Dobbs and Carek provide an avenue for understanding both the marked popularity and reported effectiveness of the integrated program outlined above (23). They make the point that medical interviewing represents a complex matrix that includes not only obvious skills, such as engagement behaviors and empathic verbalizations, but also a complicated set of internal thought processes and decision trees. These processes include understanding the data base requirements and selecting the information areas that are most important considering time constraints and clinical task. Other complex thought processes include an ability to compare in-coming data with the previous knowledge base, an ability to synthesize knowledge on the spot, and hypothesis testing (as seen in differential diagnosis). Finally, the interviewer must also have an ability to utilize this material in an effective manner in the ongoing interview and an ability to flexibly adapt to the defenses of the patient.Unlike many medical and psychiatric interviewing courses reported in the literature, our course assumes from the start that all of the above skills must be given in-depth attention and emphasizes their interrelationship in actual clinical practice. Engagement skills are taught hand-in-hand with structuring techniques, and emphasis is placed on helping trainees understand the patient'score psychological pain at the same time diagnostic interviewing is explored. In addition, trainees are taught to flexibly alter their styles to suit the clinical task. For example, in one class the instructor demonstrates a relatively structured emergency room evaluation, and in another class, the same instructor demonstrates a relatively unstructured psychodynamic assessment from which the students jointly create a psychogenetic formulation.The integrated approach is complemented by the individualization of instruction, which is one of the leading reasons for trainee satisfaction. The individualization begins with the videotape session in which the instructor finds out the trainee's strengths and weaknesses and continues through the use of direct supervision and self-monitoring. In our opinion, the experiential emphasis of the program and the use of direct and videotape supervision are the most powerful agents for change. The following principles summarize what we have learned about developing an interviewing curriculum design for psychiatric residents:1. Residents respond enthusiastically to a program rooted in a broadly based theoretical understanding. (The presence of different disciplines among the trainees can enhance this process but is not necessary.)2 It is valuable to focus on methods of helping the resident integrate numerous skills, such as engagement techniques, DSM-III-R diagnosis, structuring techniques, and psychodynamic understanding, as they appear in actual clinical practice.3. The course should occur in a setting in which the principles are immediately clinically applicable and experiential learning is emphasized.4. Individualized training, in which the weaknesses and strengths of the resident are delineated, is perceived as very helpful by most trainees.5. Specific goals for the individual should be defined with a concise and clarifying supervisory language.6. Progress should be monitored continuously.7. It is valuable to provide access to a range of educational techniques such as a core textbook, supplemental readings, didactics, and various forms of direct and indirect supervision.8. Feedback from residents, including their attitudes toward the quality of specific techniques and their preference for specific techniques, should be carefully evaluated.Further research is needed to determine which educational techniques may be most cost effective. Depending on the availability of resources, the above principles can be im-plemented in a flexible fashion. For instance, our program meets the need for a wellgrounded theoretical foundation through the use of didactics, a textbook dedicated to interviewing process, and supplemental readings. This same principle could be achieved without the use of lecture material using a small group seminar and a textbook.Future areas for research include the following: outcome studies with control groups to determine the overall effectiveness of interviewing courses as well as the efficacy of specific educational techniques; the development of methods for rapidly matching trainees with the educational techniques that best suit their individual needs; improved systems for delineating specific trainee weaknesses; longitudinal studies of the long-term impact of the training; and further studies on the impact of training programs on the trainee's attitudes toward learning itself and toward the supervision process.In the long run, one of the major goals of interviewing programs such as ours is to stimulate intellectual excitement about the interviewing process. It is hoped that this excitement will involve residents in an ongoing evaluation of their interviewing styles. Only if this openness for future learning has been achieved can a training program fulfill its promise. As Sir William Osler astutely observed, "The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation" (24).