Abstract
BackgroundVerbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim 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 and gender.MethodsDuring 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 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses.ResultsFemale students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy.ConclusionsUndergraduate 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. These results suggest that explicit communication training and feedback might be necessary to raise students’ awareness for the different aspects of communication and their interaction.
Highlights
Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter
The aim of our study was to analyze, whether and how well final year undergraduate medical students use skills of verbal and non-verbal communication during history taking and whether a correlation can be found with the empathy shown towards a standardized patient as observed by an external rater and with gender
In July 2011, 30 undergraduate medical students near graduation from the medical faculty of Hamburg University participated in a performance assessment resembling the first day of a beginning resident in hospital called UHTRUST (Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test), which had been developed in a cooperation between the universities of Utrecht and Hamburg [37]
Summary
Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. Verbal as well as non-verbal communication and empathy play an important role in patient-physician encounters. Affiliative styles of communication were shown to be positively related to patients’ satisfaction with a physician while a negative association of patients’ satisfaction with a physician correlated with dominant/active communication styles [1, 2]. An affiliative style of communication reduced patients’ anxiety and facilitated their openness whereas a dominant/active communication style displayed reprimanding or condescending features, which resulted in reduced patient disclosure and compliance [1]. A physician’s communication style seems to be very important for the first encounter with a new patient, because patients build their first impression of a physician by a strong focus on his or her communication style [1]. In patient-physician communication, a patient-centred approach is crucial which includes five aspects: a biopsychosocial perspective, the ‘patient-as-person’, sharing power and responsibility, therapeutic alliance, and ‘doctor-as-person’ [6]
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