All American Institute of Medical Sciences

MD PROGRAMME
Spring, Midterm Examination February 27, 2015

COMMUNICATION SKILLS 11
Time allowed: 30 minutes
Sandra Delapenha

Candidates must NOT start writing their answers until told to do so

Answer ALL Questions using the Answer Sheet provided choosing the BEST Answer
No calculators are permitted in this examination.
No electronic devices capable of storing and retrieving text, including electronic dictionaries,
may be used.
DO NOT turn examination paper over until instructed to do so

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Please circle one letter for each question to indicate the one BEST answer
1. It is better to achieve, A sense of trust, harmony and cooperation, at a particular stage of the
Medical Interview when compared to any other. What stage or point is that?
a. During the Active Listening stage
b. While Setting the Agenda
c. During Information Management
d. When Responding to Emotion
e. Early in Rapport Building
2. Which is the least helpful approach in building rapport?
a. Attempting to develop trust
b. Finding something in common between you and patient
c. When talking to a patient who has a rather soft and meek voice, try to respond in a perky and animated
voice
d. Sharing a personal story with the patient
e. Attempting to match the body language of the patient
3. Which is not likely to be an outcome of building Rapport?
a. Patient cooperation with treatment plan
b. Good relationship between doctor and patient
c. Reduced ability to influence the patient
d. A closer match in between behavior of doctor and patient
e. A smoother flow through the interviewing process

4. According to the Kalamazoo Consensus Statement, the fundamental communication task in

Physician-patient communication is to:
a. Meet and greet the patient in a friendly professional manner
b. Understand the power of non-verbal communication
c. Avoid patterns of blocking behavior that inhibit the flow of information from the patient
d. Build a strong, therapeutic, and effective relationship
e. Gather information by means of probing, clarification and confirmation to maintain both perspective and
structure in an exchange
5. A growing body of evidence links effective physician-patient communication to certain desirable
outcomes. All the following are examples of these outcomes EXCEPT:
a. lower patient stress levels
b. improved patient compliance
c. higher physician satisfaction

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d. Increase physician paternalism
e. fewer medical malpractice lawsuits
6. A critique of the traditional approach to Dr-Patient relationship is that Doctors have tended to
emphasize one of the following, and given the others insufficient attention. Which one is it?
a. encouraging the role of the patients family
b. investigating the work environment
c. acknowledging the role of the community
d. focusing on the right diagnosis and the right medicine
e. emphasizing the effectiveness of empathy and rapport
7. Which of the following is not recommended when giving sad news
A. Summarize and offer support to the patient
B. Use simple and direct language
C. Delay revealing the bad information till the right time
D. Wait for signs that the family member is ready to listen for further information
E. Begin with open ended questions

8. For doctors, one of the following is unlikely to be an outcome of the use of effective
communications skills:
a. More accurate identification of patients problems
b. Patients who are more likely to work along with the doctor or health team, adhere to the treatment
protocol, and change behavior if needed or take advise
c. Patients psychological distress, sense of vulnerability and anxiety are lessened
d. Reduction in patients need to understand their treatment options and other proposed investigations
e. The doctors sense of well-being is improved
9. Many deficiencies in doctor-patient communication have been mention. Of the statements below,
which one is likely to be present when effective communication skills are used?
.
a. Psychosocial and psychiatric problems are common in general medical practice, but these diagnoses
are missed in up to 50% of cases
b. Approximately half the complaints and concerns of patients are not elicited by physicians
c. A high proportion of patients understand and remember what the doctor told them
d. Doctors often misperceive the amount and type of information patients want
e. In 50% of visits the patient and the doctor do not agree on the nature of the main presenting problem

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10. There are many social movements, thoughts, attitudes and prevailing opinions with which doctors
must contend in present-day society. Which of the following is not one of these?
a. Counterculture/social revolution (sexual revolution, Marijuana use.)
b. The rise of feminism
c. Rise of paternalism
d. Gay rights movement
e. Hispanic African-American Civil Rights Movement
11 Which of the following is said to be true of contemporary society
a. Increasing female literacy has not affected the presence of women in the labor market
b. Studies show that Fertility Rates have a weak correlation with female school enrollment
c. Life expectancy has made only moderate gains in low and middle income countries
d.

There has been an erosion of the Status Quo and the traditional role of the elites such as physicians

e. Communication technologies have been slow in their world-wide expansion

12. Which is not a characteristics of the emerging, new type of patient in the 21st Century?
a.

Patients insist on knowing more about potential treatment options

b. Patients proactively use the internet, to learn more about medical conditions,
c. Patients share medical information and interact with others on the internet around the world
d. There is an increasing trust of the healthcare system (the drug producers, regulators, etc.)
e.

An increasing demand that medical information be supported by real-world evidence

13. Which of the following is least consistent with the concept of Patient Centricity
a. Patients are becoming e-patient empowered by the internet
b. It implies a more collaborative and participatory relationship between patients and health care providers
c. It implies that patients want access to their data on-demand, at-will
d. For the physician, It implies that she (or he) remains the sole owner of health care knowledge
e. The doctors office becomes a welcoming place that puts into context the overwhelming information
available to patients

14. All of the following characterize the rise of health-care consumerism except
a. Mail order pharmacies
b. A rise in Alternative Care
c. Reduced access to assessments that distinguish between the performance levels of healthcare
providers
d. Medical advice and medical care online
e. Awareness of treatment options before hearing physicians advice

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15. All except one of the following are apropos statements in the context of modern patients
Customer Service expectations. Which is the exception?
a. Customer expectations are driven be increasing pressure for time
b. There is an expectation that service will become less personalized
c. Expectation are driven by broad experience with customer service revolutions in other industries (e.g.,
online banking)
d. Patients have better knowledge of health issues
e. Expectation are driven by more information and awareness of trends and activities in other jurisdictions
(especially US, Canada)

16. The recommended approach in Breaking Bad News is to:

A. Talk with the patient in a busy corridor with lots of activities that help distract the patient from too
much grief
B. Greet the patient and immediately give the news, so the patient gets it over with quickly.
C. Avoid dealing with too many questions at this time.
D. Distance yourself from the patient and the situation and avoid showing much emotion so you dont
become emotional yourself.
E. Wait for a few moments to allow family and friends to express, feel and convey emotion or grief
before moving on.

17. Non-committal verbalizations - mmh.. Hmm... Ok... I see...

a. Serves the function of a closed question
b. Tends to redirect and focus the patients thoughts
c. Interrupts the patients flow of ideas
d. An effective way to elicit patients concerns for setting an agenda
e. Makes the patient feel isolated
18. Which of the following is thought to contribute least to an empathic environment?
a. Adequate parking facilities
b. Comfort of waiting room chairs.....
c. Physicians dressing down rather than up
d. Friendliness of the staff
e. Punctuality of the physician.

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19. The doctor nods her head, leaning forward in her seat, saying Yes, and then or Uh-huh, go
on. This is an interviewing technique called:
a. Closed-ended questioning
b. Reflection
c. Confrontation
d. Interpretation
e. Facilitation
20. When communicating face-to-face, negativity is often apparent when a participant:
a. Leans forward in his chair
b. Crosses his legs
c. Crosses his arms across his chest
d. Rests his chin on his hand
e. Nods his head frequently
21. In an attempt to be patient-centered, the doctor is applying the FIFE approach. Which of the
following questions would NOT be asked
a. What are you most concerned about?"
b. Did you notice those symptoms before you attended the banquet?
c. What do you think this pain means?"
d. How has your illness affected you day to day?
e. Do you have expectations about how doctors can help?
22. Which of the following is the best overall approach to gain an understanding of the PPI (patients
perspective on illness)?
a. Use of Reassurance
b. Use of Interpretation
c. Use of Positive Reinforcement
d. Use of Summation
e. Use of Active Listening
23. In a skit depicting Management of Information, a doctor addresses a patient during an office visit.
Which of the following scenarios suggests the least competent application of this skill?
a.

To an elderly patient who has been speaking about fears of dying: Doctor: Aging causes many people
to think about death.

b. To a patient who has just recounted an painful incident and begins to cry: Doctor .[: silence]
c. To an older patient suffering from insomnia: Doctor: You will be given a small dose of medication that
will make you sleepy. You take it only at night. It is a small blue pill, in this blue bottle
d. While interviewing, for the first time, a new patient who complains of depression: Doctor Do you have a
husband or boyfriend? In may be helpful to include him in discussions

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e. To a middle-aged patient on a days sick-leave from his job: Doctor :I just want to make sure that Ive
gotten everything right up to this point: you say you have elevated temperature, feelings of nausea and
frequent urination
24. Which of the following statements by a doctor is not Active Listening?
a. Obviously youve given the cause some thought. What things cross your mind about the cause of this
problem?
b. What about the pain has you upset
c. What has you so concerned about this headache?
d. I can see you are concerned. How long have you had the headaches?
e. You mentioned it being awful. What did you mean by that
25. A discussion with a doctor over the telephone would likely exclude which of the following?
a. Identification of patient problems
b. Need by the doctor to maintain an unconditional positive regard for the patient
c. Referring to the patient by his/ her preferred form of address
d. Non-verbal communication
e. Showing an authentic interest in the patient

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