Medical Students Learning Communication Skills in a Second Language: Empathy and expectations

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.

The level and determinants of empathy among medical students from Arabic speaking countries: A systematic review

Aim

This systematic review aims to investigate the level of empathy among medical students in Arabic speaking countries and analyze its determinants.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2022 (PRISMA), the authors conducted a systematic research of studies investigating the level and determinants of empathy among medical students in Arabic speaking countries. The databases PubMed, Scopus, web of science and google scholar were searched.

Results

Ten studies from six countries were included. Nine of which had a cross-sectional study design. Level of empathy was assessed using the Jefferson scale in seven studies and using the Interpersonal Reactivity Index in two studies. The mean of empathy scale ranges between 97.65±14.10 to 106.55±19.16 in studies used the Jefferson scale of empathy. The associated factors with empathy were gender; high levels of empathy were reported in female students. Other factors are explored in relation with empathy such as specialty preference (surgery or medicine, "people-orientated" specialties or ''technology-oriented specialties''), family factors (marital status of parents, satisfactory relationship with parents, parents level of education and household income) and factors related to medical education (academic performance, year of study and type of curriculum) but the results are heterogeneous.

Conclusion

This is the first systematic review, which illustrated the determinants of empathy in Arabic medical students. Our results revealed varied results on empathy determinants. Further studies may guarantee a full exploration of this ability in order to improve the doctor-patient relationship and patient management in the Arab world.

Promoting physician-patient language concordance in undergraduate medical education: a peer assisted learning approach

BACKGROUND

Verbal communication plays an important role in the patient-physician relationship. Research shows that language concordance, when a healthcare professional communicates fluently in the patient's preferred language, contributes to patient satisfaction and improves healthcare outcomes. Yet, many medical schools worldwide, including most institutions in the Arab world, use English as the language of instruction. As a result, students lack confidence and feel unprepared to communicate effectively with the local population. This manuscript describes the development, implementation and early perceptions of an Arabic language program for medical students in the United Arab Emirates.

METHODS

In 2020, the learning communities at Khalifa University College of Medicine and Health Sciences launched a pilot program implementing a Peer Assisted Learning (PAL) framework to teach Arabic medical terminology and language to both native and non-native Arabic speaking medical students. A web-based survey was administered to the first two cohorts of students to assess satisfaction with the classes and the program's impact on students' communication skills during clinical encounters.

RESULTS

Early perceptions of the program were very positive, with 43/48 students (89.6%) reporting that they used the information during home visits and clinical rotations, and 42 students (87.5%) admitting that the classes made them feel more comfortable in communicating with the Arabic speaking local patient population.

CONCLUSION

This paper explores a new educational approach to address the challenge of language barriers in healthcare. A feasible, low cost program using peer assisted learning can improve students' comfort in communicating with patients in the local language.

Medical Students' Perspectives on the Factors Affecting Empathy Development During Their Undergraduate Training

INTRODUCTION

This study investigated the perspectives of medical students on the factors influencing empathy development during their undergraduate training.

METHODOLOGY

A descriptive phenomenological approach was used to generate illustrations of empathy development and decline that had educational significance and applicability. Individual online semi-structured interviews were conducted to elicit experiential details from twelve final-year medical students. The interview recordings were transcribed verbatim, and data were analysed employing Braun and Clarke's thematic analysis method.

RESULTS

The self-reported empathic behavior of medical students seemed to have improved with time in medical school. Students attributed their empathy development to real patient encounters, positive role-modelling by teachers, and attainment of confidence and personal maturity. They identified exams, academic overload, time constraints, personal stresses, negative role models, unconducive learning environments, and lack of formal empathy training as barriers to empathy development.

CONCLUSION

Medical institutes should identify and address the barriers to empathy development and encourage the holistic development of medical students. Furthermore, medical educators should model their behavior accurately for their increasing roles and responsibilities and support the students in their empathic expressions with patients.

In someone else's shoes, are all wearers the same? Empathy in multi-ethnic Asian medical students

Objectives

Considerable research interest has been observed in ascertaining the actual pattern of empathy skill acquisition, but this aspect remains largely unexplored in Asian medical students. This study explored the empathy trait in Asian medical students from different levels of seniority and investigated the association between students’ empathy traits and their socio-demographic and socio-economic backgrounds.

Methods

To explore the empathy trait, the Year 1 to Year 5 medical students completed the students’ socio-demographic/economic and validated Interpersonal Reactivity Index (IRI) questionnaires.

Results

The participants scored highest in the empathetic concerns (EC) and lowest in the personal distress (PD) subscale. Female participants scored significantly higher on the EC, PD, and fantasy subscales. Participants who went to government high schools scored higher on the PD and EC subscales. Participants who stated a preference for specialisation that required more communication with patients scored higher on the EC and Perspective Taking subscales.

Conclusions

The empathy traits of Asian medical students may have cultural influences that are determined by their geographical background. Consistent observations regarding the inclination toward cognitive empathy traits in females were observed. This study also found that empathy traits are predictive of choices for postgraduate speciality training and that there is a difference in medical students’ empathy traits during the different phases of study in medical school.

The impact of the English medical curriculum on medical history taking from Arabic speaking patients by medical students

Introduction:

Medical education in Saudi medical colleges is delivered to students through a completely English language curriculum, whereas the practice that students face in the hospital is generally conducted in Arabic language settings. We suggest that the linguistic gap between the adopted medical curriculum and actual practice could influence students' confidence and level of difficulty in history taking in Arabic. The study aimed to identify the effects of learning history taking in the English language on applying it in the medical student's native language.

Methods:

This cross-sectional design study was held in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS). The targeted sample size was 377 medical students from the fourth to the sixth year, and stratified random sampling was used. The questionnaire used was self-developed, validated, and pilot tested in other medical colleges. The questionnaire asked about students' confidence, the difficulty of Arabic history taking, and suggested strategies to improve the current curriculum.

Results:

The response rate was 290 participants (76.9%), males were 205 (71%), and 136 (47%) were in the fourth year. Agreement on feeling confident while taking history taking in Arabic was 98 (33.8%), 102 (35.2%) were neutral, and 90 (31%) disagreed. Moreover, 138 (47.6%) of students preferred training for Objective Structured Clinical Examination (OSCE) in Arabic more than English, 86 (29.7%) were neutral, while 66 (22.8%) disagreed. The mean level of difficulty was 2.1 ± 0.7 (range 1- 5). Additionally, 198 (68%) of students suggested adding short Arabic history courses.

Conclusion:

Students considered history taking in Arabic as easy, even though they were not completely confident. Further efforts are needed to uplift students' of confidence to optimal levels.

Advances in Knowledge:

Communication is the cornerstone of medical education as well as clinical practice. The study explores the impact of instruction language on the physician-patient communication dynamic, providing better infrastructure for evidence-based educational practice.

Application to Patient Care:

This study gives insight into the students' level of preparation to practice in their local community and language. Furthermore, the study addresses strategies to enhance students communication skills and alleviate linguistic barriers in the physician-patient encounter.

Language of written medical educational materials for non-English speaking populations: an evaluation of a simplified bi-lingual approach

BACKGROUND

Debates have arisen in various non-English speaking countries over the chosen language of instruction in medical education, whether it has to be the English language or the mother tongue. English-based education supporters argue that English is the leading international language of medicine and research, and a crucial tool for Continuing Medical Education (CME), as well as for students who seek practice abroad. On the other hand, mother-tongue-based medical education supporters present it as a way to endorse communication and comprehension between medical practitioners and health care system users, to bridge the gap between practitioners and the paramedical staff, and to overcome linguistic dualism and the language thinking disparity while studying in another. This study aimed to evaluate one of the simplified bi-lingual approaches in terms of medical-educational-written texts for a non-English speaking population: Arabic speaking medical students in specific.

METHODS

1546 Arabic-speaking-medical students from different countries participated in a one-step-interactive-experimental-online test. The test assessed participants' scientific comprehension of three distinct written paragraphs: The first paragraph used conventional mother tongue (Arabic), the second combined English terminology and simplified mother tongue (hybrid), and the third used an English excerpt (English). Two multiple-choice questions (First question in Arabic, second in English) followed each paragraph. Response time was communicated for each paragraph. Participants were asked to select their favorable method. Repeated Measures ANOVA models and Paired Samples t-Test were used for statistical analysis.

RESULTS

Participants scored a mean of [0.10] for the Arabic paragraph, [0.72] for the hybrid paragraph, and [0.24] for the English paragraph (P <  0.001). Results showed a significantly higher mean of points and correct answers within the fastest time for the hybrid paragraph [0.68] compared to the Arabic [0.08] and English [0.18] paragraphs (P <  0.001). Moreover, 50% of participants preferred the hybrid paragraph over the other two paragraphs.

CONCLUSIONS

Taking into consideration the large number of participants and the statistically significant results, authors propose that simplified Arabic combined with English terminology may present a viable alternative method for medical-educational-written texts in Arabic-speaking population.