Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France.
Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609, Brest, France.
BMC Med Educ. 2020 Dec 4;20(1):491. doi: 10.1186/s12909-020-02401-0.
Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients' satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses.
Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis.
From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task 'Gathering information' (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for 'Exploration of the patients' problems to discover the biomedical perspective' (p = 0.007), 'Exploration of the patients' problems to discover background information and context' (p = 0.0004) and for 'Closing the session - Forward planning' (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups.
Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students' awareness for this type of communication and increase doctor-patient interaction effectiveness.
言语和非言语交流以及同理心是医患互动的核心，与患者的满意度有关。非言语交流往往会压倒言语信息。本研究旨在分析医学生在使用角色扮演（SRP）和演员模拟患者（ASP）两种不同教学方法时如何使用言语和非言语交流，以及在两种不同姿势下非言语行为是否不同。
三位评估者评估了 20 名扮演医生角色的学生，其中 10 名来自 SRP 组，10 名来自 ASP 组。使用卡尔加里-剑桥参考观察指南（CCG）对视频进行分析，为了更准确地评估非言语交流，我们还评估了紧张和姿势的迹象。同理心采用 CARE 问卷进行评估。采用独立的曼-惠特尼 U 检验和 Qhi 平方检验进行统计分析。
从 CCG 得分的 6 项主要任务中，我们在 ASP 组中获得了更高的“收集信息”任务得分（p=0.0008）。关于 CCG 的 17 个描述符，ASP 组在“探索患者的问题以发现生物医学视角”（p=0.007）、“探索患者的问题以发现背景信息和背景”（p=0.0004）和“结束会议-前瞻性规划”（p=0.02）方面的得分明显更高。关于非言语行为项目，与 SRP 组相比，ASP 组的紧张程度明显更高（p<0.0001）。关于同理心，SRP 组和 ASP 组之间没有差异。
医学生在两种沟通技巧培训方法中表现出不同的言语和非言语沟通行为。这些结果表明，这两种方法都有一定的优势，可能需要更明确的非言语沟通培训，以提高学生对这种沟通方式的认识，并提高医患互动的效果。
