Effects of micro- and subtle-expression reading skill training in medical students: A randomized trial

Do educational interventions reduce the gender gap in communication skills?- a systematic review

BACKGROUND

Efficient doctor-patient communication is essential for improving patient care. The impact of educational interventions on the communication skills of male and female students has not been systematically reviewed. The aim of this review is to identify interventions used to improve communication skills in medical curricula and investigate their effectiveness in improving the communication skills of male and female medical students.

METHODS

A systematic review of the literature was conducted using the PRISMA guidelines. Inclusion criteria were as follows: used intervention strategies aiming to improve communication skills, participants were medical students, and studies were primary research studies, systematic reviews, or meta-analyses.

RESULTS

2913 articles were identified based on search terms. After title, abstract, and full-text review, 58 studies were included with interventions consisting of Training or Drama Courses, Curriculum-Integrated, Patient Learning Courses, and Community-Based Learning Courses. 69% of articles reported improved communication skills for both genders equally, 28% for women more than men, and 3% for men more than women. 16 of the 58 articles reported numerical data regarding communication skills pre-and post-intervention. Analysis revealed that post-intervention scores are significantly greater than pre-intervention scores for both male (p < 0.001) and female students (p < 0.001). While the post-test scores of male students were significantly lower than that of female students (p = 0.01), there is no significant difference between genders for the benefits, or difference between post-intervention and pre-intervention scores (p = 0.15), suggesting that both genders benefited equally.

CONCLUSION

Implementation of communication training into medical education leads to improvement in communication skills of medical students, irrespective of gender. No specific interventions benefitting male students have been identified from published literature, suggesting need of further studies to explore the phenomenon of gender gap in communication skills and how to minimize the differences between male and female students.

Relationship between low mood and micro-expression processing: evidence of negative bias in interpreting fleeting facial expressions

Depression affects the recognition of emotion in facial expressions by reducing the detection accuracy and adding a bias towards negativity. However, no study has examined associations between depression and the recognition of microfacial expressions (fleeting facial cues of emotions in people's faces). Thus, we investigated associations between low mood and micro-expression processing using video stimuli of micro-expressions. We examined whether (i) individuals with low mood had trouble recognizing emotions, (ii) were more likely to perceive happy facial expressions as neutral and neutral facial expressions as sad, and (iii) recognized sad emotional expressions better than control subjects (n = 349). We found that participants with low mood showed poorer performance when judging emotions in faces (p = 0.03). Furthermore, there was a specific deficit among them in recognizing happiness. Lastly, participants with low moods were more likely to perceive neutral faces as sad (p = 0.042). However, no evidence was found that individuals with low moods confused happy faces as neutral or were better than the control group at recognizing sad faces. Our results show that mood affects the perception of emotions in facial expressions, which has the potential to negatively affect interpersonal interactions and ultimately quality of life.

Trainee psychotherapists' emotion recognition accuracy improves after training: emotion recognition training as a tool for psychotherapy education

Introduction

Psychotherapists' emotional and empathic competencies have a positive influence on psychotherapy outcome and alliance. However, it is doubtful whether psychotherapy education in itself leads to improvements in trainee psychotherapists' emotion recognition accuracy (ERA), which is an essential part of these competencies.

Methods

In a randomized, controlled, double-blind study (N = 68), we trained trainee psychotherapists (57% psychodynamic therapy and 43% cognitive behavioral therapy) to detect non-verbal emotional expressions in others using standardized computerized trainings - one for multimodal emotion recognition accuracy and one for micro expression recognition accuracy - and compared their results to an active control group one week after the training (n = 60) and at the one-year follow up (n = 55). The participants trained once weekly during a three-week period. As outcome measures, we used a multimodal emotion recognition accuracy task, a micro expression recognition accuracy task and an emotion recognition accuracy task for verbal and non-verbal (combined) emotional expressions in medical settings.

Results

The results of mixed multilevel analyses suggest that the multimodal emotion recognition accuracy training led to significantly steeper increases than the other two conditions from pretest to the posttest one week after the last training session. When comparing the pretest to follow-up differences in slopes, the superiority of the multimodal training group was still detectable in the unimodal audio modality and the unimodal video modality (in comparison to the control training group), but not when considering the multimodal audio-video modality or the total score of the multimodal emotion recognition accuracy measure. The micro expression training group showed a significantly steeper change trajectory from pretest to posttest compared to the control training group, but not compared to the multimodal training group. However, the effect vanished again until the one-year follow-up. There were no differences in change trajectories for the outcome measure about emotion recognition accuracy in medical settings.

Discussion

We conclude that trainee psychotherapists' emotion recognition accuracy can be effectively trained, especially multimodal emotion recognition accuracy, and suggest that the changes in unimodal emotion recognition accuracy (audio-only and video-only) are long-lasting. Implications of these findings for the psychotherapy education are discussed.

A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students

Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices.

Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome.

Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture.

Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.

Training Emotion Recognition Accuracy: Results for Multimodal Expressions and Facial Micro Expressions

Nonverbal emotion recognition accuracy (ERA) is a central feature of successful communication and interaction, and is of importance for many professions. We developed and evaluated two ERA training programs-one focusing on dynamic multimodal expressions (audio, video, audio-video) and one focusing on facial micro expressions. Sixty-seven subjects were randomized to one of two experimental groups (multimodal, micro expression) or an active control group (emotional working memory task). Participants trained once weekly with a brief computerized training program for three consecutive weeks. Pre-post outcome measures consisted of a multimodal ERA task, a micro expression recognition task, and a task about patients' emotional cues. Post measurement took place approximately a week after the last training session. Non-parametric mixed analyses of variance using the Aligned Rank Transform were used to evaluate the effectiveness of the training programs. Results showed that multimodal training was significantly more effective in improving multimodal ERA compared to micro expression training or the control training; and the micro expression training was significantly more effective in improving micro expression ERA compared to the other two training conditions. Both pre-post effects can be interpreted as large. No group differences were found for the outcome measure about recognizing patients' emotion cues. There were no transfer effects of the training programs, meaning that participants only improved significantly for the specific facet of ERA that they had trained on. Further, low baseline ERA was associated with larger ERA improvements. Results are discussed with regard to methodological and conceptual aspects, and practical implications and future directions are explored.

The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.

METHOD

The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.

RESULTS

The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.

CONCLUSIONS

Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.

Developing a novel framework for non-technical skills learning strategies for undergraduates: A systematic review

OBJECTIVES

There is substantial lack of guidance when it comes to the implementation of non-technical skills (NTS) in undergraduate medical education. This review aimed to identify and critically evaluate published literature on learning strategies for NTS in undergraduate medical education and to derive a training framework targeted towards standardizing future training interventions.

METHODS

A systematic review of the MEDLINE database was performed using a prospective protocol following PRISMA guidelines. Studies evaluating undergraduate medical students exposed to NTS interventions, which measured subjective or objective outcomes in selected attributes, were included.

RESULTS

Initial systematic search yielded a total of 5079 articles, out of which 68 fulfilled the inclusion criteria. A total of 24 NTS were identified, with communication skills being the most commonly reported skill evaluated (n = 37). A variety of educational tools were used (n = 32), noteworthy being the use of simulated patients. Great heterogeneity was also observed in measured outcomes and methods of assessment. A 'triad of outcomes' in NTS training was devised (knowledge, skill performance and attitude towards skills) and used for classification of all reported outcomes. Extracted data were used to design a non-technical skill training framework.

CONCLUSIONS

The existing literature describes a plethora of NTS interventions in undergraduate medical education, with varied outcomes and assessments. We hereby propose the 'NTS Training Framework', in an attempt to coordinate future research and catalyze the identification of an ideal NTS course structure to form tomorrow's physicians.

The effect of communication training using standardized patients on nonverbal behaviors in medical students

PURPOSE

Nonverbal communication (NVC) is important in the patient-physician relationship, but the effect of NVC education is not well kown. In this study, we try to identify if students' NVC abilities are improved through communication training.

METHODS

First-year medical students conducted medical interviews, which were performed with standardized patients (SPs) before and after communication skill education, and recorded in video. Fifty-one students were enrolled for this study. Two researchers used the NVC checklist, which consists of 12 nonverbal behaviors, to analyze and compare the students' nonverbal expressions in the interviews recorded before and after the education.

RESULTS

After the students participated in communication training, open body position and adequate facial expression were increased while unnecessary silence, un-purposive movements, and giggling were decreased. These results can be interpreted as positive effects of the education. However, hand gesture was increased as a negative effect of the education. The total NVC score of the 12 nonverbal behaviors in the NVC checklist improved significantly, rising from 8.56 to 10.03.

CONCLUSION

Communication skill education using SPs can improve nonverbal behaviors of medical students, especially facial expression, un-purposive movement, body position, unnecessary silence, and giggle, but not hand gesture. Further research is needed on a variety of teaching methods to improve NVCs.