How Do Medical Students Respond to Emotional Cues and Concerns Expressed by Simulated Patients during OSCE Consultations? – A Multilevel Study

Yuefang Zhou,Alex Collinson,Anita Laidlaw,Gerry Humphris

doi:10.1371/journal.pone.0079166

Abstract

ObjectivesHow medical students handle negative emotions expressed by simulated patients during Objective Structured Clinical Examinations (OSCE) has not been fully investigated. We aim to explore (i) whether medical students respond differently to different types of patients’ emotional cues; and (2) possible effects of patients’ progressive disclosure of emotional cues on students’ responses.MethodsForty OSCE consultations were video recorded and coded for patients’ expressions of emotional distress and students’ responses using a validated behavioural coding scheme (the Verona Coding Definitions of Emotional Sequence). Logistic multilevel regression was adopted to model the probability of the occurrence of student reduce space response behaviour as a function of the number of patients’ expressions of emotional cues.ResultsWe found that medical students offered responses that differed to emotional cue types expressed by simulated patients. Students appeared to provide space to emotional cues when expressed in vague and unspecific words and reduce space to cues emphasizing physiological or cognitive correlates. We also found that medical students were less likely to explore patients’ emotional distress nearer the end of the consultation and when the duration of a patient speech turn got larger. Cumulative frequency of patients’ emotional cues also predicted students’ reduce space behaviour.Practical ImplicationsUnderstanding how medical students manage negative emotions has significant implications for training programme development focusing on emotion recognition skills and patient-centred communication approach. In addition, the statistical approaches adopted by this study will encourage researchers in healthcare communication to search for appropriate analytical techniques to test theoretical propositions.

Highlights

An empathic response to patient’s emotional needs is one of the key features of patient-centred care [1,2,3,4]
While investigating medical students’ immediate responses to different cue types, we aimed to explore how simulated patients progressively extend disclosure of their emotional cues and the effect this has on student responses
This study describes how medical students manage emotional cues and concerns expressed by simulated patients in their Objective Structured Clinical Examinations (OSCE) consultations

Summary

Introduction

An empathic response to patient’s emotional needs is one of the key features of patient-centred care [1,2,3,4]. Del Piccolo et al [21] categorised responses into three groups using the Verona Coding Definitions of Emotional Sequence (VR-CoDES) [24,25]: (i) provide space in a non-explicit way, providing space with explicit reference to either (ii) the affective or (iii) the factual content. Using multinomial regression, they modelled the immediate responses of psychiatrists to cues and concerns of the patient considering patient, psychiatrist and consultation variables. Researching impacts of provider response to patient emotionally charged expressions on patient outcomes has received increasing attention in recent years [26,27], no studies, have yet researched the communication influences on health outcomes adopting a multilevel approach

Objectives

Methods

Results

Discussion

Conclusion