A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study.

Chunfeng Liu,Kathryn L Mccabe,Silas Taylor,Rafael A Calvo,Renee L Lim

doi:10.2196/jmir.6299

Abstract

BackgroundIn the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication.ObjectiveThis study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students.MethodsWe conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1–5 (group A) or to complete EQClinic training during weeks 8–11 (group B). EQClinic delivered an automated visual presentation of students’ nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6–7 and 12–13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students’ performance during face-to-face consultations pre- and postexposure to EQClinic.ResultsWe randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4–16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement.ConclusionsThe EQClinic is a useful tool for medical students’ clinical communication skills training that can be applied to university settings to improve students clinical communication skills development.

Highlights

There is good evidence that effective patient-clinician communication can positively influence patient health outcomes [1,2,3]
That we showed no significant difference between group scores in the second face-to-face assessment seems to indicate that the timing of exposure to EQClinic within a teaching curriculum did not influence students’ learning results
We showed that at the commencement of the curriculum, when students did not have significant knowledge of clinical communication skills, exposure to EQClinic yielded a measurable bump in their clinical communication skills

Summary

Introduction

There is good evidence that effective patient-clinician communication can positively influence patient health outcomes [1,2,3]. A clinician’s supportive expressions can help the patient to develop greater feelings of trust toward their clinician These feelings of trust lead to greater patient self-efficacy, where the patient is more likely to follow recommended therapies, resulting in a better treatment outcome [4]. This evidence has meant that more training programs are being offered to students to help them learn clinical communication skills. Despite the importance of communication skills, the time allocated to such training within medical curricula is often limited This is influenced, in part, by the logistics of providing large groups of medical students with access to SPs with whom they can practice and formulate their communication techniques. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication

Methods

Results

Discussion

Conclusion