Hence, no further revision was necessary. The CARE questionnaire was piloted with ten patient interviews five interviews of two patients by two independent raters MM, a physician, and DV, an educationalist. A maximum difference of eight points for the total score was defined as acceptable. After repeated discussion of the rating aspects, an acceptable agreement was reached. The videos were watched once for each questionnaire, i.
Of the 30 participating final year students, 22 were female and eight were male. This resulted in patient interviews altogether with patient histories taken by female students and 40 histories taken by male students. All students were in the final year of their undergraduate medical curriculum lasting 6 years in total.
The objective of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy. We found a significant correlation between verbal and non-verbal communication in our study. This could be interpreted as a sign for congruent communication, which is important for the interpersonal relationship [ 44 ].
This study also showed that inconsistent messages were associated with greater interpersonal distances, which might hamper the patient-physician relationship. The significant correlation of empathy with non-verbal communication but not with verbal communication supports the finding that physician involvement was associated with higher patient ratings of empathy and satisfaction [ 45 ]. Gaze and body orientation, two aspects of non-verbal communication, which were part of our observation scale, have been demonstrated to be important links to the perception of clinical empathy [ 46 ]. Furthermore, our findings support the idea, that non-verbal behaviour might be more important than verbal messages in the communication of empathy [ 47 ] and serves as the primary vehicle for expressing emotions [ 45 ].
Participants reached the highest scores for verbal and non-verbal communication skills with case 4, the female patient with difficulties to speak and swallow whom her husband accompanied. From patients with aphasia it is known, that family members want physicians to try to communicate with the patient [ 48 ]. Whether students behaved in this manner instinctively or whether they were encouraged to behave in this way by training cannot be distinguished.
hergaticcontdrop.ga With respect to gender differences, female students reached significantly higher scores than male students for verbal and non-verbal communication skills over all cases and in case 3, the woman with abdominal pain, and they received significantly higher scores for empathy in case 3. For communicating error disclosures, it is known that female physicians smiled more and were more attentive than male physicians were [ 49 ].
This might also be the case in our patient scenario with a female patient who was brought to the consulting room in a wheelchair because of severe abdominal pain. Another study reports empirical evidence for more signs of non-verbal and verbal ways of communication in female physicians including smiling, disclosing information about themselves, and encouraging and facilitating others to talk more freely [ 50 ].
The higher ratings for empathy are in line with another study, which showed that female students were more patient-centred than male students [ 51 ]. Furthermore, students in this study were more attuned to the concerns of patients of their own gender [ 51 ], which also might be the case with the patient in case 3. The patient in case 3 was interrupted most frequently after the shortest interval from the start of the conversation and the highest number of W-questions was asked.
Furthermore, in case 3 students have been shown to have asked significantly more questions about medical details than in any other case [ 38 ]. Case 3 covers the symptom abdominal pain, which is taught repeatedly in our 6-year undergraduate medical curriculum [ 36 ] and W-questions are important to distinguish differential diagnoses [ 52 ]. Our results might demonstrate, that students have studied the workup of patients with abdominal pain well.
However, female students were found to interrupt patients significantly earlier than male students over all cases. With respect to interrupting a conversation, the important finding in the literature is that the quality of the interruption needs to be distinguished as there is a cooperative and an intrusive way of interrupting [ 53 ]. In physician-patient interviews, female patients exhibited cooperative interruptions more frequently than male patients [ 54 ].
Whether this might be the case for the female students in our study and account for the higher frequency of interruptions by female students requires further investigation. The medical students in our study show a decline of empathy during their undergraduate medical education [ 55 ]. Unfortunately, this is in line with observations of other groups in undergraduate [ 56 ] and postgraduate [ 57 ] medical students. A strength of our study is the special format of a validated competency based assessment [ 37 ] with video material of student-patient encounters.
One weakness of this project is that only the CARE questionnaire is a validated instrument while the observation forms for signs of verbal and non-verbal communication were designed using aspects from the literature. Another strength of this project is the external rating of the patient interviews with the CARE questionnaire, which is independent of the personal perception of empathy by the simulated patients.
An additional weakness is the fact that the participant-patient encounters were only filmed with one camera, which does not allow for a very differentiated analysis of the facial mimic of participant and patient. Furthermore, the camera was visible and could have influenced the participants and the standardized patients in their reactions.
However, a strength is that a similar format of videotaping is used in our communication course, which allows differentiated video feedback to the participants. In conclusion, undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects and empathy in a competency-based assessment.
While their verbal communication correlated significantly with their non-verbal communication but not with their empathy, their empathy correlated significantly with their non-verbal communication. Female students interrupted the simulated patients earlier than male students but showed in several cases significantly more signs of non-verbal communication. Since verbal and non-verbal aspects of communication are known to have an important impact on the physician-patient-encounter, the differences in communicatory aspects measured in our study suggest explicit teaching of verbal and non-verbal aspects of communication in communication classes during undergraduate training.
Assessing different aspects of communication under simulated circumstances could be an important means for giving feedback to the students. No internal or external sources of funding were used to support this work. Data and materials can be obtained from the corresponding author upon request. DV and SH designed the study. MM coordinated the study and the data acquisition. DV and SH drafted the manuscript. All authors read and approved the final manuscript. Participation was voluntary, anonymized and with written consent. DV and MM declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Particular acknowledgment goes to our 4 trained clinical raters for their contribution to this work, and to James Brimicombe, our data manager, who developed the online rating system. Table 2 shows self-reported demographic characteristics of patients. Webb and P. Indeed, the importance of good communication is so critical that Australian guidelines list effective communication as part of the required conduct for all doctors. Despite evidence indicating that the average length of the patient-physician encounter has not changed significantly in recent years, 9 specific survey data indicate a correlation between patient participation in capitated health plans and shorter office visits. Patient Exp J. The categorical numerical variables were described using counts percentages and means SD or medians 25th percentile and 75th percentile.
First Online: 03 July Part of the following topical collections: Approaches to teaching and learning. Background Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. Methods During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in videos of physician-patient encounters.
Conclusions Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. Background Verbal as well as non-verbal communication and empathy play an important role in patient-physician encounters. Sample Of the 30 participating final year students, 22 were female and eight were male.
Significant gender differences could not be found. Table 1 Verbal communication. Table 2 Average number of W-questions. Students interrupted the patient in case 3, compared to all other cases, significantly earlier, already after 7. Patient Recruitment Data collection took place between August and July , with recruitment of 1 or 2 physicians at a time in each practice. Patient and Physician Ratings Immediately following the appointment, the patient was asked to complete a short questionnaire.
View this table: In this window In a new window. Table 1 Physician-Patient Communication Items. Trained Clinical Rater Ratings In addition to physician self ratings and patient ratings, 56 of the consultations were selected for rating by experienced, trained clinical raters all family physicians.