practice treatments. All treatments were designed to be as involving as possible. Could you give me your Opinion on reporting check list results. Is it preferable to use only three items for the sleep factor score, or would you suggest the six-item score? Are there any new factor studies that provide additional information? If information regarding anxious and tense adjectives in the high activation factor are available, I would very much like to have any new findings or references. Looking forward to hearing from you. Sincerely, Nancy Tyler enclosure nt CALIFORNIA STATE UNIVERSITY LONG BEACH June 29, 1973 Ms. Nancy A. Tyler 5265 "aole Brook Lane Flint. Michigan 48016 Dear "5. Tyler: I believe I sent you a cooy of Apoendix 8 (Factor Analytic Studies) of the NIHH Terminal Project Report; if not let me know. and I will send it. Thounh other adjectives sometimes load on D-S in various analyses. sleepv. tired, and drowsv invariably appear. Therefore. I would stick with those three. I am currently reanalyzino data from an AD ACL containino tense and anxious. and I will send you the results when they become available. Sincerely. 5.5:: TC: A Associate Professor, Psycholoqv .im LONG BEACH CALIFORNIA 90840 THE CALIFORNIA STATE UNIVERSITY AND COLLEGES 176 APPENDIX D VISUAL AIDS APPENDIX D VISUAL AIDS Used In Model Videotape And Teach Another Practice NON-VERBAL BEHAVIORS 1. Eye Contact —- Consistent 2. Physically Relaxed Posture 3. Natural Facial Expression 4. Directly Face The Other Person 1 VERBAL BEHAVIORS 1. Opening The Interview And Invitations To Talk 2. Encouraging The Patient To Continue Talking 2 INVITATIONS To TALK ‘ Open Vs. Closed Questions Open 1.Person Is Important l.Facts & Details Are 2.Patient Has Chance Important To Tell About Self 2.Patient Has No Chance 3.Emphasizes Feelings To Explore Self 4.Demonstrates Interest 3.Emphasizes Facts In Patients 4.0ften Puts Patient In His Place--Or Rejects Patient 3 177 178 USE INVITATIONS TO TALK ~— To Begin The Interview To Obtain Examples of Behavior To Get The Patient To Elaborate To Focus on Feelings tthH .0. DISTINGUISH THE QUALITY OF THE INVITATION TO TALK Obtain Mileage Responses Vs. Yes/No Responses Begin with: Avoid: How.. Where.. 13.. Does.. What.. I Wonder.. Are.. Did.. When.. Tell Me.. Was.. Has.. Were.. Have.. 5 a. b. c. d. e. f. g. MINIMAL ENCOURAGEMENT TO TALK Examples: ”oh? II II so?" ll Then? II II And? II The repetition of one or two key words. "Tell me more." "How do you feel about that?" "Give me an example." "What does that mean to you?" "Umm-hmmm." APPENDIX E MODEL VIDEOTAPE CONTENT Approximate w NNNN NI-‘NUJN N LUI-‘NI—‘NNM N bl—‘UN Time minutes minutes minutes minutes minute minutes minute minutes minutes minutes minutes minutes minute minutes minutes minutes minutes minutes minutes minutes minutes minute minutes APPENDIX E MODEL VIDEOTAPE CONTENT Description of Content Introduction by Director & Staff of Dental Hygiene Program Background Information on Attending Behaviors Identification of Non-verbal Interview Skills Good & Poor Examples of Eye Contact, l min. each Emphasize & Explain other non-verbal skills Good & Poor Examples of other non-verbal skills Review of All Non-verbal interview skills Additional Good Models of all non-verbal Interview Skills (combined example) Introduction of Verbal Interview Skills (ITT and ECT) Open & Closed characteristics of ITT Six 30-second examples of good & poor ITT's Review of ITT's Situations (4) where ITT's can be used Four 30-second examples of situations using good ITT's Two one-minute examples of ITT's Two minutes of summary examples(ITT's) Review & Summary of ITT as verbal skill Faculty discussion of quality of ITT's Presentation of Encouragements as the second initial verbal interview skill Two 1-minute model examples of ECT's Three l-minute good examples of ECT's Review of ECT as a verbal skill Summary Review of all the Initial Non-verbal and Verbal Initial Interview Skills 179 APPENDIX F INSTRUCTIONS FOR ASSISTANTS MODEL, PRACTICE, AND VIDEO MONITOR TECHNICIAN APPENDIX F INTERVIEW’SKILLS TRAINING PROGRAM Instructions for Model Tape Assistant General Instructions 1. Greet the 5s as they arrive to view the model film. 2. Check the name of the 5.0n the list provided as the .5 reports. 3. Ask the 5 to take a seat in the room. Materials 1. Master Schedule List for Model tape. 2. Pencil. Other Instructions IFUJNI" e e 0 Arrive early. See that there are twenty chairs available. Check that the room arrangement is adequate. Check operation of videotape monitor. See that both monitors are ready: load the videotape on the recorder unit so that it is ready to play. 180 181 INTERVIEW SKILLS TRAINING PROGRAM Instructions for Practice Assistant General Instructions 1. 2. Greet the 5s as they arrive for their practice session. Check the name of the 5.0n the list provided. Note type of practice. Give the prOper practice envelOpe,as directed on master list, to each 5, Provide 5 with pencils. Direct the 5 to their practice room. Tell the 5 they are to turn in materials envelope to you at the end of their practice session. Materials mqmmIkUNH e e s 0 Master Practice Schedule List Envelopes Videotapes Pencils Stopwatches Posters TV Monitors Tape Cassette Sets and players Other Instructions 1. 2. In time between practice sessions, prepare the next set of materials so that you will be prepared for the 5s arriving. Double check to see that appropriate videotape copies are included in each 5s envelOpe as the master list code requires. StOpwatches, posters, TV monitors, and tape cassette players will be stationed in the practice rooms and remain there during all practice sessions. YOu will check the tape cassette sets out to 5s assigned to Practice 5 on your master list. 182 INTERVIEW SKILLS TRAINING PROGRAM instructions for Practice Video Monitor Technician Assist in setting up TV monitors in each of the appropriate practice rooms. Check to see that the set is operational and positioned for viewing. During the discrimination practice sessions be available as assigned to operate the monitor, rewind the tape, and correct any mechanical difficulties if they occur. You are not to speak to the 5, Simply operate the equip- ment as the 5_directs when she is ready to view the tape. APPENDIX G ANNOUNCEMENT TO CLASS OF TRAINEES APPENDIX G ANNOUNCEMENT TO CLASS OF TRAINEES YOu are about to be introduced to a basic skill training program that is considered to be important in your work with patients. A variety of instruction and practice experiences will be planned in this learning sequence. All activities should result in your being more confident and successful in communicating with your patients in the clinic. Mastery of the skills presented in training should also result in your being able to elicit better cooperation and motivation from the patient you are working with in the clinic. During this series of learning activities we will be conducting a research study to determine how instruction can be made more effective. All information will be coded for research and, therefore, will be confidential. The results will in no way effect your grade, but will be helpful in determining more efficient means of training dental hygienists in the people-relating skills needed in their day-to-day work with patients. An important element of this training experience will be the use of television in instruction. For this reason we want you to be familiar with the equipment and the way in which the equipment is set up. ‘We want you to be as comfor- table with the presence of the TV equipment as you are with the dental chair and tools that you use--regard it as an important learning tool that will be useful to you. When you conduct an interview with your patient as you usually do, we want you to continue to work, basically ignoring the use of the TV camera and recorder. In summary, your best efforts will assist in helping you learn skills applicable to your clinic patient relationships and also provide information on more efficient and effective means of instructing dental hygienists. Next week, starting Monday, we will begin the Interview Skills Training Program. Each of you will have an individual- ized schedule noting (a) your code number for research purposes, and (b) the days, times, and room numbers for the activities scheduled. If there is any difficulty that arises, please leave a message with Mrs. Brooks at the clinic. She also has your schedule if you need to consult with her. 183 184 Please arrive at the clinic and be ready to check in at Room 416 approximately five minutes ahead of the appoint— ment time. The assistants there will be expecting you. APPENDIX H SUBJECT ASSIGNMENT FORMS APPENDIX H SUBJECT ASSIGNMENT FORMS Code # Day Room Time Activity Name Monday 9—10a.m. (Tue.or Clinic Week 1 Schedule: Thurs.) 416 TV March 26-30 C.C. Friday 1 11-12a.m. Code # Day Room Time Activity (Tue.or Practice Name Thurs.) Clinic (50 min.) Clinic Following Week 2 Schedule: same 416 pgactice TV April 2-6 Reminder: Please be prompt. Your practice must start on time so that you are finished before the next person arrives. Check in with the assistant in the hall by Room 416 to pick up practice materials. Then go to your scheduled practice room. 185 APPENDIX I GENERAL INSTRUCTIONS FOR PRACTICE SESSIONS APPENDIX I GENERAL INSTRUCTIONS FOR PRACTICE SESSIONS General Instructions: The following 50-minute practice period contains activities designed to assist in the mastery in each 1. of interview skills. Put forth your best effort practice activity. Everything needed for your practice session is provided in the envelope and practice room. Go to the practice room for which you have been scheduled. Open your materials envelope and begin your practice. Carefully follow the instructions outlined in the materials. When you have finished your practice, place everything you received back in the materials envelope and return the envelope to the assistant waiting in the hall (across from room 416). 186 APPENDIX J DISCRIMINATION PRACTICE WRITTEN MATERIALS APPENDIX J DISCRIMINATION PRACTICE This practice session is designed to help you discrim- inate both verbal and non-verbal interview skills as observed on TV. Before you can master interview skills you must first be able to discriminate what you see or observe. Discrimin- ation practice helps observers (a) become more keenly aware of the presence of a particular skill: (b) focus on the degree to which a skill is present. Again, the two ways to discriminate are (a) to become aware of whether or not the interviewing behavior of interest can be observed; (b) to note the degree to which the interviewing behavior exists. This discrimination practice will give experience in applying these two criteria. Discrimination means to make a distinction, to separate one from another, to distinguish, or to differentiate. In learning new skills it is important to separate, choose, and distinguish. Every day with many activities we discriminate and make distinctions. we taste different foods and notice if they are sweet or sour. we look outside and can tell if it is light or dark, day or night. Some discriminations are so obvious to us that we don't stop to think that we are applying a discrimination skill when we note differences. 187 188 Other discriminations are more complex or more difficult. Think about the discriminations we make with color. we know different colors, we learn to label them. From simple yellow, red, blue, and green, the automobile advertiser makes us more aware of sunburst yellow, fire-engine red, powder blue, and British racing green. Various shades and distinctions of color are usually learned. However, some of us who are color blind may be unable to make some discriminations. Although physiological and inherited characteristics may limit some discriminations for a few, most discriminating ability is the result of our learning and our practice. Think about some of the discriminations you have prob- ably practiced since you enrolled in the dental hygiene pro- gram. The color of gums, stains on teeth, the shape and size of teeth are important in making some of the distinc- tions necessary in dentistry. Perhaps, we could think of many of these learned distinctions as non-verbal discrimin- ations. We can observe and discriminate or separate just by what we notice. Although the discrimination may be more complex, we often judge non-verbal looks and decide if a man may be interested in us or not. we learn to read facial expressions and tone of voice to complement what we observe so that we can better discriminate. Perhaps, with your parents or close friends, with husbands, we become better discriminators of what they mean. Sometimes we have learned it is just as 189 important to know what peOple say as well as what they don't say. Have you had the experience of having a report passed on to you second hand, and asked, "But, how did she say it?"-- an effort on your part to discriminate the more accurate meaning of words. we all have experience in making complex discriminations. Most of this experience is learned over years of practice. It may be important to emphasize that we all have learned to make discriminations. Some are simple: some are complex. Through practice we increase our skill in making discriminations and often this leads us to the mastery of the skill involved. Therefore, this practice session will focus on discriminations we can practice in noting interview skills. HOpefully, this will provide an excellent means of mastering interview skills. 190 Code PRACTICE INSTRUCTIONS CHECKLIST Follow instructions carefully. Each instruction is outlined step by step. Read the instruction. Read instructions again as necessary. When you have completed a step, check (v) it in the blank provided. Continue to the next instruction. Times are indicated for each step. There should be ample time. The approximate times provided are guides so that you will be able to complete the practice session on schedule. For your own use, make any notes on the practice instructions checklist that may be helpful to you. Approximate Checki/ Step Instructions Time Guide When Complete 3 min. 1.0 First read the remainder of this practice instructions checklist. 1.1 Your practice involves discrimin- ation activities--practice in discriminating whether interview skills are being used or not. 1.2 Look over all the materials in your envelope. Scan them so that you can obtain an idea of what needs to be completed during your practice session. v- 3 min. I 2.0 Read the paper on Discrimination Practice. 20 min. I 3.0 Scan the Discrimination Practice Rating Form. 3.1 The tape should be set for you on the TV playback unit. Signal the assistant when you are ready to begin. Tell the assistant when you want to stop the tape. .wu.wt-an * 3.2 Observe the TV tape so that you can rate each example of interview skill performance. Code 191 Practice instructions checklist, p. 2. Approximate Checkv’ Step Instructions Time Guide When Complete 3.3 At the end of Example 6, the 16 min. 4 min. v-- 0s *p on. I c -- ”on--- ~0~ us“. A 1 3.4 assistant will rewind the tape to the beginning. Rate the first examples again as indicated on your rating form. Now, rate the verbal skills. These discriminations involve open and closed invitations to talk. These are short examples--watch carefully. Continue to Part D. where you discriminate and tally: (a) the number of invitations to talk, (b) decide whether they are Open or closed as you tally, (c) count the number of minimal encouragements used to con- tinue the patient talking, (d) tally the number of other comments made by the interviewer. Rewind the tape so that it will be ready for the next viewer. 0...... A- Summarize in your own words the strengths and weaknesses you obser- ved as you watched the interviewers. 4 min. 3"." Complete the adjective check list provided. Follow directions on the check list to describe your feeling or mood. Place all materials used during the practice session back in the envelope. Go turn in all materials to the assistant waiting in the hall at Room 416. 192 Code SUMMARIZE YOUR GENERAL IMPRESSIONS OF THIS PRACTICE SESSION: Code General Instructions: presented on the TV monitor. 193 DISCRIMINATION RATINGS Observe each example of behavior After you have observed the example, turn the video recorder off and make your discrim- inations. After making your notes and ratings, recorder and watch the next example. Section I. Part A. Example 1: Example 2: Example 3: Part B. Example 4: Example 5: Non-verbal Interview Skills. Simply note if each interview skill is or not. write in "yes" or "no.“ a. b. c. d. Eye contact Physically relaxed posture Natural facial expression Directly facing the other person Simply note if each interview skill is or not. Write in "yes" or "no." a. b. c. d. Eye contact Physically relaxed posture Natural facial expression Directly facing the other person Simply note if each interview skill is or not. Write in "yes" or "no." a. b. c. d. Eye contact Physically relaxed posture Natural facial expression Directly facing the other person Simply note if each interview skill is or a. b. c. d. not. Write in "yes" or "no." Eye contact Physically relaxed posture Natural facial expression Directly facing the other person Simply note if each interview skill is or not. Write in "yes" or "no." a. b. c. d. Eye contact Physically relaxed posture Natural facial expression Directly facing the other person turn on the present present present present present 194 Code Discrimination Ratings, p. 2 Example 6: Simply note if each interview skill is present or not. Write in "yes" or "no." a. Eye contact b. Physically relaxed posture c. Natural facial expression d. Directly facing the other person Section II. Non-verbal Interview Skills Example 1: Circle the appropriate number describing the interviewer's eye contact. In your own words tell why you made this discrimination. very good Reason for eye contact rating: good fair poor very poor I-‘NWIFUI II II II II II Example 2: Circle the appropriate number describing the interviewer's eye contact. In your own words tell why you made this discrimination. very good Reason for eye contact rating: good fair poor very poor l-‘Nw-FU'I II II II II II Example 3: Circle the apprOpriate number describing the interviewer's eye contact. Tell why you made this discrimination. 5 = very good Reason for eye contact rating: 4 = good 3 = fair 2 = poor 1 = very poor Example 4: Circle the apprOpriate number describing the interviewer's physical posture, natural gestures, and facial expression. State the reason for your rating in your own words. very good Reason for rating: good fair poor very poor HNUIbU'I II II II II II Code Example Example Section Part C. Example Example Example Example Example Example 5: 6: III. 13: 14: 15. 16. 17: 18: 195 Discrimination Ratings, p. 3 Circle the appropriate number describing the interviewer's physical posture, natural gestures, and facial expression. State the reason for your rating in your own words. I-‘Nw-hUl very good good fair poor very poor Reason for rating: Circle the apprOpriate number describing the interviewer's physical posture, natural gestures, and facial expression. State the reason for your rating in your own words. I-‘Nthl very good good fair poor Reason for rating: very poor Verbal Interview Skills Rate Open Rate open Rate Open Rate open Rate Open Rate open the interviewer's invitation to talk or closed. Open Closed the interviewer's invitation to talk or closed. Open Closed the interviewer's invitation to talk or closed. Open Closed the interviewer's invitation to talk or closed. Open Closed the interviewer's invitation to talk or closed. Open Closed the interviewer's invitation to talk or closed. . Open Closed as as as as as as Code Part D. Example 19: Example 20: Example 21: Example 22: Example 23: 196 Discrimination Ratings, p. 4 Rate the invitation to talk as Open or closed. If more than one invitation is offered, place a tally mark in the box to illustrate. (For 1 Open invitation and one closed invitation, the tally would look like this... Open['7______1 Closed Open Closed Tally every invitation as open or closed. Open Closed 1 —] Tally in the boxes provided the number of open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Open ‘ Closed Number of invitations I Number of minimal encouragements Tally in the boxes provided the number of open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Open Closed Number of invitations [ Number of minimal encouragement Other comments Tally in the boxes provided the number of open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Open 5 Closed Number of invitations L I Number of minimal [7 encouragements Other comments Code Example 24: Example 25: Example 26: 197 Discrimination Ratings, p. 5 Tally in the boxes provided the number of open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Number of invitations Number of minimal encouragements Other comments rgpen I Closed Tally in the boxes provided the number of Open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Number of invitations Number of minimal encouragements Other comments Open Closed I Tally in the boxes provided the number of Open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Number of invitations Number of minimal encouragements Other comments Open Closed F APPENDIX K FEEDBACK AND SUPERVISOR PRACTICE WRITTEN MATERIALS APPENDIX K FEEDBACK AND SUPERVISOR PRACTICE‘WRITTEN MATERIALS Code PRACTICE INSTRUCTIONS CHECKLIST Follow instructions carefully. Each instruction is outlined step by step. Read the instruction. Read instructions again as necessary. When you have completed a step, check (V) it in the blank provided. Continue to the next instructions. Times are indicated for each step. There should be ample time. The approximate times provided are guides so that you will be able to complete the practice session on schedule. For your own use, make any notes on the practice instructions checklist that may be helpful to you. Approximate Cheeky! Step Instructions Time Guide When Complete 2 minutes 1.0 First read through the remainder of the practice instructions checklist. 1.1 Look over all the materials in your envelope. Scan them so that you can obtain an idea of what needs to be completed during your practice session. 1.2 Then, organize the written materials from the envelOpe so that you are ready to use them as needed. 2 minutes 2.0 YOur practice session involves: a. observing your performance from your first interview. b. analyzing and discussing what you would like to change in your next interview. 0. receiving comments and sug- gestions from a dental supervisor. 198 199 w “~WOCM'~QIN§.- Code Practice Instructions Checklist, p. 2. Approximate Check\/ Step Instructions Time Guide When Complete d. reviewing the suggestions and comments so that you are prepared for your next interview. 2.1 Supervisor places the videotape 2.3 on the TV playback unit so that it is ready to be viewed. Hygienist reads through the in- structions for viewing so that she knows how to keep the log and what the procedure will be for viewing. Make sure that you can view the monitor well. Keep your log sheet available so you can make notes comfortably when you step for this purpose. Relax. A“... 16 minutes 3.0 A Refer to Instructions for Viewing. Complete the first observation as outlined on the Instructions for Viewing. Both hygienist and sup- ervisor should have Viewing Log forms ready. The supervisor should use the step watch to divide ob- serving times into segments. _a 16 minutes I __ "-’ -~- Refer to Instructions for Viewing. Complete the second observation as outlined on the Instructions for Viewing. 10 minutes w :‘w— .~ ~5...‘ Refer to Instructions for Viewing. Complete the third observation as outlined on the Instructions for Viewing. Code 200 Practice Instructions Checklist, p. 3. Approximate Check J Time Guide When Complete Step Instructions 1 minute ‘~‘~| “ Supervisor discusses the importance of using skills in the interview. REMEMBER THE INTERVIEW SKILLS YOU ‘WISH TO CHANGE AND CONTINUE USING CAN BE PRACTICED IN EVERY INTER- VIEW IN THE CLINIC. 3 minutes 7.0 *‘w‘ “Me--1 e. . .- .- ..- Hygienist completes the adjective check list provided. Follow directions on the check list to describe your feeling or mood. Supervisor rewinds tape while hygienist finishes checklist. All materials used during the practice session are returned to the envelope. . - -‘—oo-.-‘ .1F Go turn in all materials to the assistant waiting in the hall at Room 416. a- A”... ~ - -.— 201 Code INSTRUCTIONS FOR VIEWING I. FIRST OBSERVATION. Supervisor times the segments. 16 min. Time Activipy 2 min...Observe tape for two minutes. 1 min...Make notes in Viewing Log. 2 min...Discuss behaviors hygienist wants to change. Identify better means of using interview skills. 2 min...Observe tape for two minutes. 1 min...Make notes in Viewing Log. 2 min...Discuss behaviors hygienist wants to change. Identify better means of using interview skills. 3 min...Observe last segment of performance for 3 minutes. 1 min...Make notes in Viewing Log. 2 min...Discuss behaviors hygienist wants to change. Identify better means of using interview skills. Rewind tape during this discussion. II. SECOND OBSERVATION. Supervisor times the segments. 16 min. Time Activity min...Observe tape for two minutes. min...Make notes in Viewing Log. min...Discuss behaviors the supervisor presents. Identify better means of using interview skills. min...Observe tape for two minutes. min...Make notes in Viewing Log. min...Discuss behaviors the supervisor presents. Identify better means of using interview skills. min...Observe tape for three minutes. min...Make notes in Viewing Log. min...Discuss behaviors the supervisor presents. Identify better means of using interview skills. Rewind tape during this discussion. NI—‘N NI—‘w NI—‘N III. THIRD OBSERVATION. Hygienist reviews supervisor's feed- back. 10 min. min...Observe tape for two minutes. min...Hygienist gives verbal report of feedback. Supervisor keeps log. min...Observe tape for two minutes. min...Hygienist gives verbal report of feedback. Supervisor keeps log. min...Observe tape for three minutes. min...Hygienist gives verbal report of feedback. Supervisor keeps log. l—‘N PM) PM 202 Code Person (Hygienist or Supervisor) VIEWING LOG write in the interview behaviors identified. I. First Observation. After viewing each segment, the hygienist should identify or describe ppp_behavior in each segment she would like to change. I.A.First (2-minute) segment: I.B.Second (2-minute) segment: I.C.Third (3-minute) segment: II. Second Observation. After viewing each segment, the supervisor will identify appropriate and positive inter- view skills and give evaluative feedback to the hygienist. II.A.First (2 minute) segment: II.B.Second (2-minute) segment: II.C.Third (3 minute) segment: III. Third Observation. After viewing each segment the hygienist will identify to the supervisor the behaviors previously noted by the supervisor in the second obser- vation. The hygienist can report these verbally: she does not refer to the log. The supervisor will have the log available for this observation. III.A.First (2-minute) segment: III.B.Second (2-minute) segment: III.C.Third (3-minute) segment: APPENDIX L TEACH ANOTHER PRACTICE WRITTEN MATERIALS APPENDIX L TEACH ANOTHER PRACTICE WRITTEN MATERIALS Code PRACTICE INSTRUCTIONS CHECKLIST Follow instructions carefully. Each instruction is outlined step by step. Read the instruction. Read instructions again as necessary. When you have completed a step, check (J) it in the blank provided. Continue to the next instruction. Times are indicated for each step. Use the time allowed for each step. The times provided are guides so that you will be able to complete the practice session on schedule. A stop watch is available to assist in timing. For your own use, make any notes on the practice instructions checklist that may be helpful to you. Approximate Check\/ Step Instructions Time Guide When Complete 3 minutes 1.0 First read the remainder of this Practice Instruction Checklist. 1.1 Look over all the materials in your envelope. Scan them so that you can obtain an idea of what needs to be completed during your practice session. 1.2 Check the set of posters provided in your practice room. You may use these as an outline in any manner that helps you explain the interview’skills. 1.3 Now, organize the materials so that you are ready to use them as needed. 1 minute 2.0 Your practice session involves: a. individualized tutoring. 203 Code Approximate Time Guide 204 Practice instructions checklist, p. 2. CheckJ Step When Complete Instructions 1 minute 2.0 2.1 continued: b. explaining the interview skills to another individual. c. demonstrating the interview skills to another individual. d. answering any questions that are asked by the individual you are training. e. assisting in every way you can so that the other indi- vidual can identify, label, and use the interview skills. Your practice session follows a well understood principle--"If you wish to learn something, to master it, teach it to someone else." Being actively involved in teaching another these interview skills should help you master them. Keep this in mind as you practice. Refer to the Teaching Guide. Use the posters and summary guides as it suggests. Check off each activ- ity on the Teaching Guide. Study the guide before you begin. 41 minutes 3.0 - v Turn to the Teaching Guide and complete each activity. 4 minutes 4.1 Give your trainee the test to com- plete. This will help you judge how well she mastered what you were teaching. Put the posters back in order in the corner of the room so that they will be ready for the next practice session. Fill in the adjective check list. Describe your feeling or mood as directed. Put all written materials in your envelope. Code 205 Practice instructions checklist, p. 3. 5.0 Go turn in all materials to the assistant waiting in the hall at Room 416. 206 Code 41 minutes TEACHING GUIDE Step 3.0 2 minutes I. INTRODUCTION. (Refer to Summary Guide 1) Time Activity 2 min......Exp1ain the idea or concept of attending behavior. Ask the trainee to tell you what the idea means in her own words. Explain to the trainee that the interview skills she is about to learn are specific examples of attending behaviors. Explain that some skills are verbal and some are non-verbal. 10 minutes II. TEACHING NON-VERBAL INTERVIEW SKILLS (Use Poster 1) Time Activipy l min......Present the four non-verbal skills to the trainee. Explain the importance of skill l--eye contact. 1 min......Demonstrate poor, then good examples of eye contact. 1 min......Ask the trainee to be an interviewer and demonstrate that she can use good eye contact. 1 min......Explain the importance of skill 2 and 3-- physically relaxed posture and natural facial expression. min......Demonstrate poor, then good examples of posture and facial expression. min......Explain the importance of skill 4--directly facing the other person. min......Demonstrate poor, then good examples of directly facing the other during interviewing. min......Ask the trainee to be the interviewer and demon- strate 555 the non-verbal skills. 2 min......Check to see if the trainee has any questions. Name the 4 skills again for the trainee. Ask the trainee to identify each of the 4 skills from memory. Repeat. PI r- I6 P‘ 20 minutes III. TEACHING INVITATIONS TO TALK (Use Posters 2,3,4,5: Summary 2, and 3.) Time Activity 7 min......l min...Introduce both verbal skills. (Poster 2) Explain and stress the importance of invitations to talk in finding out how the person being interviewed sees his situation. 207 Code Teaching guide, p. 2. 20 minutes III. TEACHING INVITATIONS TO TALK, continued. Time Activity 1 min...Tell the trainee how the characteristics of an invitation to talk are different. (Poster 3) The trainee needs to under- stand the effect of an open vs. closed invitation so she knows yhy’this skill is important. 3 min...Read each example invitation provided on the written guide. (Refer to Summary 2) Have the trainee respond to each example. Discuss. 2 min...Using the tOpic of college classes, demon- strate how to use Open invitations to talk to enable the trainee to tell you about her college classes. 13 min.....2 min...Discuss the use of open invitations after your demonstration interview. Re-emphasize Poster 3. 1 min...Exp1ain and tell about the variety of situations where the use of an invitation to talk is appropriate. (Poster 4) 2 min...Illustrate the situations by presenting the examples in Summary Guide 3. Have the trainee respond to each example and then discuss the example. 1 min...Exp1ain how we can distinguish the quality of an invitation to talk. (Poster 5) 5 min...Ask the trainee to be the interviewer and make up three examples that illustrate invitations to talk that probably would elicit yes-no responses. As the trainee gives an example, respond to the example as if you were the person being interviewed. Ask the trainee to give three examples that illustrate invitations to talk that probably would elicit mileage responses. Respond to each example as if you were the person being interviewed. 2 min...Check to see if the trainee has any quest- ions about using invitations to talk. Ask the trainee to summarize this skill in her own words. 208 Code Teaching guide, p. 3. 5 minutes IV. TEACHING MINIMAL ENCOURAGEMENTS TO TALK (Use Poster 6) Time Activity 1 min.....Present the second verbal skill--minimal encourage- ments to talk. Be sure to point out how this follows and is based on a good invitation to talk. 2 min.....Demonstrate the use of minimal encourages by initiating an interview on the topic of what college courses or employment the trainee plans for next fall. 2 min.....Discuss your interview. Label for the trainee the kinds of minimal encouragements to talk that you used. Review the poster for other examples. Junk .—i _ _L‘ ‘— 4 minutes V. REVIEW (Use all posters) 2 min.....Review all the posters as a summary of the skills you presented. Ask the trainee if there are any questions. Thank the trainee for her involvement in the practice session. 2 min.....Have the trainee review the interview skills in her own words. Go back to Step 4.0 on the Practice Instructions Checklist. 209 SUMMARY GUIDE 1 ATTENDING BEHAVIORS An important aspect of establishing a relationship is being aware of, and responsive to, the communications of that individual and communicating this attentiveness. The communication of attentiveness is a potent reinforcer in your interaction with a patient. Attention plays an essential role in establishing a relationship and in motivating your patient. Individuals give attention to one another by a variety of means. Attending behaviors can be both non-verbal and verbal. In essence, attending behaviors can be defined as simple listening. When you communicate attentiveness to a patient, they might describe the experience as--"She really listens to what I say...She seems to be interested in me." When you attend to another, your verbal and non-verbal be- haviors consistently communicate very clearly that you are listening. Think about the times when you have felt someone lis- tened to you. Were you aware of the specific behaviors they engaged in that communicated "attending" or "listening"? Can you recall a moment when you felt someone listened? Attending behaviors not only make us feel like we are being listened to, but they can be specifically defined, observed, learned, and practiced. 210 Attention and the accompanying constructs of attending behavior provide a comprehensive framework of skills for the beginning interviewer. All effective professionals use attending skills in relating to people, but professionals in different fields may "attend" to different feelings or con- tent as their tasks and situations vary. 211 SUMMARY GUIDE 2 INVITATIONS TO TALK Read each example of an invitation to talk, and have the interview trainee respond to each one. The following invitations to talk can probably be responded to with a "yes" or "no"--usually this is the kind of response they might obtain. Have the trainee imagine they are a patient and respond to the following: . Is there something with which I can help you? was it painful? Are you interested in returning in six months? were you concerned with what the dentist might think? Does that feel comfortable? Did you call for an appointment? Has it bothered you in the last week? Have you determined where the tooth hurts? memo: IbUNI-l A better way to word the previous examples allows for the person to respond in other than "yes-no" varieties. By beginning the open invitation with different words, the patient is asked to respond in a manner that permits a lot of information to be obtained. Have the trainee consider the following possibilities and imagine the kind of response a patient would give. Have the interview trainee answer the following questions. . How can I help you? . I wonder how painful it was. How interested are you in returning in six months? . What concern did you have with your dentist's thoughts? huNH 212 5. How does that feel? Can you describe how that feels? 6. When did you call for an appointment? 7. Tell me, when was the last time it bothered you? 8. Where does it hurt? Discuss the responses obtained with each set of invitations. 213 SUMMARY GUIDE 3 INVITATIONS TO TALK ARE USEFUL IN DIFFERENT SITUATIONS Open invitations to talk are extremely useful in a number of different situations. The following are some examples. Try them out. 1. To begin an interview. How have things gone since the last time we talked together? Tell me how you care for your teeth. 2. ‘To get theupatient to elabogate on a ppint. Could you tell me more about that? How do you feel when you skip brushing? 3. To elicit examples of specific behavior. Will you give me a specific example? Can you show me how you use a toothbrush? 4. To focus attentign on feelings. What are you feeling as you're telling me this? How did you feel then? 214 Code INTERVIEW SKILLS INFORMATION TEST Instructions for the trainee: You have just received individualized instruction in interview skills. Please complete the following items. 1. There were two different kinds of skills you learned-- and interview skills. 2. Give examples of non-verbal interview skills: 3. Why is it desirable to use an Open invitation to talk? 4. Please make up one example of an Open invitation to talk. 5. When do you use a minimal encouragement to talk. 6. Give two examples of minimal encouragements to talk. 7. What was the most meaningful thing you learned about interview skills? 8. Do you think you could try out these interview skills based on what you learned in this last hour? APPENDIX M COMBINATION PRACTICE WRITTEN MATERIALS APPENDIX.M COMBINATION PRACTICE WRITTEN MATERIALS Code PRACTICE INSTRUCTIONS CHECKLIST Follow instructions carefullyg, Each instruction is outlined step by step. Read the instruction. Read instructions again as necessary. When you have completed a step, check (J) it in the blank provided. Continue to the next instruction. Times are indicated for each step. There should be ample time. The approximate times provided are guides so that you will be able to complete the practice session on schedule. For your own use, make any notes on the practice instructions checklist that may be helpful to you. Approximate Check~/ Step instructions Time Guide When Complete 3 minutes 1.0 First read the remainder of this practice instructions checklist. 1.1 Your practice session involves a combination of the following activities: (a) Practice in discriminating whether interview skills are being used or not. (b) Observing your performance from your first interview. Analyzing and discussing what you would like to change in your next interview. Receiving comments and sug- gestions from a dental supervisor. Reviewing the suggestions and comments so that you are prepared for your next inter- view. 215 216 Code Practice instructions checklist, p. 2. Approximate Checkvv Step gnstructions Time Guide When Complete 1.1 continued: (c) Individualized tutoring. Explaining the interview skills to another individual. Demonstrating the interview skills to another individual. Answering any questions that are asked by the individual that you are training. Assisting in every way you can so that the other individual can identify, label, and use the interview skills. 1.2 Scan the materials you have in your envelope. Everything you need should be available in the envelOpe and the practice room. (a) Discrimination practice in- volves written materials and a TV tape. (b) A TV tape and log forms are provided so that you can observe your performance and make notes. When you are ready for this activity a supervisor will be waiting at the practice room door to assist you. (c) Teaching another practice follows a well understood principle--"If you wish to learn something, to master it, teach it to someone else." Being actively involved in teaching another these inter- view skills should help you master them. Keep this in mind as you practice. 217 Code Practice instructions checklist, p. 3. Approximate Check“ Step Time Guide When Complete instructions 1.2 continued: (c) A trainee will be waiting at the door when you are ready for this activity. Posters are available in the practice room. Check them now: they should assist you in the instructing session. 13 minutes 2.3 Read the written materials regarding discrimination skill practice. Using the discrimination practice rating form watch the examples on the TV monitor and make your ratings. After the last example, rewind the tape. Go to the door and meet your super- visor. 16 minutes 3.0 Refer to the Instructions for View- ing form. Use it as your checklist for this activity. 14 minutes Refer to the Teacher's Guide. Use it as your checklist for this activity. _A—k 4 minutes 5.0 5.1 5.2 Put the posters back in order in the corner of the room so that they will be ready for the next practice session. Fill in the adjective check list. Describe your feeling or mood as directed. Put all materials in your envelope. 45:0 urn in a ma eria s o e assistant waiting in the hall at Room 416. 218 Code DISCRIMINATION PRACTICE This practice session is designed to help you discrim- inate both verbal and non-verbal interview skills as observed on TV. Before you can master interview skills you must first be able to discriminate what you see or observe. Discrim- ination practice helps observers (a) become more keenly aware of the presence of a particular skill; (b) focus on the degree to which a skill is present. Again, the two ways to discriminate are (a) to become aware of whether or not the interviewing behavior of interest can be observed: (b) to note the degree to which the interviewing behavior exists. This discrimination practice will give experience in applying these two criteria. Discrimination means to make a distinction, to separate one from another, to distinguish, or to differentiate. In learning new skills it is important to separate, choose, and distinguish. Every day with many activities we discriminate and make distinctions. we taste different foods and notice if they are sweet or sour. we look outside and can tell if it is light or dark, day or night. Some discriminations are so obvious to us that we don't stop to think that we are applying a discrimination skill when we note differences. Other discriminations are more complex or more difficult. Think about the discriminations we make with color. We know different colors, we learn to label them. From simple yellow, red, blue, and green, the automobile advertiser makes us aware of sunburst yellow, fire-engine red, powder blue, and British racing green. Various shades and distinctions of color are usually learned. However, some of us who are color blind may be unable to make some discriminations. Although physiological and inherited characteristics may limit some discriminations for a few, most discriminating ability is the result of our learning and our practice. Think about some of the discriminations you have prob- ably practiced since you enrolled in the dental hygiene program. The color of gums, stains on teeth, the shape and size of teeth are important in making some of the distinctions necessary in dentistry. Perhaps, we could think of many of these learned distinctions as non-verbal discriminations. we can observe and discriminate or separate just by what we notice. 219 Discrimination Practice, p. 2. Although the discrimination may be more complex, we often judge non-verbal looks and decide if a man may be interested in us or not. we learn to read facial express- ions and tone of voice to complement what we observe so that we can better discriminate. Perhaps, with your parents or close friends, with husbands, we become better discrim- inators of what they mean. Sometimes we have learned it is just as important to know what people say as well as what they don't say. Have you had the experience of having a report passed on to you second hand, and asked, "But, how did she say it?" An effort on your part to discriminate the more accurate meaning of words. We all have experience in making complex discriminations. Most of this experience is learned over years of practice. It may be important to emphasize that we all have learned to make discriminations. Some are simple: some are complex. Through practice we increase our skill in making discriminations and often this leads us to the mastery of the skill involved. Therefore, this practice session will focus on discriminations we can practice in noting inter- view skills. Hopefully, this will provide an excellent means of mastering interview skills. 220 Code DISCRIMINATION RATINGS General Instructions: Observe each example of behavior presented on the TV monitor. After you have observed the example, turn the video recorder off and make your dis- criminations. After making your notes and ratings, turn on the recorder and watch the next example. Section I. Non-verbal Interview Skills. Part A. Example 1: Simply note if each interview skill is present or not. Write in "yes" or "no." a. Eye contact b. Physically relaxed posture 0. Natural facial expression d. Directly facing the other person Example 2: Simply note if each interview skill is present or not. Write in "yes" or "no." a. Eye contact b. Physically relaxed posture c. Natural facial expression d. Directly facing the other person Example 3: Simply note if each interview skill is present or not. Write in "yes" or "no." a. Eye contact b. Physically relaxed posture c. Natural facial expression d. Directly facing the other person Part Example 4: Circle the apprOpriate number describing the interviewer's eye contact. In your own words tell why you made this discrimination. very good Reason for eye contact rating: good fair poor very poor In I—‘NMDU‘I II II II II II Example 5: Circle the appropriate number describing the interviewer's eye contact. In your own words tell why you made this discrimination. 5 = very good Reason for eye contact rating: 4 = good 3 = fair 2 = poor 1 = very poor Code Example Section Part C. Example Example Example Section Example Example 6: II. 16: 17: 18: III. 22: 23: 221 Discrimination Ratings, p. 2. Circle the appropriate number describing the i nterviewer's physical posture, natural gestures, and facial expression. State the reason for your rating in your own words. I-‘NwohUl very good Reason for rating: good fair poor very poor Verbal Interview Skills. Rate the interviewer's invitation to talk as Open or closed. Open Closed Rate the interviewer's invitation to talk as Open or closed. Open Closed Rate the interviewer's invitation to talk as Open or closed. Open Closed Part D. Tally in the boxes provided the number of Open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Open Closed Number of invitations I Number of minimal encouragements Other comments Tally in the boxes provided the number of open and closed invitations to talk and the number of minimal encouragements to continue talking offered by the interviewer. Tally any other kinds of comments in the bottom box. Open Closed Number of invitations Number of minimal encouragements Other comments Code Example 24: 222 Discrimination Ratings, p. 3. Same instructions. Number of invitations Number of minimal encouragements Other comments Open I Closed Code 223 INSTRUCTIONS FOR VIEWING First Observation. Supervisor times segments. Time Activity II. 2 min.....Observe tape for 2 minutes. 1 min.....Make notes in Viewing Log. 2 min.....Discuss behaviors hygienist wants to change. Identify better means of using interview skills. Second Observation. Supervisor times segments. Time Activity III. 2 min.....Observe the next two minutes on the tape. 1 min.....Make notes in Viewing Log. 2 min.....Discuss the behaviors the supervisor presents. Identify better means of using interview skills. Third Observation. Supervisor times segments. Time Activity 3 min.....Observe the last three minutes on the tape. 1 min.....Make notes in Viewing Log. (Rewind tape during the time you make notes.) 2 min.....The hygienist should first be able to repeat the supervisor's comments from the second observation before discussing the third observation. The hygienist should compare this segment to the comments given by the supervisor at the end of the second obser— vation. Then, discuss and identify any other interview behaviors that might improve inter- view'skills. 224 Code Person (Hygienist or Supervisor) VIEWING LOG write in the interview behaviors identified. I. First Observation. The hygienist should identify at least one behavior she would like to change. II. Second Observation. The supervisor will identify appropriate and positive interview skills and give evaluative feedback to the hygienist. III. Third Observation. The hygienist should first review the comments made by the supervisor in the second observation. Then, the hygienist should compare this segment of performance to identify any other interview behaviors that might improve her interview skills. 225 Code TEACHING GUIDE Time Activity 1 min.....Present the four non-verbal skills to the trainee. (Use Poster 1) min.....Demonstrate poor and good examples of each of the non-verbal interview behaviors for the trainee. min.....Ask the trainee to be the interviewer and to demonstrate for you gii of the non-verbal skills. Suggest a topic relating to college classes for the next fall semester. min.....Introduce both verbal interview skills (Use Poster 2). Explain the importance of each skill. min.....Explain the importance and characteristics of the invitation to talk (Use Poster 3). Illustrate the situations where an invitation to talk can be used (Poster 4). Explain how we can distinguish the quality of an invitation to talk (Poster 5). min.....Using Summary Guide 2 and the examples given, ' demonstrate the verbal skills. Offer an invitation to talk (use the second set of examples) and then follow the trainee's response with a minimal encouragement to continue talking. Practice with as many examples as you can during the three minutes. min.....Discuss with the trainee the use of minimal encouragements to talk (Poster 6). Describe how you used these when you were practicing with the example of Summary Guide 2. min.....Review and respond to the trainee's questions. Have the trainee summarize and tell you in her own words what interview skills were presented and why they are useful. 226 Code __ SUMMARY GUIDE 2 INVITATIONS TO TALK Read each example of an invitation to talk, and have the interview trainee respond to each one. The following invitations to talk can probably be responded to with a "yes" or "no"--usually this is the kind of response they might obtain. Have the trainee imagine they are a patient and respond to the following: 1. Is there something with which I can help you? 2. Was it painful? 3. Are you interested in returning in six months? 4. were you concerned with what the dentist might think? 5. Does that feel comfortable? 6. Did you call for an appointment? 7. Has it bothered you in the last week? 8. Have you determined where the tooth hurts? A better way to word the previous examples allows for the person to respond in other than "yes-no" varieties. By beginning the Open invitation with different words, the pat- ient is asked to respond in a manner that permits a lot of information to be obtained. Have the trainee consider the following possibilities and imagine the kind of response a patient would give. Have the interview trainee answer the following questions. 1. How can I help you? 2. I wonder how painful it was. 3. How interested are you in returning in six months? 4. What concern did you have with your dentist's thoughts? 5. How does that feel? Can you describe how that feels? 6. When did you call for an appointment? 7. Tell me, when was the last time it bothered you? 8. Where does it hurt? Discuss the responses obtained with each set of invitations. APPENDIX N CONTROL GROUP PRACTICE WRITTEN MATERIALS APPENDIX N CONTROL GROUP PRACTICE WRITTEN MATERIALS Code PRACTICE INSTRUCTIONS CHECKLIST Follow instructions carefully; Each instruction is outlined step by step. Read the instruction. Read instructions again as necessary. When you have completed a step, check (V) it in the blank provided. Continue to the next instruction. Times are indicated for each step. There should be ample time. The approximate times provided are guides so that you will be able to complete the practice session on schedule. For your own use, make any notes on the practice instructions checklist that may be helpful to you. Approximate Checkvr Step instructions Time Guide When Complete 3 minutes 1.0 First read the remainder of this Practice Instruction Checklist. 1.1 Look over all the materials in your envelope. Scan them so that you can obtain an idea of what needs to be completed during your practice session. 1.2 Then, organize the written materials from the envelope so that you are ready to use them as needed. 2 minutes 2.0 Your practice session involves: a. listening to three tape cassettes. b. observing the pictured materials accompanying each cassette, and c. completing the written evaluation and questions for each of the three tapes. 227 228 Code Practice instructions checklist, p. 2. Instructions Approximate Check \l 8 tsp Time Guide When Complete .¥ A A -w I A“... _‘ 2.1 Your three cassettes are provided in the box. Remove your three cassette packages from the box. Each package looks like a small notebook. Line them up like three books on a shelf and notice their titles and numbers. 2.2 Record the following information: Set number on my box of cassettes: Numbers and titles of my 3 cassettes (List in numerical order...1,4,6 or 2,3,5): Tape # Title Tape # Title Tape # Title You are to listen to each of the three tapes in the numerical order just listed. Go ahead to step 3. - “AA...— AAA 22 minutes for both steps 3 & 4 VM'o-ln - Take your first tape cassette package. Be sure you follow numerical order. Open the tape book. Read the front page. See that you have the evaluation form for the tape handy. Review the written evaluation form. Remove the tape and insert it in the tape cassette player. 3.1 Listen to the tape. Follow any instruction the tape cassette presents. 3.2 Stop the tape at the end. Push the rewind button on the tape cassette player. Let the tape rewind while you begin to complete the written evaluation form and the questions for that tape. 229 Code Practice instructions checklist, p. 3. Approximate CheckJ Step Instructions Time Guide When Complete 22 minutes 3.3 Fill in the evaluation form. Answer the questions. continued Do not leave any question blank. write or circle the best answers. 3.4 When your evaluation is completed and your questions answered, remove the cassette from the player and return it to the pocket in the tape book. 3.5 Make sure that you have all materials in their original con- dition--(rewind the tape, do not mark in the tape book)--so that they are ready for the next listener. 4.0 Take your second tape cassette package. Be sure you follow numerical order. Open the tape book. Read the front page. See that you have the evaluation form handy. Review the written evalua- tion form. Remove the tape and insert it in the tape cassette player. 4.1 Listen to the tape. Follow any instructions the tape cassette presents. 4.2 Stop the tape at the end. Push the rewind button on the tape cassette player. Let the tape rewind while you begin to complete the written evaluation form for that tape. 4.3 Fill in the evaluation form. Answer the questions on the other I form. Do not leave any question blank. 4.4 When your evaluation is completed and your questions answered, remove the cassette from the player and return it to the pocket in the tape book. 230 Code Practice instructions checklist, p. 4. Approximate CheckJ' Step Instructions Time Guide When Complete 4.5 Make sure you have all materials in their original condition so that they are ready for the next listener. 16 minutes 5.4 Take your third and last tape cassette package. Open the tape book. Read the front page. See that you have the last evaluation form handy. Review the form. If other materials remain, place them where you can refer to them. Remove the cassette and insert it in the tape cassette player. Listen to the tape. Follow any instructions the tape cassette presents. StOp the tape at the end. Push the rewind button on the tape cassette player. Let the tape rewind while you begin to complete the written evaluation form and the questions for that tape. Fill in the evaluation form. Answer the questions. Do not leave any question blank. Write in or circle your best answers. When your evaluation is completed and your questions answered, remove the cassette from the player and return it to the pocket in the tape book. Make sure that you have all mater- ials in their original condition. Everything should be ready for the next listener. 231 Code Practice instructions checklist, p. 5. Approximate Check ‘1 Step Instructions Time Guide When Complete 3 minutes 6.0 Think for three minutes about the content in all three tapes. Do you think there are appropriate types of information that can be used to make you more effective when you talk with patients? 6.1 Summarize your general impressions of this practice session on the form provided. Be candid and honest. 4 minutes 7.0 Place all three of the tape cassette packages back in the box so that they are ready to be returned to the assistant. 7.1 Complete the adjective check list. Describe your feeling or mood as directed. 7.2 Put all written materials in your envelOpe. ' w a '7' “WW r—av v v 8.0 Go turn in all materials to the assistant waiting in the hall at Room 416. 232 Code SET 1: QUESTIONS FOR TAPES 1, 4, AND 6 Answer these questions to indicate hOW'Well you understood the materials presented on the tape cassettes. A. Tape 1, The Subject Is Plaque. Circle Answer 1. Bacterial plaque, unchecked, leads to dental disease. True False 2. Bone disintegrates in the final stages of periodontal disease. True False 3. write in your answer. Where does plaque accumulate? B. Tape 4, Brush: Brush: Brush: 4. Pits and grooves of the back teeth are especially hard to brush. True False 5. When brushing, you should flex the bristles of the brush. True False 6. write in your answer. What is the "critical zone?" C. Tape 6, Snack Sense 7. Food labels are stressed as an important source of information. True False 8. Everyone should restrict sticky foods to meal time. True False 9. Describe what the term "trigger foods" means. 233 Code Answer these questions to indicate how well you understood the materials presented on the tape cassettes. A. Tape 2, Clean Up Your Smile. Circle Answer 1. There are three acceptable ways of brushing. True 2. Mouthwashes are necessary to clean up your smile. 3. Discuss. What is the relationship of the brush to the brushing method? B. Tape 3, Floss! Floss! Floss! 4. The tape describes the loop method of flossing. 5. Fifteen inches of floss are recommended. 6. Describe the method recommended for flossing. C. Tape 5, Food Sense. 7. The average citizen consumes 115 pounds of sugar yearly. True 8. The best rule to follow is: Avoid trigger foods between meals. 9. Give some examples of Trigger Foods. True False False False False False False Code 234 EVALUATION FORM FOR TAPE CASSETTE NUMBER TITLE Circle the appropriate favorability rating to indicate your Opinion for statements one through three. Write a few words or a sentence to explain your opinions and ratings. 1. The content in this tape cassette is adequate for use with adult patients. They could listen and complete the cassette on their own without assistance from a dental hygienist. 5 .... very favorable .... favorable .... somewhat favorable .... unfavorable .... very unfavorable I-‘Nw-h Reasons why: The content in this tape cassette is adequate for use with children (ages 5 through 12). They could listen and complete the cassette on their own without assist- ance from a hygienist. .... very favorable .... favorable .... somewhat favorable .... unfavorable .... very unfavorable I-‘anbU'l Reasons why: The content in this tape cassette is adequate for use with dental hygienists just beginning training (first week of the first semester in training). .... very favorable .... favorable .... somewhat favorable .... unfavorable .... very unfavorable l—‘NW-bUl Reasons why: What additional information should this tape contain? What information or content should be deleted or changed? 235 Code SUMMARIZE YOUR GENERAL IMPRESSIONS OF THIS PRACTICE SESSION *Tape cassettes for control group practice were developed by the Preventive Dentistry Section, Dental Health Center, 14th Avenue and Lake Street, San Francisco, California 94118. The set is entitled SAVE, Self-learning Audio Visual Education on Dental Plaque Diseases. APPENDIX 0 SUPERVISOR'S INSTRUCTIONS FOR PRACTICE SESSIONS APPENDIX 0 SUPERVISOR'S INSTRUCTIONS FOR PRACTICE SESSIONS All materials will be brought to the practice room by the subject in her envelope or be available in the room (TV equipment). A stOp watch is necessary for the practice session. The supervisor should time the segments on the tape being observed. Each student interview contains 7 minutes of interview performance; the segments are divided into 2 minutes, 2 minutes, and 3 minutes. For the combination practice sessions, the subjects will come to the door when they are ready for your assistance. If practice started on the hour exactly as scheduled, this should come at 16 minutes after the hour. YOur involvement is scheduled for 16 minutes of tape obser- vation, making notes in a "Viewing Log" and discussing with the student the specific interview behaviors involved. Please do all you can to help the student relax and feel positive about their first interview performance and the practice session when they view it. It may help to compare the first interview performance to their exper- iences of the first time in clinic. For the feedback practice where you are involved for the hour (50 minutes), the following information may be help- ful. When you first enter the room allow the subject a chance to read through the "Practice Instructions Check- list". While they complete the first portion of instruc- tions, please load the tape on the videotape recorder and get it ready for viewing if it is not ready to go. The first portion on the tape announces the subject number: double check this with the subject code number to insure that everything is in order. Set the digit counter at 000 so that the tape can be stopped on rewinding; this will prevent your needing to rethread the tape for the two times you rewind it. There is a form called Instruc— tions for Viewing, when the student is ready follow the steps outlined on the form. 236 237 To guide you in the feedback given to each student, please follow these general rules of thumb, regardless of content. lst Observation: 2nd Observation: 3rd Observation: Respond to each interview skill the student desires to change. Model or act out an improved example as soon as the behavior is identified, labeled, and discussed. After viewing each segment, give two positive comments and one suggestion for improvement. Have the student repeat the suggestions you have made for each segment, respond in a positive way..."that's good," "fine, I think you know..." Finally, stress that they can practice these interview skills every day and when they work through the semester in the clinic. APPENDIX P PHYSICAL FACILITIES: DENTAL CLINIC FLOOR PLAN APPENDIX P DENTAL CLINIC FLOOR PLAN PHYSICAL FACILITIES: UHZHQU BBQ: .m006h 36¢ .Z9 1H ooaaao . 000 00 0066666006 GO6UQM00W 606000 60060 . Emf6. 0066666006 0 006 606000 60060 0006 6603 P P ‘ I : 00¢ 606 i ¢o¢ 066060 I No¢ T6060>060 66066000 0 600600060 600006000 >9 u0>9 0006 06060 «00000 00000 0000606 I000 066xm "00000 0000 0000606000 "N0¢ 606 «06¢ 006660 0.60600660 u-¢ "00660060 60 00660660606000 60006>6o06 606 6000006660 00660060 0306>60606 600n600 606 0060060006> >8 ”06¢ «mmHBHQHUCm 238 APPENDIX Q NON-VERBAL AND VERBAL RATING SCALES 9 3 2 60060 60 6o6>0006 60 0006060006 666006060000 006006066 “00000>6600660 00600 I6coaaoo “6600000060000 000 66606=q 060000660606 60060>000 00060>00 poem >60> 606>0006 006006066 60 0066000000 006 ooea66 ease: «Head soon 60 000 000: 06 0066006 60030000 "0060060606 00000 .0>60000006 000» 0600003 006600660 "66600660 60060 0006 600 06 00006 "60060 60 moaxooH 666=o6066o ad: 606 .60060 60 06030 6000 060030060 60000>6o>06 0606060 000 6660000066 60060 0066 6030 00606 “60060 006 06 w06000660 o6o>0 06 00000 6000 660> e 060000>oa 0000Ia60 :66: 0060600606 0000 0000 000 000 “0606000 6006 000 6006000 060 06 06066006000 60060>oa 60 660060 "006606000 6006060000 "00606000 0063066 .6060600 .0060606 0 00606000 0000606 006000000 06 6666660 06 0066066 606 .006060mw 06606606000 0600 “00606000 06000000 .6006066600 N 6 Adamoaev 606><060 ozHszeea dememozoz .o 60000>oa 000: 000 060 606060 0608 06006 606 .600a0>oa 60663 000 0000 60066 “00606000 0so>600 .6660n “00606000 00060660000 .000606 00600060 0003 00>0 w06006a 00606000 600 .0>oa 0066 "000066 00000 “0066:600w 0>6000ON0 06606060 60 00606000 0066066 660006660 .00606eow 00 mw0660600m 066666 000w >60> poem 6000 6000 h60> e m N 6 umphmmo .0 00060 0663 600a I0>6o>06 00000060000 000 066600 6000 060000 000 60080>oa 000600 60060 006006 0000066000 “6000 0600000 00660606 000 60000>oa 6006 60606 “0636000 0060606 .6000 .6060600 000w h60> 600606 000 6060666660 60050000 “666000 060606 60 60>60 6.00000 6006 606 “0606000 06006606800 poem 000000 0606000 6000 0066066 606 .600a0>oa 60663 .0000 "0606000 0006066006 .00006 6000 p6o>0 06 08000 "066600 0606000 0>6000ox0 60 066650 0606000 6006 00 .0606000 66660 .06066 6000 h60> c m mmqzoz 6 nabhmom Maom .< 244) 60060 06 .00» 060000 “0006060000 .00> 000 06 000000 0066600 60660» 0060600606 “06000000 000 000660000 0.60060 0663 000 0066 03066 00660060>000 "60060 0663.60066 306606 0606 000 000660006060 006>60606 606 006600660 60660> 000 0000060 I60000 60 0306606 60060 000 06 00000 060360 600 600 "6006000 60066606 0663 06060 "600 000 666 0663 666 000 60066006 000660006000 .06000000 6006000 06066006000 0066 60060 0660>60 666000600000 “0600003 006600660 60660> 00066 I0000 «60606 .66600 00000 00660060>000 60660> 606 .60066006 000660006000 660606000> 06066006000 00006 «006000000000 0060> 60 0006 “0066 6666 06 0006600660 600>060666 0306606 .0000 60 600 0006 "660 60060 00606 00000060 06 60060 00006 606 00606000 000 00606006 "60060 6000 60 6006000 00606 0000 660> 0000 6000 6000 660» 0 m N 6 66<00000 02602066< 0<006> .0 60060606 0.60060 60 660660» 0 6666000 6060060 0600660606 06006000 0006060006 000660006060 666060000600.66006 006>060 000 6006606 600 600>060666 0000600000 66060006 60x000 0606 13000 .660>6600600 you 0000 "600 0663 6006000 600>0606 00060>00 “Hum 60 000 6666000 000 660660> 60 000 66600 06000 606 “6006000 600>0606 0663 06060 6 0000600000 "Hum 06606606000 .06000000 000660000 "000 0000060 600066: you 0000 0606 0660060 06 00000 "600 60 660660> 000 000 0066066 600>060666 0663 00000 660 06 06666 “60060 000600000 06 6666660 00006 "Hum 60 000 066666 660> 60 00 0000 660> 0000 6000 6000 6600 0 n N 6 66060 02606<6 00066200 on mazm:mo<0=oozm 0o 00: m>6600000 .0 0.0.6 06 00660606 0.6.0.6 0606 0000006606 6006000 300 000 006006 600>0606 “666060600 0066 00066 :066>06 "966 60 000 0>66 -00660 .06000 03000 "666 60 6666000 000 660660> 0000 660> 966 300 60660 60 000000006 00 0066066000 06 0066600660000 0000 000060 606 .696 600>0606 0666 6006066600 .06000000 0000 600>060666 060660 00066 I0000 “666 6666000 6000 “00000006 000600 60 006066 060360 6.00000 606 996 060660 “666 60 660660> 00006 0 000 0066066 6000 0000 1600000 60 00306606 6006000 600>060666 0006006 300 0000 IO6606 06 00066066266 00600 6660066660 .00060 0600 "666 60 000 066666 660> 60 00 6000 660> c n N 6 66666 6006 00 mzo66<66>26 60 00: m>6606066 .< mm6 APPENDIX R NON-VERBAL AND VERBAL EVENT RECORDER OUTPUT APPENDIX R EVENT RECORDER OUTPUT FOR NON-VERBAL ITEMS A line for each judge was used to record the frequency and duration of eye contact. The number of breaks in eye contact were tallied from each line for the seven-minute interview interval. The frequency of breaks in eye contact was recorded as the score for each subject by each of the three judges. By computer this score was transformed by reversing the direction so that the minimum number of breaks reflected the higher and positive end of the continuum with maximum breaks resulting in lower scores (y = 100 - x). The total number of squares for the seven-minutes represented the duration of eye contact. One square equaled two seconds of eye contact duration. Total seconds of duration were used for each subject's score for this item. Line 1, Judge 1 Line 2, Judge 2 Line 3, Judge 3 241 242 EVENT RECORDER OUTPUT FOR VERBAL ITEMS Nine lines or channels were used for all the verbal interview skill items. The first set of lines were used to record invitations to talk (ITT). The first line in the set was used for each judge to record the frequency of good invitations (G—ITT) and the second line was used to record the frequency of poor invitations to talk (P-ITT). The last three lines were used to record encouragements to continue talking (ECT). Each mark indicated an invitation or an encouragement. The total frequency count was used as the score by each of the three judges for each subject. Line 4. Judge 1 G-ITT Line 18, Judge 1 ECT Line 5, Judge 1 P-ITT Line 19, Judge 2 ECT Line 7, Judge 2 G-ITT Line 20, Judge 3 ECT Line 8, Judge 2 P-ITT Line 9, Judge 3 G-ITT Line 10,Judge 3 P—ITT I. ”1...-.. M. c... -c- um APPENDIX S INSTRUCTIONS FOR VIDEOTAPING INTERVIEWS APPENDIX 8 INSTRUCTIONS FOR VIDEOTAPING INTERVIEWS Please conduct an initial interview with your patient as you usually do in the clinic. Meet your patient, greet them, and bring them to the interview room just as you would usually do. The dental chair in the interview room can be adjusted for patient comfort. It is not exactly the same as the model in the clinic, but similiar. so it can accommodate different patients. Once you begin your interview you will be given seven minutes to talk with the patient. At the end of seven min- utes the assistant will knock twice. End your interview after this point. Take a sentence or two as appropriate to close the interview. If the interview extends to ten min- utes the assistant will knock again and enter soihat the television camera can be turned off. We want you to be as comfortable with the presence of the TV equipment as you are with the dental chair and tools that you use. Basically ignore the presence of the TV camera as you talk with your patient. Patient gustructions Please be yourself and participate for seven minutes to be interviewed as a patient attending the dental hygiene clinic for your first visit. 243 APPENDIX T INSTRUCTIONS FOR INTERVIEW ASSISTANTS APPENDIX T INSTRUCTIONS FOR INTERVIEW ASSISTANTS Instructions for Assistant: General Assistant General Instructions 1. Take roll. Check name as subject reports 2. Ask subject to read the instructions for videotaping interviews. 3. Ask subject to meet and greet a patient from the waiting room and return to conduct their interview. 4. When subject returns note name of patient on master schedule. Each patient is to be involved only once. 5. Introduce subject to videotape assistant. 6. Keep a steady flow of subjects ready as they report so that little time is wasted between interviews. Materials 1. Master Schedule List. (For reference if necessary) 2. Time log for videotaping. 3. Pencils. 4. Instructions for Videotaping Interviews. 244 24S INSTRUCTIONS FOR INTERVIEW ASSISTANTS Instructions for Videotape Assistant and Technician General Instructions Videotape Technician: 1. 2. 3 4. mm Check subject's code against general assistant's and videotape assistant's master list. See that sufficient tape is available for each subject before they begin to tape their interview. Note recording machine digits on log. Enter tape number, position on tape, and subject code on log. Enter information on videotape label. Record subject code on TV tape prior to interview. Videotape Assistant: mefl 11. Usher subject and patient in for their interview. As they begin, clock the time using the stop watch. At the end of 7 minutes knock twice. If the interview extends to 10 minutes knock and enter so that the television set can be turned off. Usher the subject and patient to exit door. gpecific Instructions (for Videotape Technician) WNH O O 9. See that the interview set up is ready to go. Check position of camera and chairs. See that TV equipment is functioning properly: lighting appropriate, etc. Monitor TV equipment functioning to maintain quality of taping. Materials GJQO‘U‘wal-J Blank tape TV camera and monitor. Camera lights. Labels for tapes Master Schedule List Videotape assistant's log St0p watch Pencils 246 Materials Suggestions (During videotaping) (DQON 00. Load tape. Set counter at 0000. Check video set up and record subject number. "This is subject No. 1A ." Advance slightly. Leave a few seconds between knock & turning off recorder. Allow last sentence to be completed and subject to leave. then turn off machine. Continue in this manner. Fill in label as you go. When tape is completed. Advance fast forward and set aside with label. Load a fresh tape. Don't try to rewind until the entire mornings interviews are complete or at break time. Time is of the essence to complete all scheduled interviews. The most ideal method keeps the interviews rolling with little or no time in between. When tapes are rewound then place label inside the container. .‘~ "3‘?“ am am .. WEI—v' '14}. my: 247 INTERVIEW SKILLS PERFORMANCE LOGS Time Log for Videotaping Day: Date: Times: Page: Subject Time to Patient Name Time Comments Code Report 4 Interview Starts VIDEOTAPE Assistant's Schedule and Log Day: Date: Times: Page: Subject Videotape Records Time General Code No.of Rec. Position 7 min./ Comments Tape Digits On Tape y'overtime Begin. amount APPENDIX U DENTAL HYGIENE STUDENT SURVEY APPENDIX U DENTAL HYGIENE STUDENT SURVEY Name or Code Number Directions: Please circle the apprOpriate numbers. Your comments will be appreciated. Your information will assist in evaluation of the interview skills training program and provide suggestions for the curriculum. The TV tape illustrated the interview skills very well. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: The TV tape explained the interview skills very well. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: Experts other than dental hygiene students need to demon- strate the interview skills. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: The practice session helped me learn the interview skills. 1 2 3 4 5 strongly agree neutral disagree strongly agree - disagree Comments: 248 10. 249 Written handouts (study guides) detailing interview skill content would be helpful. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: I would spend extra hours (free time) to view the tape illustrating interview skills additional times. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: Rate your third interview for your overall effectiveness in using interview skills. . l 2 3 4 5 very effective neutral ineffective very effective ineffective Comments: Rate your first interview for your overall effectiveness in using interview skills. 1 2 3 4 5 very effective neutral ineffective very effective ineffective Comments: Rate your second interview for your overall effectiveness in using interview skills. 1 2 3 4 5 very effective neutral ineffective very effective ineffective Comments: I would not like to continue learning other more advanced interview skills. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: ll. 12. l3. 14. 15. 250 Where do you suggest the interview training skills be placed in the curriculum? 1 2 3 4 5 First First Second Second Not Semester Semester Semester Semester At Before After Before After All Mid-Term Mid—Term Mid-Term Mid-Term Comments: Opportunities for use of interview skills arise during clinic work. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: When opportunities arise to use the interview skills in the clinic, I feel very uneasy using the skills. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: There was too much content in the demonstration TV tape. 1 2 3 4 5 strongly agree neutral disagree strongly agree disagree Comments: Did you review your first interview videotape? Yes No__ If no, would you have liked to review your interview performance? Yes No Comments: If yes, to what extent was reviewing your tape profitable? l 2 3 4 5 very profitable neutral unprofitable very profitable unprofitable Comments: 16. 17. 18. 19. 20. 251 Describe the most valuable skill or concept that you learned from your interview experience. Describe the most valuable skill or concept that you learned from your practice experience. How do you feel about having your instructor view your interview performance? What was the most disappointing part of this interview skills training program? If this program were going to be reorganized, what one specific suggestion would you make. APPENDIX V INTERCORRELATIONS OF INTERVIEW SKILL ITEMS 252 udoEnuouud A0002 msmuH HHflxm 30w>uoucu Hanuo> can Hmnuo>lcoz How acowuoaouuoououcH oo.H Nv. mN. Nm. mv. oo.H mm. Nv. hm. oo.H as. am. oo.H wh. oo.H >908 >ZUOB mm> MMBUH ntBH MH NH HH OH m mm. Nm. mm. on. oo.H m 55. mN. mH.I Ho. ma. 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