Interventions for improving medical students' interpersonal communication in medical consultations.

BACKGROUND: Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS: We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS: We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

Suggestibility in neglected children: The influence of intelligence, language, and social skills.

We administered the GSS-2, a standardised measure of suggestibility, to 5- to 12-year-old children to ascertain whether neglected children's responses to leading questions distinguish them from those of their non-neglected counterparts. Neglected children (n = 75) were more likely than an age-matched sample of non-neglected children (n = 75) to yield to leading questions, despite no difference in their ability to recall the test stimuli. Subsequent collection of individual difference data from the neglected sample revealed that this effect could not be attributed to intelligence, language ability, problem behaviours, age at onset of neglect, or time spent in out-of-home care. With respect to social skill, however, suggestibility was positively correlated with communicative skill, and marginally positively correlated with assertion and engagement. While on the surface our social skills findings seem counter-intuitive, it is possible that maltreated children with relative strengths in these areas have learned to comply with adults in their environment as a way to protect themselves or even foster belonging. Our data, while preliminary, raise interesting questions about whether targeted interventions could help these children to more actively participate in decisions about their lives.

The roles of prior experience and the timing of misinformation presentation on young children's event memories.

The current study addressed how the timing of interviews affected children's memories of unique and repeated events. Five- to six-year-olds (N=125) participated in activities 1 or 4 times and were misinformed either 3 or 21 days after the only or last event. Although single-experience children were subsequently less accurate in the 21- versus 3-day condition, the timing of the misinformation session did not affect memories of repeated-experience children regarding invariant details. Children were more suggestible in the 21- versus 3-day condition for variable details when the test occurred soon after misinformation presentation. Thus, timing differentially affected memories of single and repeated events and depended on the combination of event-misinformation and misinformation-test delays rather than the overall retention interval.

The consistency of false suggestions moderates children's reports of a single instance of a repeated event: predicting increases and decreases in suggestibility.

Participants (6- and 7-year-olds, N=130) participated in classroom activities four times. Children were interviewed about the final occurrence (target event) either 1 week or 4 weeks later, during which half of the event items were described inaccurately. Half of these suggestions were consistent with the theme of the detail across the occurrences (e.g., always sat on a kind of floor mat) or were inconsistent (e.g., sat on a chair). When memory for the target event was tested 1 day later, children falsely recognized fewer inconsistent suggestions than consistent suggestions, especially compared with a control group of children who experienced the event just one time. Furthermore, the longer delay reduced accuracy only for consistent suggestions. Source-monitoring ability was strongly and positively related to resistance to suggestions, and encouraging children to identify the source of false suggestions allowed them to retract a significant proportion of their reports of inconsistent suggestions but not of consistent suggestions. The results suggest that the gist consistency of suggestions determines whether event repetition increases or decreases suggestibility.

The effect of intellectual disability on children's recall of an event across different question types.

This research examined the performance of 80 children aged 9-12 years with either a mild and moderate intellectual disability when recalling an innocuous event that was staged in their school. The children actively participated in a 30-min magic show, which included 21 specific target items. The first interview (held 3 days after the magic show) provided false and true biasing information about these 21 items. The second interview (held the following day) was designed to elicit the children's recall of the target details using the least number of specific prompts possible. The children's performance was compared with that of 2 control groups; a group of mainstream children matched for mental age and a group of mainstream children matched for chronological age. Overall, this study showed that children with either a mild or moderate intellectual disability can provide accurate and highly specific event-related information. However, their recall is less complete and less clear in response to free-narrative prompts and less accurate in response to specific questions when compared to both the mainstream age-matched groups. The implications of the findings for legal professionals and researchers are discussed.

The Video Suggestibility Scale for Children: how generalizable is children's performance to other measures of suggestibility?

This study explored the generalizability of the Video Suggestibility Scale for Children (VSSC), which was developed by Scullin and colleagues (Scullin & Ceci, 2001; Scullin & Hembrooke, 1998) as a tool for discriminating among children (aged three to five years) who have different levels of suggestibility. The VSSC consists of two subscales; Yield (a measure of children's willingness to acquiesce to misleading questions) and Shift (a measure of children's tendency to change their responses after feedback from the interviewer). Children's (N = 77) performance on each of the subscales was compared with their performance using several other measures of suggestibility. These measures included children's willingness to assent to a false event as well as the number of false interviewer suggestions and false new details that the children provided when responding to cued-recall questions about an independent true-biased and an independent false (non-experienced) event. An independent samples t-test revealed that those children who assented to the false event generated higher scores on the Yield measure. Hierarchical regression analyses revealed that Yield was a significant predictor of the number of false details reported about the false activity, but not the true-biased activity. There was no significant relationship between the Shift subscale and any of the dependent variables. The potential contribution of the VSSC for forensic researchers and practitioners is discussed.