Associations of medical student empathy with clinical competence

ObjectiveEmpathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence.MethodsThis study combined cross-sectional data from four consecutive years of medical students (N = 590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, andObjectiveStructured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity.ResultsJSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests.ConclusionJSPE scores were positively associated with OSCE communication scores in medical students.Practice implicationsThis study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age.     

Existing instruments for assessing physician communication skills: Are they valid in a computerized setting?

ObjectivesThis study aims to highlight the differences in physicians’ scores on two communication assessment tools: the SEGUE and an EMR-specific communication skills checklist. The first tool ignores the presence of the EMR in the exam room and the second, though not formally validated, rather focuses on it.MethodsWe use the Wilcoxon Signed Ranks Test to compare physicians’ scores on each of the tools during 16 simulated medical encounters that were rated by two different raters.ResultsResults show a significant difference between physicians’ scores on each tool (z = −3.519, p < 0.05 for the first rater, and z = −3.521, p < 0.05 for the second rater), while scores on the EMR-specific communication skills checklist were significantly and consistently lower.ConclusionThese results imply that current communication assessment tools that do not incorporate items that are relevant for communication tasks during EMR use may produce inaccurate results.Practice implicationsWe therefore suggest that a new instrument, possibly an extension of existing ones, should be developed and empirically validated.     

Voices emerging from the shadows: Radiologic practitioners’ experiences of challenging conversations

ObjectiveTraditionally, radiologists have practiced their profession behind the scenes. Today, radiologic practitioners face mounting expectations to communicate more directly with patients. However, their experiences with patient communication are not well understood. The aim of this study was to describe the challenges of radiologic practitioners when communicating with patients.MethodsTwelve day-long interprofessional communication skills workshops for radiologic clinicians were held at Boston Children’s Hospital. Prior to each workshop, participants were asked to write narratives describing experiences with difficult radiologic conversations that they found particularly challenging or satisfying. The narratives were transcribed and analyzed through thematic content analysis by two researchers.ResultsRadiologists, radiology trainees, technologists, nurses, and medical interpreters completed 92 narratives. The most challenging aspects of healthcare conversations included: Conveying Serious News (n = 44/92; 48%); Expanded Scope of Radiologic Practice (n = 37/92; 40%); Inexperience and Gaps in Education (n = 15/92; 16%); Clinical Uncertainty (n = 14/92; 15%); and Interprofessional Teamwork (n = 9/92; 10%).ConclusionRadiologic clinicians face substantial communicative challenges focused on conveying serious, unexpected and uncertain diagnoses amid practical challenges and limited educational opportunities.Practice implicationsInnovative educational curricula that address these challenges may enhance radiologic practitioners’ success in adopting patient-centered communication.     

Breaking bad news to patients with cancer: A randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients

ObjectiveThis study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures.MethodsThis randomized control study (N = 66) compared intervention and control groups of students (n = 28) and residents’ (n = 38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures.ResultsFollow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p = 0.007, r = −0.47; breast cancer (BC), p = 0.003, r = −0.53), attention to patient responses after BBN (CC, p < 0.001, r = −0.74; BC, p = 0.001, r = −0.65), and addressing feelings (BC, p = 0.006, r = −0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r = −0.43), communication related to emotions (p = 0.034, r = −0.30), determining patient’s readiness to proceed after BBN and communication preferences (p = 0.041, r = −0.28), active listening (p = 0.011, r = −0.37), addressing feelings (p < 0.001, r = −0.65), and global interview performance (p = 0.001, r = −0.51).ConclusionThis brief BBN training module is an effective method of improving BBN communication skills among medical students and residents.Practice implicationsImplementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.     

The impact of expert- and peer feedback on communication skills of undergraduate dental students – a single-blinded,randomized, controlled clinical trial

ObjectiveTo evaluate the effect of peer- and expert feedback on communication skills of undergraduate dental students.MethodsAll students of the first clinical treatment course (n = 46) were randomly assigned into two groups. For three times a medical-dental interview/consultation of each student with a real patient was videotaped. After every consultation the videos were assessed either by a person experienced in communication (expert group) or by a fellow student (peer group), giving the students feedback regarding their chairside performed communication skills. Before and after the feedback-interventions all students conducted an interview with simulated patients, which was rated using a validated global rating and analyzed statistically.ResultsGlobal ratings mean scores after feedback-intervention were significantly improved (p < 0.05). Thereby, no significant differences in the overall assessment could be observed between expert and peer feedback (p > 0.05).ConclusionDuring this study students improved their communication skills in dentist-patient interactions. The communication experience of the feedback provider seems not to have any impact on the communication skills in undergraduate dental students.Practice implicationsThe clinical courses in dentistry offer the opportunity to implement peer-feedback interventions in real treatment situation as part of communication training to longitudinally improve communication skills.     

Designing,delivering and evaluating a distance learning nursing course responsive to students needs

Background and purposeThe majority of available studies in distance learning in nursing and health lack the sufficient details of course design and delivery processes which greatly affect the learning outcomes. Also, little is available about the fairness of this method of education to students with limited access to course resources. We describe the design and delivery processes and experience, in terms of satisfaction and achievement, of undergraduate nursing students in a distance course. The difference in achievement between the distance students and a comparable cohort of hybrid students is also examined. We also demonstrate the possibility of providing accessible education to students with limited technological resources.MethodsParticipants included all undergraduate nursing students who were enrolled in a distance and a hybrid section of a communication skills course offered at a School of Nursing in Jordan. The distance course was created using Blackboard and Tegrity learning management systems. The design and delivery processes of the distance course incorporated three pedagogical principles that enhance: (a) course access and navigation; (b) communication and interaction; and (c) active and collaborative learning experiences. After course completion, distance students completed a 27-item satisfaction questionnaire. Achievement in the course and correlates of satisfaction were measured.ResultsThe final sample included 25 students in the distance section and 35 in the hybrid section (N = 60). The mean score of overall satisfaction in the distance section was 4.14 (0.32) out of a 5-point scale, indicating a high satisfaction. Results revealed significant associations between total satisfaction score and achievement in the distance course, grade expected in the course, and frequency of accessing the course materials (p < .05). All distance students, including students with limited technological resources available at home, managed to successfully complete the course. Major concerns reported by distance students were related to lack of time management skills and negative attitudes toward group assignments. The mean final course grade of the distance section (80 ± 8.2) was significantly higher than the hybrid section (72.2 ± 9.5), (t = 3.5, p < .05).ConclusionsThe use of effective instructional strategies resulted in delivering successful distance learning, even for students with limited resources. Institutions have to make strategic decisions on how to optimize the use of technology to fit their individualized learning environments. Instructors need to become familiar with the characteristics of students cohort served by the course and design the course accordingly. In addition, students should be guided on how to manage their time in distance learning environments and work effectively in group assignments.     

The effect of multimedia-based education on students’ anger management skill

IntroductionAnger leads to behaviors that cause a lot of damage. Life skills training can be effective in controlling anger because anger is due to a lack of skills and unpredictability of the situation. The present study aimed to determine the effect of multimedia-based education on students’ anger management skill.Material and methodsThe quasi-experimental study was performed on 88 students of Anesthesiology, Nursing, Midwifery and Operating Room of North Khorasan Nursing and Midwifery School. The educational content was screened through the monitor in front of the main hall of the Nursing & Midwifery School during the students’ attendance for one week. Students’ anger control skills were assessed by tests paired T-test, independent T-test and one-way ANOVA. Data were analyzed using spss16 software.ResultsThe mean age of the students was 20 ± 2.3. Regarding the effect of multimedia-based education on students’ anger control skills, the mean of anger control score was 24.61 ± 2.83 (Min = 11 and Max = 33) before the intervention, and 28.64 ± 2.40 after the intervention. There was a significant difference in mean scores before and after the intervention (P = .000).ConclusionMultimedia-based education has been effective in controlling students’ anger. Given the effect of multimedia-based education on anger control skills, this approach can be used to teach other essential topics to students, including life skills, especially in health science students.     

Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

Effectiveness of training final-year undergraduate nutritionists in motivational interviewing

ObjectivesTo assess the efficacy of a motivational interviewing (MI) training programme on trainee nutritionists.MethodsA repeated measures design was applied to assess clinician behaviours in a ‘helping’ conversation. Participants were 32 nutrition students, assessed at baseline and one-month follow-up.ResultsThe training significantly reduced the use of closed questions and MI non-adherent behaviours (MINA) (P for both = <0.001). Trainees significantly increased reflections, affirmations, summaries (P for all = <0.001) and the use of open questions (P = <0.013) which are all key indicators of MI beginner-competence. The talk-time ratio of the nutritionists also changed significantly, in favour of the client which serves as an indication of MI being used effectively. There were also significant increases in ‘global' scores for empathy, direction, autonomy/support, collaboration and evocation.ConclusionsNewly trained nutritionists 1 month post-training have a consultation style which suggested positive outcomes for clients. The trainees' scores at the one month post-training assessment were verifiable as ‘beginning proficiency'.Practice implicationsBehaviour change counselling skills for nutritionists were enhanced, at one month post-training. MI training workshops with video feedback enhances communication skills which are likely to lead to positive consultation-behaviour changes in the trainee nutritionists.     

Concordancia competencial entre el Examen Clínico Objetivo Estructurado y la prueba de casos clínicos computarizados de Medicina: ¿estamos evaluando lo mismo?

BackgroundIn the 2020-21 academic year, Spanish medical schools carried out an assessment with computerised clinical cases (called CCS-OSCE) and some, in addition, a conventional OSCE with simulators and simulated patients (CS-OSCE). The inter-faculty OSCE Committee assumed the competencies assessed with both tests to be equal. The aim of the study is to check their similarity by assessing the concordance of students' results in the competencies assessed with the two tests.Methods108 students participated in the CCS-OSCE of 10 clinical cases and a CS-OSCE of 12 stations. There were two versions of the CS-OSCE to reduce the copying effect among students. The CCS-OSCE had 303 items, and the CS-OSCE had 320 and 321 items. The five competency domains assessed with both tests were: anamnesis, clinical examination, clinical judgement, prevention and professionalism. The internal consistency of both OSCE was measured with Cronbach's alpha. Correlation between competency domains was tested with Pearson's correlation coefficient (R).ResultsStudents obtained similar overall mean scores in both tests (ECOEs-CS: 69.54%; ECOE-CCS: 71.35%). There were significant differences in 4 of 5 competency domains assessed by both tests. The internal consistency with respect to their competence domains was: ECOE-CS-1 α = 0.62; ECOE-CS-2 α = 0.54 and ECOE-CCS α = 0.38. No correlation was found between students' overall scores in the two tests (R = 0.184; p = 0.056), nor between the similar competency domains assessed with both tests (R = –0.2 to 0.37).ConclusionThe results do not support the similarity of competences assessed with both tests. Further studies will be necessary in order to define the competences assessed with the CCS-OSCE.     

Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication

ObjectivesMedically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans’ MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement.MethodsVeterans experiencing MUS (n = 204) reported on their primary care providers’ communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement.ResultsVeterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients’ illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction.Conclusions and practice implicationsProviders’ interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.     

Examiner characteristics and interrater reliability in a communication OSCE

ObjectiveTo identify inter-individual examiner factors associated with interrater reliability in a summative communication OSCE in the 4th study year.MethodsThe OSCE consists of 4 stations assessed with a 4-item 5-point global rating instrument. A bivariate secondary analysis of interrater reliability in relation to 4 examiner factors (gender, profession, OSCE experience, examiner training) was conducted. Intraclass correlation coefficients (ICC) were calculated and compared between examiner dyads of different similarity.Results169 pairwise ratings from 19 different examiners in 16 dyads were analysed. Interrater reliability is significantly higher in examiner dyads of same vs. different gender (ICC = 0.76 (95%CI = 0.65-0.83) vs. ICC = 0.41 (95%CI = 0.21-0.57)), in dyads of two clinicians vs. non-clinical/mixed professions (ICC = 0.72 (95%CI = 0.56-0.83) vs. ICC = 0.57 (95%CI = 0.41-0.69)), and in dyads with high vs. low/mixed OSCE experience (ICC = 0.73 (95%CI 0.50-0.87) vs. ICC = 0.56 (95%CI = 0.41-0.69)). Participation in recent examiner training had no influence on ICCs.ConclusionBetter concordance of ratings between clinically active examiners might be a hint for context specificity of good communication. Higher interrater reliability between examiners with same gender may indicate gender-specific communication concepts.Practice implicationsMedical faculties introducing summative assessment of communication competence should focus the influence of examiner characteristics on interrater reliability.     

The impact of the learning environment sudden shifts on students’ performance in the context of the COVID-19 pandemic

IntroductionThis study aims to determine the effect of sudden changes in learning environments on students’ performance, in the context of the COVID-19 pandemic lockdown. We present an analysis of the kinesiology program, focusing on the learning modality changes through the years, and its impact on students’ performance.MethodsWe analyzed three periods over five years. During the Pre-pandemic period (2018-2019), classes had been taught in-person, during the pandemic (2020-2021) classes had been taught online, and during end of lockdown (2022) classes had return to in-person modality. In addition, we also examined the academic performance outcomes by gender during the three periods.ResultsWe found that the academic performance significantly increased in all cohort of career, increasing the average grade from 4.7 ± 0.08 (2018 to 2019, in-person) to 5.15 ± 0.07 during the pandemic period, from 2020 to 2021, when online modality was utilized. Furthermore, when returning to in-person classes in 2022, the academic performance reduced significantly to 4.6 ± 0.17. We also found that gender did not have an influence on academic performance in any of the learning environments presented. However, during clinical internships, we found that gender had a significantly effect on academic performance.ConclusionBased on these results, we conclude that the sudden shift from in-person learning to online learning modality helped improved the learning performance of student, reflecting those results on better students’ performance scores that could be associated with the enhanced efficient use of time.     

Análisis de la ansiedad en los primeros encuentros clínicos: experiencias utilizando la simulación clínica en estudiantes de pregrado

IntroductionThe first clinical encounters trigger strong feelings and emotions in medical students, when facing complex illnesses, and by feelings of guilt of «using patients’ sufferings» for their learning purposes. Clinical simulation offers them an opportunity for experiencing anxiety in a safe environment prior to being involved in the hospital. The objective of this work was to assess the level of anxiety in the first clinical encounters through clinical simulation experiences in undergraduate students.Material and methodsWe used the Inventory of Anxiety in Clinical Simulation Scenarios in a sample of 49 students. This instrument is made up of 25 items grouped into 7 factors. ANOVA test was considered to evaluate the trends by factor, for the analysis of the data.ResultsWe found an average of 2.67. In considering the gender as a factor, significant difference was obtained by using ANOVA (P = 0.016). The results of trends by factor show significant differences in corporal expressions (P = 0.003), concern about how others perceive me (P = 0.007) and worries about self-image (P = 0.019).DiscussionAssessment is of great value in medical school programs, where it becomes one of the vital elements in designing each activity developed throughout the career. Anxiety is present along the training program, having a positive or negative impact on student learning and performance, according to the way it is handled. Assessing knowledge and skills is imperative, therefore both anxiety and assessment go hand in hand. Different types of assessment can generate different levels and manifestations of anxiety in students.     

Specifying the effects of physician's communication on patients’ outcomes: A randomised controlled trial

ObjectiveTo experimentally test the effects of physician's affect-oriented communication and inducing expectations on outcomes in patients with menstrual pain.MethodsUsing a 2 × 2 RCT design, four videotaped simulated medical consultations were used, depicting a physician and a patient with menstrual pain. In the videos, two elements of physician's communication were manipulated: (1) affect-oriented communication (positive: warm, emphatic; versus negative: cold, formal), and (2) outcome expectation induction (positive versus uncertain). Participants (293 women with menstrual pain), acting as analogue patients, viewed one of the four videos. Pre- and post video participants’ outcomes (anxiety, mood, self-efficacy, outcome expectations, and satisfaction) were assessed.ResultsPositive affect-oriented communication reduced anxiety (p < 0.001), negative mood (p = 0.001), and increased satisfaction (p < 0.001) compared to negative affect-oriented communication. Positive expectations increased feelings of self-efficacy (p < 0.001) and outcome expectancies (p < 0.001), compared to uncertain expectations, but did not reduce anxiety. The combination of positive affect-oriented communication and a positive expectation reduced anxiety (p = 0.02), increased outcome expectancies (p = 0.01) and satisfaction (p = 0.001).ConclusionBeing empathic and inducing positive expectations have distinct and combined effects, demonstrating that both are needed to influence patients’ outcomes for the best.Practice implicationsContinued medical training is needed to harness placebo-effects of medical communication into practice.     

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial

ObjectiveAppropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills.MethodsFirst-year nursing students (N = 36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example’s correctness) and elaborated feedback (the true explanation).ResultsParticipants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group.ConclusionThe worked example effect was successfully adapted for learning in the provider-patient communication domain.Practice ImplicationsImplementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.     

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity

ObjectiveTo examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association.MethodsWe conducted a cross-sectional secondary data analysis with the 2011–2013 Medical Expenditures Panel Survey of parents with children ages 6–12 (n = 5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity.ResultsParents of obese children were more likely to report that their child’s healthcare provider listened carefully (OR = 1.41, p = 0.002) and spent enough time (OR = 1.33, p = 0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p < 0.001) and spending enough time (p = 0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p = 0.043) and listened carefully (p = 0.012), respectively.ConclusionParents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian.Practice implicationsHealthcare providers should ensure effective communication with obese parents of obese children.     

Audiologist-patient communication profiles in hearing rehabilitation appointments

ObjectiveTo profile the communication between audiologists and patients in initial appointments on a biomedical-psychosocial continuum; and explore the associations between these profiles and 1) characteristics of the appointment and 2) patients’ decisions to pursue hearing aids.MethodsSixty-three initial hearing assessment appointments were filmed and audiologist-patient communication was coded using the Roter Interaction Analysis System. A hierarchical cluster analysis was conducted to profile audiologist-patient communication, after which regression modelling and Chi-squared analyses were conducted.ResultsTwo distinct audiologist-patient communication profiles were identified during both the history taking phase (46 = biopsychosocial profile, 15 = psychosocial profile) and diagnosis and management planning phase (45 = expanded biomedical profile, 11 = narrowly biomedical profile). Longer appointments were significantly more likely to be associated with an expanded biomedical interaction during the diagnosis and management planning phase. No significant associations were found between audiologist-patient communication profile and patients’ decisions to pursue hearing aids.ConclusionInitial audiology consultations appear to remain clinician-centred. Three quarters of appointments began with a biopsychosocial interaction; however, 80% ended with an expanded biomedical interaction.Practice implicationsFindings suggest that audiologists could consider modifying their communication in initial appointments to more holistically address the needs of patients.