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Patient Educ Couns. 2008 Apr;71(1):26-33. Epub 2008 Feb 21.

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

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  • 1Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States.



This study explores novel characterizations of turn taking structure and its interaction and evaluative correlates.


The Roter Interaction Analysis System (RIAS) was applied to videotapes of 51 physicians with a simulated patient (SP) to create a variety of novel turn taking measures including turn frequency, rate of interactivity, density, duration, and statement pacing.


Visits averaged 52 speaker turns with an interactivity rate of 3.9 turns per visit minute. For physicians, turn duration averaged 13.7 s with a turn density of 4.2 statements paced at one statement every 3 s. For the SP, turn duration was 3 s with a turn density of 1.4 statements paced at one statement every 2 s. More turns, briefer turn duration and faster physician pacing were significantly related to positive ratings of affective demeanor, interpersonal satisfaction and collaborative decision-making. These measures, and interactivity, were also associated with a RIAS-based patient-centeredness score and more overall patient talk.


Turn taking structures can be characterized in novel ways lending depth and richness to our understanding of dialogue, relationships to the patient-centeredness of a visit, and evaluative judgments of physician performance.


The study findings suggest specificity to the interviewing admonishment "talk less and listen more" by enhancing the interactivity of the dialogue and guarding against doctors tendency toward long monologues.

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