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BRIE F COMMUNICATIO N Informational , Interpersonal , an d Intrapersona l Communicatio n in a Famil y Practic e Residen t Suppor t Grou p GAR Y L. ARTHU R 1 , J. LEBRO N MCBRID E 2 & SHELLE Y JACKSO N 3 1 Georgi a Stat e University , Atlanta , GA , USA ; 2 Floy d Medica l Cente r Famil y Practic e Residenc y Program , Rome , GA , USA ; an d 3 Texas A & M University , Corpu s Christi , TX , US A ABSTRACT Context: Thi s prospectiv e stud y compare d grou p proces s literatur e to topic s utilize d in a yearlon g famil y practic e residen t suppor t group . Objectives: Th e basi c hypothesi s wa s tha t residen t suppor t group s functio n in way s tha t ar e simila r to othe r group s to th e exten t tha t th e literatur e on grou p proces s coul d contribut e to ou r understandin g of suppor t group s fo r residents . Method: Te n possibl e discussio n topic s wer e groupe d alon g a continuu m fro m informationa l to interpersona l to intrapersonal . Analysis: Dat a wer e subjecte d to thre e repeate d measure s of analysi s of varianc e (ANOVA).

Findings: Result s re ecte d tha t informationa l topic s di d no t decrease , interpersona l topic s di d increas e signi Ž cantly , ye t intrapersona l topic s di d no t re ec t an y signi Ž can t change s ove r th e cours e of study . Discussio n an d Conclusions : Th e preliminar y Ž nding s indicate d th e researc h literatur e on grou p proces s ma y hav e applicatio n to residen t suppor t groups . Whe n mor e formalize d group s lik e Balin t group s ar e no t available , suppor t group s ma y offe r a foru m to facilitat e th e interpersona l an d intrapersona l discussion s an d communication s of residents . Recommendation s derive d fro m th e suppor t grou p experienc e an d th e researc h are given. K E YW O R D S Me dic a l e ducatio n suppor t group , re si de n t e duc at ion , re side n t communication. Autho r fo r correspondence : Gar y L. Arthur , EdD , Georgi a Stat e University , Departmen t of Counselin g an d Psychologica l Services , Universit y Plaza , Atlanta , GA 30303-308 , USA . Tel : +1-404-651-3426 . Fax : +1-404-651-1160 . E-mail : [email protected] u Educatio n fo r Health , Vol . 15 , No . 3, 2002 , 37 6 – 38 0 Educatio n fo r Healt h ISS N 1357 – 628 3 print /ISS N 1469 – 580 4 onlin e # 200 2 Taylo r & Franci s Lt d http: //www.tandf.co.uk /journal s DOI : 10.1080 /135762802100001272 3 Variou s didacti c an d experientia l method s hav e bee n use d in medica l educatio n to promot e physicia n interpersona l an d intrapersona l awarenes s (Novac k et al ., 1997) . On e of th e majo r approache s fo r enhancin g self - an d othe r awarenes s an d fo r trainin g medica l student s an d resident s to respon d empatheticall y to patient s is participatio n in a group . Thi s brie f communicatio n report s on on e suc h residen t suppor t group . Th e basi c hypothesi s wa s tha t residen t suppor t group s functio n in way s tha t ar e simila r to othe r group s to th e exten t tha t th e literatur e on grou p proces s coul d contribut e to ou r understandin g an d facilitatin g of suppor t group s fo r medica l residents . Methods Si x intern s in a famil y practic e residenc y an d a grou p leade r participate d in a suppor t grou p an d serve d as participant s in thi s study . Fo r th e research , 10 discussio n topic s wer e place d alon g a continuu m an d sorte d int o on e of thre e grou p stage s as see n in Tabl e 1. Th e topic s wer e conceptualize d by th e author s alon g thi s continuu m to re ec t fro m a les s to mor e persona l involvemen t in communicatio n (tas k – information , interpersona l – relational , intrapersona l – internal ) by th e residents . Grou p stage s wer e divide d int o early , middle , an d lat e an d paire d wit h topic s alon g thi s continuum . Normall y th e beginnin g grou p stag e is associate d wit h a fairl y hig h nee d fo r structure , inclusion , an d orientatio n (Carey , 1995 ; Gladding , 1991) . Tuckma n an d Jense n (1977 ) refe r to thi s stag e as ‘ ‘ Forming ’ ’ an d as a tim e whe n member s becom e comfortabl e wit h on e another . It wa s anticipate d tha t th e initia l topic s woul d hav e a mor e outwar d an d factua l focus . Accordin g to Tuckma n an d Jensen , member s nex t ente r th e stage s of ‘ ‘ Stormin g an d Norming ’ ’ wherei n issue s surfac e an d member s wor k towar d resolutio n (1977) . Th e topic s in thi s stag e involv e relationship s in th e Table 1.

R e s i d e n t s u p p o r t g r o u p o b je c t i v e s b y s t a g e s Early stage M iddl e stag e Late stage Informat iona l Interper sona l Intraper sona l Residen t educatio n Supervis or resident- attendan t Residen t emotiona l support Professio na l rol e Resident- nurs e Feeling s generate d in resident Suppor t balin t grou p dynamic s Resident- patien t Residen t personal /famil y Patients ’ emotional , psycholo gical , an d famil y dyamics Informat iona l ? Interper sona l objective s ? Intraper sona l objective s Residen t Suppor t Grou p Communicatio n 377 physician ’ s work . Durin g thi s tim e th e intern s wer e expecte d to shar e an d see k suppor t in issue s relate d to communicatio n an d interpersona l interaction s wit h a nurse , patien t famil y member , or a supervisor . Th e Ž na l stage s accordin g to Tuckma n an d Jense n ar e ‘ ‘ Performin g an d Adjourning ’ ’ . Thi s is a tim e whe n grou p wor k is performe d an d closur e take s place . Th e Ž na l leve l of involvemen t in th e grou p proces s wa s considere d to be intrapersona l an d involv e sharin g at a deepe r leve l of self-disclosure . Results Th e si x resident s ha d an overal l 89 % attendanc e rat e ove r th e yearlon g twice - monthl y meetings . Dat a wer e summe d fo r eac h participan t an d fo r eac h session . Th e dat a wer e the n combine d fo r eac h mont h resultin g in 10 observation s tha t wer e utilize d fo r th e analysis . Thre e repeate d measure s ANOV A wer e use d to tes t th e hypothese s in thi s stud y (Stevens , 1992) . Th e result s indicat e tha t ove r th e cours e of th e group , ther e wa s a signi Ž can t differenc e in th e frequenc y of discussio n of tas k topics . However , ther e wa s no signi Ž can t differenc e betwee n th e frequenc y of discussio n of tas k topic s whe n comparin g th e earl y an d middl e session s to th e late r sessions . A secon d repeate d measure s ANOV A wa s don e to tes t th e hypothesi s tha t ther e wa s a signi Ž can t increas e in th e discussio n of interpersona l topic s ove r th e cours e of th e group . Summar y score s of th e interpersona l topic s fro m early , middl e an d lat e session s of th e grou p wer e compared . A repeate d measure s analysi s of varianc e (ANOVA ) indicate d tha t ther e wa s a signi Ž can t differenc e in th e discussio n of interpersona l topic s ( F =8.835, p 5 0.005 ) ove r th e cours e of th e group . Additionally , result s indicate d tha t interpersona l topic s wer e discusse d mor e ofte n durin g th e latte r session s of th e grou p compare d to th e earl y an d middl e session s ( F =7.641, p 5 0.05). Finally , a thir d repeate d measure s ANOV A wa s use d to tes t th e hypothesi s tha t th e grou p interventio n woul d increas e th e participant ’ s discussio n of intrapersona l topic s suc h as persona l or famil y dynamics , emotiona l suppor t of th e resident , an d feeling s generate d in th e residen t as a resul t of th e patient . Summar y score s of th e intrapersona l topic s fro m early , middl e an d lat e session s wer e compared . Thes e result s indicat e tha t th e discussio n of intrapersona l topic s di d no t signi Ž cantl y increas e or decreas e ove r th e cours e of th e group . Discussion Thi s researc h is on e of th e ver y fe w whic h collecte d immediat e feedbac k fro m a famil y practic e residen t suppor t group . Th e signi Ž canc e of thi s researc h is it s assessmen t of ho w th e grou p member s utilize d th e suppor t grou p (task , interpersonal , intrapersonal) . 378 G. L. Arthur et al. Grou p membe r choice s in interpersona l topic s appeare d to follo w grou p process , re ectin g a signi Ž can t increas e in frequenc y whe n expected ; however , thi s wa s no t tru e fo r grou p choice s in tas k or intrapersona l topics . Tw o distinc t observation s wer e note d whic h appea r to be differen t tha n expecte d fo r grou p process . Th e Ž rs t observatio n wa s tha t normall y grou p proces s woul d expec t informationa l topic s to tak e priorit y earl y in th e grou p proces s an d the n to diminis h ove r time . However , thi s group ’ s us e of tas k topic s signi Ž cantl y increase d ove r th e middl e an d late r stage s of th e grou p whe n compare d to th e initia l stage . Anothe r note d differenc e in grou p proces s wa s tha t intrapersona l topic s di d no t follo w expectations . Ther e wa s no t a signi Ž can t differenc e in discussio n of intrapersona l topic s ove r th e cours e of th e year . It wa s note d tha t fo r tw o of th e thre e topic s (emotion / famil y an d residen t feelings ) th e frequenc y averag e wa s ofte n greate r at th e beginnin g an d middl e stage s tha n tas k or interpersona l topics. Althoug h eac h suppor t grou p ha s som e of it s ow n dynamics , thes e preliminar y Ž nding s indicat e th e researc h literatur e on grou p proces s ma y hav e applicatio n to residen t suppor t groups . Recommendation s derive d fro m ou r experienc e and / or researc h an d avenue s fo r additiona l researc h include : . Suppor t group s fo r person s in th e medica l Ž el d ma y bene Ž t fro m th e struc - tur e of a lis t of topic s tha t ar e identi Ž ed as bein g appropriat e fo r grou p dis - cussion . Thi s ma y mak e th e grou p experienc e les s ambiguous . . Tas k topic s ma y pla y a differen t rol e in medica l trainin g group s tha n othe r groups . Th e medica l educatio n emphasi s on interventio n an d ‘ ‘ doing ’ ’ ma y encourag e mor e frequen t us e of tas k oriente d discussions . Therefore , facili - tator s shoul d understan d th e valu e of tas k discussio n topic s fo r residents . . Famil y practic e resident s ma y be mor e ope n to intrapersona l discussion s tha n is ofte n indicate d in th e literatur e on medica l education . Providin g th e opportunit y fo r discussio n of intrapersona l topic s can , of course , be of grea t valu e in self-discover y an d physician / patien t relationships . . Especiall y wher e mor e formalize d group s lik e Balin t group s ar e no t avail - able , suppor t group s ma y offe r a foru m to facilitat e th e interpersona l an d in - trapersona l discussion s an d communication s of residents . References C AREY , G. (1995). Theor y an d practic e of grou p counselin g , 2n d edn . Paci Ž c Grove , CA : Brooks/Cole. G LADDING , S.T . (1991) . Grou p work : a counselin g specialit y , 2n d edn . Columbus , OH : Merrill. Residen t Suppor t Grou p Communicatio n 379 N OVACK , D.H., S UCHMAN , A.L., C LARK , W., E PSTEIN , R.M., N AJBERG , E. & K APLAN , C. (1997) . Calibratin g th e physician : persona l awarenes s an d effectiv e patien t care . Journa l of th e America n Medica l Associatio n , 278 , 502 – 509. S TEVENS , J. (1992). Applie d multivariat e statistic s fo r socia l science s . Hillsdale , NJ : Lawrenc e Eribaum . T UCKMAN , B.W. & J ENSEN , M.A.C . (1977) . Stage s of smal l grou p developmen t revisited . Grou p an d Organizationa l Studies , 2 , 419 – 327. 380 G. L. Arthur et al.