MHBM I - Communication & Interviewing (Dr

Kyi)

SLO
COMMUNICATION  Define communication and interviewing
&  List the models of communication
INTERVIEWING  Describe the different components of
communication process
 Discuss the barriers of communication

Dr Kyi Kyi Sein

 Identify verbal and non-verbal communication
MBBS, MPTM, MA (Health Social Science), Dip Med Edu, PhD (Public Health)
Associate Professor  Develop active listening skills
Department of Community Medicine
AIMST University  Discuss the effective interviewing procedures

Communication – Why?
 Do doctors need communication? Where You’re 30
are we? metres
above the
ground in a
balloon.

 Scenario 1
 Have you had a communication problem or
- A departmental head yelled his subordinate to come
failure to communication?
and help his work. No one come in.
 Scenario 2  Was there a miscommunication due to lack of
- A departmental head asked his subordinate to come understanding?
and help his work. A subordinate comes in and work but
it’s not the task that the head asked.
 Scenario 3
- A departmental head asked his subordinate to do
something for him. The subordinate did the correct job.

Community Medicine, AIMST University 1

MHBM I - Communication & Interviewing (Dr
Kyi)

Definitions
 The ideal of any communication is that the
 Communication is the process by which we
message received is the same as the
interact with each other (create and exchange
messages). message sent.
 Is the flow of information, ideas, feelings,  Communication is sharing meaning with
attitudes, perception and understanding, both others.
verbally and non-verbally, between two or  Rubber = erasure (UK), condom (US)
more parties.
 Latin word – communis = common

Types of communication
 Intrapersonal communication Linear / action
 Interpersonal/Dyadic communication Models of Human
 Small group communication (3 & > ) Communication Interactional
 Mass communication
 Public communication
Transactional

MODELS of Communication Linear Model (message transmission)

 Linear Model (C. E. Shannon and W. Weaver,

1949)
 Interactional Model
 Transactional Model

Community Medicine, AIMST University 2

MHBM I - Communication & Interviewing (Dr
Kyi)

Transactional Model (Shared message

Interactional Model (message exchange)
creation) (Barnlund et al, 1970)

Transactional Model Forms of Communication

Face to face
Telephone
Voice mail
Messaging
E-mail
Communication Form
Letter
feedback feedback

Encodes Message Decodes

Sender Receiver

Channels Channels

Verbal Non-Verbal
Noise Noise

Each person is both sending and receiving simultaneously.

The components of the communication process

Encoding the Message Decoding the

message message
Channel

Receiver
SENDER Noise

Decoding the Encoding the

message Message message
(Feedback) (Response)
Channel

Community Medicine, AIMST University 3

MHBM I - Communication & Interviewing (Dr
Kyi)

 Source credibility – competence, trustworthiness, reputation,

honesty, enthusiasm, personal integrity, attractiveness, etc.
 Message – clear, concise (vague words, information overload)
format, language, length, organized
 Channels (medium) – appropriate to the audience, message,
channel reach, cost and accessibility – (interactive channels)
 Context – Physical (time, temperature, noise, lighting), social
(no: of persons involved, intimacy), cultural (beliefs, values),
psychological (emotions, moods), educational background
(literacy) - situation
 Empathy (NOT sympathy) – attempt to feel with another
person, being sensitive to feelings and experiences of others
 Receiver – age, education, culture (give up any
sentiments of ethnocentrism), ideas, feelings, etc.
 Feedback – verbal or non-verbal – interpreting these
Source: Wikipedia, the free encyclopedia

Barriers of communication
 Psychological noise: the emotional state of the communicators,
 Two major players: sender & receiver their personalities and preconceived ideas and judgments.
 Physical noise: external factors that distract communicators like
 Two communication tools: message & channel loud music in the background or being unfamiliar with the
physical setting.
 Four communication functions: encoding,
 Physiological noise: the biological factors that interfere with
decoding, response & feedback communications such as fatigue, illness, or altered cognitive
function.
 Noise  Semantic noise: the way people speak, their use of terms, and
any dialect or literacy issues, language
 Misreading of body language
Who will say what, how, to whom, and with what  Receiver distortion: selective hearing, ignoring non-verbal cues
 Cultural difference
effect.
 Past experience

Internal and external Barriers People generally remember

 Internal • 10 % of what they read
- fatigue, attitude, lack of interest, mistrust, past • 20 % of what they hear
experiences, problems at home, physical conditions,
insufficient knowledge of the subject, information • 30 % of what they see
overload, language, cultural differences, etc. • 50 % of what they hear and see
 External • 70 % of what they say and write
- noise, distractions, e-mail not working, bad phone
connection, time of the day, using technical words,
• 90 % of what they say as they do something
environmental conditions, long communication chain

Community Medicine, AIMST University 4

MHBM I - Communication & Interviewing (Dr
Kyi)

Perceptions (the ways mind works)

Different perceptions
Selective perceptions
Attention span
Timing
Emotions

Kinesics Six
emotions
-Happiness
 Body languages -sadness
 Posture, body movements (guestures), facial -Surprise
expressions -Anger
-Fear
-disgust

Tone of the voice, pitch, volume, rate of speech, etc.

Ekman and Friesen’s six basic

emotional expressions Paralinguistics
Anger
Fear  All sound patterns that are content free.
 Ah-ha, um
 The way words are spoken (intensity, pitch)
 Pauses, speed of speech
sad happy

disgust
surprise

Community Medicine, AIMST University 5

MHBM I - Communication & Interviewing (Dr
Kyi)

Proxemics Physical contact

Public distance
-Personal Social distance
space and
 Touch – extent of touch depend on culture,
distance Personal distance gender
between
peoples Intimate  Doctors and touch
-How we
make use of
it
O – 18 inches

18 inches – 4 Feet

How people use

4 – 12 feet
space transmit
the message. 12 -25 feet
Hall (1966) – Four distance zones

This image cann ot cur rently b e displayed.

Nonverbal communication cues can

COMMUNICATION play five roles:
Repetition: they can repeat the message the person is making
 7% WORDS verbally
Contradiction: they can contradict a message the individual is trying
 Words are only labels and the listeners put their own
to convey
interpretation on speakers words
Substitution: they can substitute for a verbal message. For example,
 38% PARALINGUISTIC a person's eyes can often convey a far more vivid
 The way in which something is said - the accent, tone and message than words and often do
voice modulation is important to the listener (e.g. ah, um….) Complementing: they may add to or complement a verbal message.
 55% BODY LANGUAGE A boss who pats a person on the back in addition to
giving praise can increase the impact of the message
 What a speaker looks like while delivering a message
Accenting: they may accent or underline a verbal message.
affects the listener’s understanding most.
Pounding the table, for example, can underline a
message.

TOTAL COMMUNICATION PROCESS –

How we spend our communication time.

- hearing is not a listening

- hearing is not an understanding

The most
neglected
communication
skill is listening

Community Medicine, AIMST University 6

MHBM I - Communication & Interviewing (Dr
Kyi)

Active listening Seven sins of not listening

 Active listening is the basis for all good  Filtering
communication (the heart of communication)
 Guessing (hidden motives)
 Involves verbal and non-verbal means
 Discounting (when lack respect to speaker)
- body gestures and postures
 Relating
- eye contact
 Rehearsing (thinking how to say next
- asking appropriate questions (probing)
sentence)
- paraphrasing
 Forecasting
- reflecting
- summarizing  Placating (agree with everything anyone else
says)

Four types of listening Hierarchy of Active listening (SIER Model)

1. Empathic listening: concerned with the feelings and

emotions the interviewee is conveying
2. Content listening: listen for content, are gathering
information, focusing on the interviewee's main
ideas.
3. Appreciative listening: listen for enjoyment, such
as when an interviewee is telling a joke.
4. Critical listening: requires that we evaluate the
interviewee's message by considering the person's
credibility, assessing the validity of an interviewee's
arguments, evaluating the evidence used to
support those arguments, recognizing reasoning
fallacies , and identifying emotional appeals.

Characteristics of a good listener Questioning

 Open question - gaining the widest possible range of
 Giving frequent indications responses
 Maintaining Eye contact e.g. Can you tell me about your recent experience of attending
medical school? How was your week ends?
 Posture
 Closed question - leads almost inevitably to a ‘yes’ or ‘no’
 Making Notes
answer. It is used to establish facts and check on details.
 Asking Questions e.g. Are you clear? Did you go shopping during week ends?

 Using Effective Summarization  Clarifying question - Can I ask you to explain this in more
 Not interrupting the person detail?

 Paraphrase the speaker’s message  Probing questions – to get further details

 Interject tactfully e.g. Could you tell me more about your sufferings of being a
leprosy patient?

Community Medicine, AIMST University 7

MHBM I - Communication & Interviewing (Dr
Kyi)

Communication Styles Seven “Cs” of effective communication

 Passive communication  Correct

 Aggressive communication  Clear
 Passive-aggressive communication  Concise
 Assertive communication  Courteous
 Constructive
 Conversational
 Complete

INTERVIEW
 An interview is a communication transaction
in which an interviewer engages in
questioning and discussion with an
interviewee to gather information.
 Interpersonal communication
 Small group communication (FGI)
 Intentional (purpose)
INTERVIEWING  Use of questions and answers
 Use of communication techniques to ask
appropriate questions

Before Interview
 The information-gathering interview  Preparation
- Before Interview - purpose, confidentiality
- During Interview - to whom, where and when
- After Interview - preparation of questions for interview
- preparing for recording – note taking, tape
- checking all materials needed

Community Medicine, AIMST University 8

MHBM I - Communication & Interviewing (Dr
Kyi)

During Interview After Interview

 Introduce yourself, welcome  Make your notes immediately
 Explanation of purpose of interview  Review your own performance as an
 Ensure Privacy interviewer
 Verbal & non-verbal behaviour of interviewer
 General questions to specific ones.
 Probing, clarification, paraphrasing,
summarizing, etc.
 Attempt to remain as neutral
 Words of thanks

Checklist for Communication Activities

IS IT CLEAR?
 * Initiative of interview: acknowledgement of patient, introduces self, at
ease, attentive to patient.
 * Questioning skills: e.g., use of open-ended questions, transitional
statements, confident and skilful questioning, appropriate language, use
of different types questions, or awkward, exclusive use of closed ended or
leading questions, jargon, interrupts patient inappropriately.
 * Information-sharing skills e.g., None given, avoidance of jargon,
responsiveness to patient questions or concerns, provision of counseling
when appropriate, confident and skilful at giving information, attentive to
patient understanding; truthful.
 * Professional manner and rapport e.g., Condescending, offensive,
aggressive, judgmental, negative attitude to patient, or polite and
interested, warm, polite, empathic, concern for patient's comfort and
modesty, examinee's attention to personal hygiene, expression of interest
in the impact of the illness.
 * Listening skills: Interrupts patient inappropriately, impatient, attentive
to patient’s answers and concerns.
Communication can only be successful  * Organization of interview: Scattered, shot-gun approach, logical flow,
when both the sender and the receiver purposeful, integrated handling of encounter
understand the same information  * Closing: Abrupt, or acknowledges end of interview, or attempts
closure, or clear closure, or organized, thoughtful closure.
as a  * Compliance optimization: Did the candidate do everything possible
result of the communication. to optimize the patient’s compliance?

Take home messages References

 Communication is constant  Dianne Berry (2007). Health communication
 Communication is a process theory and practice. Open university press.
 Communication is transactional  Park’s Textbook of Preventive and Social
 Communication is learned
Medicine (21st edition)
 Communication is irreversible
 Communication is creative

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