House staff nonverbal communication skills and standardized patient satisfaction

Charles H. Griffith, John F. Wilson, Shelby Langer, Steven A. Haist

Research output: Contribution to journalArticlepeer-review

150 Scopus citations


OBJECTIVE: To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills). DESIGN: Observational. SETTING: One university-based internal medicine residency program. PARTICIPANTS: Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, post-graduate year). RESULTS: Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station. CONCLUSION: Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

Original languageEnglish
Pages (from-to)170-174
Number of pages5
JournalJournal of General Internal Medicine
Issue number3
StatePublished - Mar 1 2003

Bibliographical note

Funding Information:
Supported by the Bayer Institute for Health Care Communication (grant 98-449).


  • Doctor-patient communication
  • Nonverbal communication
  • Standardized patients

ASJC Scopus subject areas

  • Internal Medicine


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