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Meta-Analysis
. 2021 Feb 8;2(2):CD012418.
doi: 10.1002/14651858.CD012418.pub2.

Interventions for improving medical students' interpersonal communication in medical consultations

Conor Gilligan  1 , Martine Powell  2 , Marita C Lynagh  1 , Bernadette M Ward  3 , Chris Lonsdale  4 , Pam Harvey  3 , Erica L James  1 , Dominique Rich  5 , Sari P Dewi  5 , Smriti Nepal  6 , Hayley A Croft  7 , Jonathan Silverman  8
Affiliations
Meta-Analysis

Interventions for improving medical students' interpersonal communication in medical consultations

Conor Gilligan et al. Cochrane Database Syst Rev. .

Abstract

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.

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Conflict of interest statement

  1. Conor Gilligan: none known

  2. Martine Powell: none known

  3. Marita C Lynagh: none known

  4. Bernadette M Ward: none known

  5. Chris Lonsdale has received consultancy fees from commercial agencies on health promotion products. His research is supported by grants from government and philanthropic agencies

  6. Pam Harvey: none known

  7. Erica L James: none known

  8. Sari Dewi: none known

  9. Smriti Nepal: none known

  10. Dominique Rich: none known

  11. Hayley Croft: none known

  12. Jonathan Silverman has worked at the forefront of the development of communication skills, teaching in undergraduate medical education for the last 20 years, and recently retired from the School of Clinical Medicine, University of Cambridge, where he led the undergraduate communication programme. He receives royalties from two books that he wrote about healthcare communication, and he travels as president of the European Association for Communication in Healthcare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Communication intervention versus control or usual care, outcome: 1.1 Overall communication skills.
5
5
Funnel plot of comparison: 1 Communication intervention versus control or usual care, outcome: 1.1 Overall communication skills.
6
6
Forest plot of comparison: 1 Communication intervention versus control or usual care, outcome: 1.7 Empathy.
7
7
Forest plot of comparison: 1 Communication intervention versus control or usual care, outcome: 1.8 Relationship building/Rapport.
8
8
Forest plot of comparison: 1 Communication intervention versus control or usual care, outcome: 1.12 Information gathering about patient perspectives/concerns.
9
9
Forest plot of comparison: 2 Communication intervention 1 versus communication intervention 2 mode of delivery, outcome: 2.1 Overall communication skills.
10
10
Forest plot of comparison: 2 Communication intervention 1 versus communication intervention 2 mode of delivery, outcome: 2.5 Empathy.
11
11
Forest plot of comparison: 2 Communication intervention 1 versus communication intervention 2 mode of delivery, outcome: 2.6 Relationship building/rapport.
12
12
Forest plot of comparison: 3 Communication intervention 1 versus communication intervention 2 feedback approach, outcome: 3.1 Overall communication skills.
13
13
Forest plot of comparison: 4 Communication intervention 1 versus communication intervention 2 SP vs peer, outcome: 4.1 Overall communication skills.
1.1
1.1. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 1: Overall communication skills
1.2
1.2. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 2: Subgroup_Overall communication skills_control only
1.3
1.3. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 3: Sensitivity_RoB_Overall communication skills
1.4
1.4. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 4: Sensitivity_cluster 5%_Overall communication skills
1.5
1.5. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 5: Sensitivity_cluster 10%_Overall communication skills
1.6
1.6. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 6: Sensitivity_cluster 20%_Overall communication skills
1.7
1.7. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 7: Empathy
1.8
1.8. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 8: Relationship building/Rapport
1.9
1.9. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 9: Sensitivity_cluster 5%_Relationship building/Rapport
1.10
1.10. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 10: Sensitivity_cluster 10%_Relationship building/Rapport
1.11
1.11. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 11: Sensitivity_cluster 20%_Relationship building/Rapport
1.12
1.12. Analysis
Comparison 1: Communication intervention versus control or usual care, Outcome 12: Information gathering about patient perspectives/concerns
2.1
2.1. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 1: Overall communication skills
2.2
2.2. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 2: Sensitivity_cluster 5%_Overall communication skills
2.3
2.3. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 3: Sensitivity_cluster 10%_Overall communication skills
2.4
2.4. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 4: Sensitivity_cluster 20%_Overall communication skills
2.5
2.5. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 5: Empathy
2.6
2.6. Analysis
Comparison 2: Communication intervention 1 versus communication intervention 2 mode of delivery, Outcome 6: Relationship building/rapport
3.1
3.1. Analysis
Comparison 3: Communication intervention 1 versus communication intervention 2 feedback approach, Outcome 1: Overall communication skills
3.2
3.2. Analysis
Comparison 3: Communication intervention 1 versus communication intervention 2 feedback approach, Outcome 2: Sensitivity_RoB_Overall communication skills
3.3
3.3. Analysis
Comparison 3: Communication intervention 1 versus communication intervention 2 feedback approach, Outcome 3: Sensitivity_cluster 5%_Overall communication skills
3.4
3.4. Analysis
Comparison 3: Communication intervention 1 versus communication intervention 2 feedback approach, Outcome 4: Sensitivity_Cluster 10%_Overall communication skills
3.5
3.5. Analysis
Comparison 3: Communication intervention 1 versus communication intervention 2 feedback approach, Outcome 5: Sensitivity_Cluster 20%_Overall communication skills
4.1
4.1. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 1: Overall communication skills
4.2
4.2. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 2: Subgroup_Overall communication skills_SP only
4.3
4.3. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 3: Sensitivity_RoB_Overall communication skills
4.4
4.4. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 4: Sensitivity_Cluster 5%_Overall communication skills
4.5
4.5. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 5: Sensitivity_Cluster 10%_Overall communication skills
4.6
4.6. Analysis
Comparison 4: Communication intervention 1 versus communication intervention 2 SP vs peer, Outcome 6: Sensitivity_Cluster 20%_Overall communication skills
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012418

References

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Schmitz 2018 {published and unpublished data}
    1. Schmitz FM, Schnabel KP, Bauer D, Bachmann C, Woermann U, Guttormsen S. The learning effects of different presentations of worked examples on medical students' breaking-bad-news skills: a randomized and blinded field trial. Patient Education and Counseling 2018;101(8):1439-51. - PubMed
    1. Schmitz FM, Schnabel KP, Bauer D, Woermann U, Guttormsen S. Learning how to break bad news from worked examples: does the presentation format matter when hints are embedded? Results from randomised and blinded field trials. Patient Education and Counseling 2020;103(9):1850-85. [DOI: ] - PubMed
Schwartz 2010 {published data only}
    1. Schwartz A, Weiner SJ, Harris IB, Binns-Calvey A. An educational intervention for contextualizing patient care and medical students' abilities to probe for contextual issues in simulated patients. JAMA 2010;304(11):1191-7. - PubMed
Seim 1995 {published data only}
    1. Seim HC, Verhoye JR. Comparison of training techniques using a patient-centered approach to smoking cessation. Medical Education 1995;29(2):139-43. - PubMed
Shaddheau 2015 {published data only}
    1. Shaddeau A, Nimz A, Sheeder J, Tocce K. Effect of novel patient interaction on students' performance of pregnancy options counseling. Medical Education Online 2015;20(Article 29401):1-6. - PMC - PubMed
Shapiro 2009 {published data only}
    1. Shapiro SM, Lancee WJ, Richards-Bentley CME. Evaluation of a communication skills program for first-year medical students at the University of Toronto. BMC Medical Education 2009;9(11):1-8. - PMC - PubMed
Siassakos 2010 {published data only}
    1. Siassakos D, Draycott T, O'Brien K, Kenyon C, Bartlett C, Fox R. Exploratory randomized controlled trial of hybrid obstetric simulation training for undergraduate students. Simulation in Healthcare 2010;5(4):193-8. - PubMed
Snow 2016 {published data only}
    1. Snow R, Crocker J, Talbot K, Moore J, Salisbury H. Does hearing the patient perspective improve consultation skills in examinations? An exploratory randomized controlled trial in medical undergraduate education. Medical Teacher 2016;38(12):1229-35. - PubMed
Solomon 2004 {published data only (unpublished sought but not used)}
    1. Keefe CW, Thompson ME, Noel, MM. Medical students, clinical preventive services, and shared decision making. Academic Medicine; Assessing Clinical Skills supplement 2002;77(11):1160-1. - PubMed
    1. Solomon DJ, Laird-Fick HS, Keefe CW, Thompson ME, Noel MM. Using a formative simulated patient exercise for curriculum evaluation. BMC Medical Education 2004;4(8):1-6. - PMC - PubMed
Spollen 2010 {published data only}
    1. Spollen J, Thrush C, Mui D, Woods M, Tariq S, Hicks E. A randomized controlled trial of behavior change counseling education for medical students. Medical Teacher 2010;32(4):e170-7. - PubMed
Steifel 2013 {published data only}
    1. Stiefel F, Bourquin C, Layat C, Vadot S, Bonvin R, Berney A. Medical students' skills and needs for training in breaking bad news. Journal of Cancer Education 2013;28(1):187-91. - PubMed
Stolz 2012 {published data only}
    1. Stolz D, Langewitz W, Meyer A, Pierer K, Tschudi P, S'Ng Ching T, et al. Enhanced didactic methods of smoking cessation training for medical students - a randomized study. Nicotine & Tobacco Research 2012;14(2):224-8. - PubMed
Strayer 2010 {published data only}
    1. Strayer S, Pelletier S, Martindale JR, Rais S, Powell J, Schorling J. A PDA-based counseling tool for improving medical student smoking cessation counseling. Family Medicine 2010;42(5):350-7. - PubMed
Taylor 2019 {published data only}
    1. Taylor S, Haywood M, Shulruf B. Comparison of effect between simulated patient clinical skill training and student role play on objective structured clinical examination performance outcomes for medical students in Australia. Journal of Educational Evaluation for Health Professions 2019;16:3. - PMC - PubMed
Vanatta 1996 {published data only}
    1. Vannatta JB, Smith KR, Crandall S, Fischer PC, Williams K. Comparison of standardized patients and faculty in teaching medical interviewing. Academic Medicine 1996;71(12):1360-2. - PubMed
Wagner 2011 {published data only}
    1. Wagner JA, PA, Harrington KL. Evaluation of online instruction to improve medical and dental students' communication and counseling skills. Evaluation & the Health Professions 2011;34(3):383-97. - PubMed
Walsh 1999 {published data only}
    1. Walsh RA, Sanson-Fisher RW, Low A, Roche AM. Teaching medical students alcohol intervention skills: results of a controlled trial. Medical Education 1999;33(8):559-65. - PubMed
Weihs 1986 {published data only}
    1. Weihs K, Chapados JT. Interviewing skills training - a study. Social Science and Medicine 1986;23(1):31-4. - PubMed
Windish 2005 {published data only}
    1. Price EG, Windish DM, Magaziner J, Cooper LA. Assessing validity of standardized patient ratings of medical students' communication behavior using the Roter Interaction Analysis System. Patient Education and Counseling 2008;70(1):3-9. - PubMed
    1. Windish DM, Price EG, Clever SL, Magaziner JL, Thomas PA. Teaching medical students the important connection between communication and clinical reasoning. Journal of General Internal Medicine 2005;20(12):1108-13. - PMC - PubMed
Wundrich 2017 {published data only}
    1. Wündrich M, Schwartz C, Feige B, Lemper D, Nissen C, Voderholzer U. Empathy training in medical students - a randomized controlled trial. Medical Teacher 2017;39(10):1096-8. - PubMed

References to studies excluded from this review

Abraham 2001 {published data only}
    1. Abraham A, Cheng TL, Wright JL, Addlestone I, Huang Z, Greenberg L. Assessing an educational intervention to improve physician violence screening skills. Pediatrics 2001;107(5):E68. - PubMed
Abraham 2011 {published data only}
    1. Abraham A, Hawkins K, Chen R. An educational intervention to improve physician interviewing skills of adolescent patients during the pediatric clerkship. Journal of Adolescent Health 2011;48(2 Suppl 1):S34-5.
Ahmadzadeh 2019 {published data only}
    1. Ahmadzadeh A, Esfahani MN, Ahmadzad-Asl M, Shalbafan M, Shariat SV. Does watching a movie improve empathy? A cluster randomized controlled trial. Canadian Medical Education Journal 2019;10(4):e4-12. - PMC - PubMed
Aper 2012 {published data only}
    1. Aper L, Reniers J, Koole S, Valcke M, Derese A. Impact of three alternative consultation training formats on self-efficacy and consultation skills of medical students. Medical Teacher 2012;34(7):e500-7. - PubMed
Betson 1997 {published data only}
    1. Betson CL, Fielding R, Wong G, Chung SF, Nestel DF. Evaluation of two videotape instruction programmes on how to break bad news - for Cantonese-speaking medical students in Hong Kong. Journal of Audiovisual Media in Medicine 1997;20(4):172-7. - PubMed
Bientzle 2015 {published data only}
    1. Bientzle M, Griewatz J, Kimmerle J, Kuppers J, Cress U, Lammerding-Koeppel M. Impact of scientific versus emotional wording of patient questions on doctor-patient communication in an internet forum: a randomized controlled experiment with medical students. Journal of Medical Internet Research 2015;17(11):268. - PMC - PubMed
Bishop 2016 {published data only}
    1. Bishop TW, Gorniewicz J, Floyd M, Tudiver F, Odom A, Zoppi K. Innovative patient-centered skills training addressing challenging issues in cancer communications: using patients' stories that teach. International Journal of Psychiatry in Medicine 2016;51(4):357-66. - PubMed
Bittner 2016 {published data only}
    1. Bittner A, Bittner J, Jonietz A, Dybowski C, Harendza S. Translating medical documents improves students' communication skills in simulated physician-patient encounters. BMC Medical Education 2016;16:72. - PMC - PubMed
Blake 2000 {published data only}
    1. Blake K, Mann KV, Kaufman DM, Kappelman M. Learning adolescent psychosocial interviewing using simulated patients. Academic Medicine 2000;75(10 Suppl):S56-8. - PubMed
Blanch‐Hartigan 2012 {published data only}
    1. Blanch-Hartigan D. An effective training to increase accurate recognition of patient emotion cues. Patient Education and Counselling 2012;89(2):274-80. - PubMed
Bragard 2018 {published data only}
    1. Bragard I, Servotte JC, Van Cauwenberghe I, Donneau A, Dardenne N, Tubes R, et al. Breaking bad news in the emergency department: a randomized controlled study of a training using role-play simulation. Critical Care; Conference: 38th International Symposium on Intensive Care and Emergency Medicine, ISICEM 2018;22(Suppl 1):212-5.
Brown 1980 {published data only}
    1. Brown JE, O'Shea JS. Improving medical student interviewing skills. Pediatrics 1980;65(3):575-8. - PubMed
Claramita 2006 {published data only}
    1. Claramita M, Majoor G. Comparison of communication skills in medical residents with and without undergraduate communication skills training as provided by the Faculty of Medicine of Gadjah Mada University. Education for Health 2006;19(3):308-20. - PubMed
Clever 2011 {published data only}
    1. Clever SL, Dudas RA, Solomon BS, Yeh HC, Levine D, Bertram A, et al. Medical student and faculty perceptions of volunteer outpatients versus simulated patients in communication skills training. Academic Medicine 2011;86(11):1437-42. - PubMed
Craig 1992 {published data only}
    1. Craig JL. Retention of interviewing skills learned by first-year medical students: a longitudinal study. Medical Education 1992;26(4):276-81. - PubMed
D'Souza 2020 {published data only}
    1. D'Souza PC, Rasquinha SL, D'Souza TL, Jain A, Kulkarni V, Pai K. Effect of a single-session communication skills training on empathy in medical students. Academic Psychiatry 2020;44(3):289-94. - PubMed
Daetwyler 2010 {published data only}
    1. Daetwyler CJ, Cohen DG, Gracely E, Novack DH. eLearning to enhance physician patient communication: a pilot test of "doc.com" and "WebEncounter" in teaching bad news delivery. Medical Teacher 2010;32(9):e381-90. - PubMed
Daryazadeh 2020 {published data only}
    1. Daryazadeh S, Adibi P, Yamani N, Mollabashi R. Impact of narrative medicine program on improving reflective capacity and empathy of medical students in Iran. Journal of Educational Evaluation for Health Professions 2020;17(3):1-7. [DOI: ] - PMC - PubMed
Davis 1992 {published data only}
    1. Davis H, Nicholaou T. A comparison of the interviewing skills of first- and final-year medical students. Medical Education 1992;26(6):441-7. - PubMed
Dickson 2012 {published data only}
    1. Dickson RP, Engelberg RA, Back AL, Ford DW, Curtis JR. Internal medicine trainee self-assessments of end-of-life communication skills do not predict assessments of patients, families, or clinician-evaluators. Journal of Palliative Medicine 2012;15(4):418-26. - PMC - PubMed
Duke 2015 {published data only}
    1. Duke P, Grosseman S, Novack DH, Rosenzweig S. Preserving third year medical students' empathy and enhancing self-reflection using small group "virtual hangout" technology. Medical Teacher 2015;37(6):566-71. - PubMed
Ellis 2002 {published data only}
    1. Ellis MV, Krengel M, Beck M. Testing self-focused attention theory in clinical supervision: effects on supervisee anxiety and performance. Medical Teacher 2002;49(1):101-16.
Fernndez‐Olano 2008 {published data only}
    1. Fernndez-Olano C, Montoya-Fernndez J, Salinas-Sanchez AS. Impact of clinical interview training on the empathy level of medical students and medical residents. Medical Teacher 2008;30(3):322-4. - PubMed
Fine 1977 {published data only}
    1. Fine VK, Therrien ME. Empathy in the doctor-patient relationship: skill training for medical students. Journal of Medical Education 1977;52(9):752-7. - PubMed
Fukuta 2018 {published data only (unpublished sought but not used)}
    1. Fukuta J, Morgan J. First-person perspective video to enhance simulation. Simulation 2018;15:231-5. - PubMed
Ghofranipour 2018 {published data only}
    1. Ghofranipour F, Ghaffarifar S, Ahmadi F, Hosseinzadeh H, Akbarzadeh A. Improving interns' patient-physician communication skills: application of self-efficacy theory, a pilot study. Cogent Psychology 2018;5(1):1-13.
Gorniewicz 2017 {published data only}
    1. Gorniewicz J, Floyd M, Krishnan K, Bishop Thomas W, Tudiver F, Lang F. Breaking bad news to patients with cancer: a randomized control trial of a brief communication skills training module incorporating the stories and preferences of actual patients. Patient Education and Counseling 2017;100(4):665-6. - PMC - PubMed
Haeseler 2011 {published data only}
    1. Haeseler F, Fortin AH, Pfeiffer C, Walters C, Martino S. Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case. Patient Education and Counseling 2011;84(1):27-30. - PMC - PubMed
Haq 2006 {published data only}
    1. Haq I, Fuller J, Dacre J. The use of patient partners with back pain to teach undergraduate medical students. Rheumatology 2006;45(4):430-4. - PubMed
Hoffman 2014 {published data only (unpublished sought but not used)}
    1. Hoffmann TC, Bennett ST, Tomsett C, DelMar C. Brief training of student clinicians in shared decision making: a single-blind randomized controlled trial. Journal of General Internal Medicine 2014;29(6):844-9. - PMC - PubMed
Junger 2005 {published data only}
    1. Junger J, Schafer S, Roth C, Schellberg D, Friedman M, Nikendei C. Effects of basic clinical skills training on objective structured clinical examination performance. Medical Education 2005;39(10):1015-20. - PubMed
Kalet 2005 {published data only}
    1. Kalet AL, Janicik R, Schwartz M, Roses, D, Hopkins MA, Riles T. Teaching communication skills on the surgery clerkship. Medical Education Online 2005;10(16):1-8. - PubMed
Karanth 2008 {published data only}
    1. Karanth K, Veena L, Kumar MV. Implementation and evaluation by formal assessments and term end student feedback of a new methodology of clinical teaching in surgery in small group sessions. Annals of the Academy of Medicine 2008;37(12):1008-11. - PubMed
Koponen 2012 {published data only}
    1. Koponen J, Pyorala E, Isotalus P. Comparing three experiential learning methods and their effect on medical students' attitudes to learning communication skills. Medical Teacher 2012;34(3):e198-207. - PubMed
Koponen 2014 {published data only}
    1. Koponen J, Pyorala E, Isotalus P. Communication skills for medical students: results from three experiential methods. Simulation and Gaming 2014;45(2):235-54.
Kron 2017 {published data only}
    1. Kron FW, Fetters MD, Scerbo MW, White CB, Lypson ML, Padilla MA, et al. Using a computer simulation for teaching communication skills: a blinded multisite mixed methods randomized controlled trial. Paitent Education and Counseling 2017;100(4):748-59. - PMC - PubMed
Lau 2001 {published data only}
    1. Lau KCJ, Stewart SM, Fielding R. Preliminary evaluation of "interpreter" role plays in teaching communication skills to medical undergraduates. Medical Education 2001;35(3):217-21. - PubMed
Leber 2012 {published data only}
    1. Leber M, He C, Akhtar S, Asher S, Bania T, Di C, et al. A comparison of individualized feedback versus standard didactic lecture to teach interpersonal communication skills to emergency medicine residents: a multicenter randomized controlled trial. Annals of Emergency Medicine 2012;60(4 Suppl 1):S41.
LeBlanc 2009 {published data only}
    1. LeBlanc V, Tabak D, Kneebone R, Nestel D, MacRae H, Moulton C. Psychometric properties of an integrated assessment of technical and communication skills. American Journal of Surgery 2009;197:96-101. - PubMed
Lee 2004 {published data only}
    1. Lee JH, Shin JS Suh DH, Eun HC. Evaluation of the outcome of communication skill training using a role play model in the dermatological clerkship. Korean Journal of Dermatology 2004;42(11):1440-8.
Leung 2015 {published data only}
    1. Leung CG, Russell D, Way DP, Thompson L, Greenberger S, Kman NE. Observation without active participation is an effective method of learning in high fidelity simulation. Academic Emergency Medicine 2015;22(5 Suppl 1):S193-4.
Malik 2013 {published data only}
    1. Malik S, Zaheer R, Bilal M. Impact of movie-based simulation training, with or without conventional verbal demonstration on observed OSPE scores in medical undergraduates: a double control study. Journal of Ayub Medical College, Abbottabad 2013;25:127-8. - PubMed
Malik 2014 {published data only}
    1. Malik S, Zaheer R, Bilal M. Impact of movie-based simulation training, with or without conventional verbal demonstration, on observed OSPE scores in male & female medical undergraduates: a double control study. Nepal Journal of Epidemiology 2014;4(2):1. - PubMed
Marko 2015 {published data only}
    1. Marko EK, Buery-Joyner SD, Sheridan MJ, Nieves K, Khoury AN, Dalrymple JL. Structured teaching of early pregnancy loss counseling. Obstetrics and Gynecology 2015;126(Suppl 4):S1-6. - PubMed
Moulton 2009 {published data only (unpublished sought but not used)}
    1. Moulton C, Tabak D, Kneebone R, Nestel D, MacRae H, LeBlanc VR. Teaching communication skills using the integrated procedural performance instrument (IPPI): a randomized controlled trial. American Journal of Surgery 2009;197(1):113-8. - PubMed
Pettit 2017 {published data only}
    1. Pettit KE, Turner JS, Kindrat JK, Blythe GJ, Hasty GE, Perkins AJ, et al. Effect of socioeconomic status bias on medical student-patient interactions using an emergency medicine simulation. AEM Education and Training 2017;1(1):126-31. - PMC - PubMed
Phisalprapa 2013 {published data only}
    1. Phisalprapa P, Pandejpong D. Effect of ambulatory medicine tutorial on clinical performance of 5th year medical students. Journal of the Medical Association of Thailand 2013;96(Suppl 2):S75-81. - PubMed
Quirk 1982 {published data only}
    1. Quirk M, Babineau RA. Teaching interviewing skills to students in clinical years: a comparative analysis of three strategies. Journal of Medical Education 1982;57(12):939-41. - PubMed
Reinders 2010 {published data only}
    1. Reinders ME, Blankenstein AH, Horst HE, Knol DL, Schoonheim PL, Marwijk HWJ. Does patient feedback improve the consultation skills of general practice trainees? A controlled trial. Medical Education 2010;44(2):156-64. - PubMed
Ricciotti 2010 {published data only}
    1. Ricciotti H, Hacker M, Flesco L, Dodge L, Huang G. Randomized, controlled trial of a normal pregnancy virtual patient to teach medical students counseling skills. Journal of Reproductive Medicine 2010;55:498-502. - PubMed
Saba 2014 {published data only}
    1. Saba GW, Chou CL, Satterfield J, Teherani A, Hauer K, Poncelet A, et al. Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students. Medical Education Online 2014;19:22522. - PMC - PubMed
Scheidt 1986 {published data only}
    1. Scheidt PC, Lazoritz S, Ebbeling WL, Figelman AR, Moessner HF, Singer JE. Evaluation of system providing feedback to students on videotaped patient encounters. Journal of Medical Education 1986;61(7):585-90. - PubMed
Schwartz 2007 {published data only}
    1. Schwartz LR, Fernandez R, Kouyoumjian SR, Jones KA, Compton S. A randomized comparison trial of case-based learning versus human patient simulation in medical student education. Academic Emergency Medicine 2007;14(2):130-7. - PubMed
Scott 1976 {published data only}
    1. Scott N, Donnelly M, Hess J. Longitudinal investigation of changes in interviewing performance of medical students. Journal of Clinical Psychology 2007;32(2):424-31. - PubMed
Servotte 2019 {published data only}
    1. Servotte JC, Bragard I, Szyld D, Van Ngoc P, Scholtes B, Van Cauwenberge I, et al. Efficacy of a short role-play training on breaking bad news in the emergency department. Western Journal of Emergency Medicine 2019;20(6):893-902. - PMC - PubMed
Sokas 1991 {published data only}
    1. Sokas RK, Diserens D, Johnston MA. Integrating occupational health into the medicine clerkship using problem-based learning. Journal of General Internal Medicine 1991;6(5):450-4. - PubMed
Stillman 1976 {published data only}
    1. Stillman PL, Sabers DL, Redfield DL. The use of paraprofessionals to teach interviewing skills. Pediatrics 2855;57(5):769-74. - PubMed
Taylor 2018 {published data only}
    1. Taylor S, Bobba S, Roome S, Ahmadzai M, Tran D, Vickers D, et al. Simulated patient and role play methodologies for communication skills training in an undergraduate medical program: randomized, crossover trial. Education for Health 2018;31(1):10-6. - PubMed
Tolsgaard 2013 {published data only}
    1. Tolsgaard MG, Bjorck S, Rasmussen MB, Gustafsson A, Ringsted C. Improving efficiency of clinical skills training: a randomized trial. Journal of General Internal Medicine 2013;28(8):1072-7. - PMC - PubMed
Walsh 2001 {published data only}
    1. Walsh RA, Roche AM, Sanson-Fisher RW, Saunders JB. Interactional skills of students from traditional and non-traditional medical schools before and after alcohol education. Medical Education 2001;35(3):211-6. - PubMed
Werner 2013 {published data only}
    1. Werner A, Holderried F, Schaffeler N, Weyrich P, Riessen R, Zipfel S, et al. Communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks - a randomized controlled trial. BMC Medical Education 2013;13:15. - PMC - PubMed
Wolf 1987 {published data only}
    1. Wolf FM, Woolliscroft JO, Calhoun JG, Boxer GJ. A controlled experiment in teaching students to respond to patients' emotional concerns. Journal of Medical Education 1987;62(1):25-34. - PubMed

References to studies awaiting assessment

Ahmadreza 2011 {published data only}
    1. Ahmadreza Z, Armindokht S, Maedeh M. Design, implementation and evaluation a tool to strengthen physician-patient communication skills of medical students. Iranian Journal of Medical Education 2011;10(5):1-8.
Alyami 2019 {published data only}
    1. Alyami H, Alawami M, Lyndon M, Alyami M, Coomarasamy C, Henning M, et al. Impact of using a 3D visual metaphor serious game to teach history-taking content to medical students: longitudinal mixed methods pilot study. JMIR Serious Games 2019;7(3):e13748. [DOI: ] - PMC - PubMed
Barais 2012 {published data only}
    1. Barais M, Attencourt C, Calvez A, Le Floch Pinar T, Pradier EH, Le R. Becoming old makes one empathic: a randomized controlled trial. European Journal of General Practice 2012;18(3):171.
Caruso 1994 {published data only}
    1. Caruso B, Nieman, LZ, Gracely E. Developing and assessing the effectiveness of an HIV sexual history and risk assessment workshop for medical professionals. Journal of Sex Education and Therapy 1994;20:10-109.
Cherry 2010 {published data only}
    1. Cherry G, Fletcher I, O'Sullivan H. The communication skills of medical students: video analysis, OSCE scores and emotional intelligence. Medical Education Supplement 2010;44:149.
Dubosh 2019 {published data only}
    1. Dubosh NM, Hall MM, Novack V, Shafat T, Shapiro NI, Ullman EA. A multimodal curriculum with patient feedback to improve medical student communication: pilot study. Western Journal of Emergency Medicine 2019;21(1):115-21. - PMC - PubMed
Engler 1981 {published data only}
    1. Engler CM. An analysis of medical students' acquisition and retention of interviewing skills. Dissertation Abstracts International 1981;41:3422-3.
Florenzano 2000 {published data only}
    1. Florenzano R, Altuzarra R, Carvajal C, Weil K, Dorr A, Fullerton C, et al. Improving the quality of clinical interview teaching: evaluation of an intervention with medical students. Revista Medica de Chile 2000;128(3):294-300. - PubMed
Geoffroy 2020 {published data only}
    1. Geoffroy PA, Delyon J, Strullu M, Dinh AT, Duboc H, Zafrani L, et al. Standardized patients or conventional lecture for teaching communication skills to undergraduate medical students: a randomized controlled study. Psychiatry Investigation 2020;17(4):299-305. [DOI: ] - PMC - PubMed
Hartigan 2012 {published data only}
    1. Hartigan DB. Towards more accurate recognition of patient emotion cues: meta-analysis of training literature and development of an assessment tool and multi-component intervention for clinicians. Dissertation Abstracts International: Section B: The Sciences and Engineering 2012;72(8-B):4998.
Hermann‐Werner 2019b {published data only}
    1. Hermann-Werner A, Weber H, Loda T, Keifenheim KE, Erschens R, Molbert SC, et al. "But Dr Google said..." – Training medical students how to communicate with E-patients. Medical Teacher 2019;41(12):1434-40. [DOI: ] - PubMed
Holtedahl 1999 {published data only}
    1. Holtedahl KA, Bo B, Hansen AH, Hensrud A, Johansen ML, Prydz P, et al. Student education in a laboratory for general practice skills. Journal of the Norwegian Medical Association 1999;119(19):2854-7. - PubMed
Jaury 2018 {published data only}
    1. Jaury P, Buffel du Vaure C, Bunge L, Galam E, Vincens M, Catu-Pinault A, et al. Patient relationship training inspired by Balint groups in the 4th year of medical school. Assessment of these PRT groups on clinical empathy by a multisite controlled randomized trial. Psycho-Oncology 2018;12(1):8-12.
Kaper 2019 {published data only}
    1. Kaper MS, Reijneveld SA, Es FD, Zeeuw J, Almansa J, Koot JAR, et al. Effectiveness of a comprehensive health literacy consultation skills training for undergraduate medical students: a randomized controlled trial. International Journal of Environmemtal Research and Public Health 2019;17(1):1-15. - PMC - PubMed
Koch 2020 {published data only}
    1. Koch C, Dreimuller N, Weiskircher J, Deis N, Gaitzsch E, Wagner S, et al. Teaching conflicts of interest and shared decision-making to improve risk communication: a randomized controlled trial. Journal of General Internal Medicine 2020;35(2):473-80. [DOI: ] - PMC - PubMed
Lai 2020 {published data only}
    1. Lai MMY, Roberts N, Mohebbi M, Martin J. A randomised controlled trial of feedback to improve patient satisfaction and consultation skills in medical students. BMC Medical Education 2020;20(1):277. [DOI: ] - PMC - PubMed
Martin 2017 {published data only}
    1. Martin, O, Rockenbauch K, Kleinert E, Stöbel-Richter Y. Effectively communicate active listening: comparison of two concepts [Aktives Zuhören effektivvermittelnZwei Konzepte im Vergleich]. Der Nervenarzt 2017;88(9):1026-35. - PubMed
Mazori 2019 {published data only}
    1. MazoriAY, Maron MI, Osterbur MLB, Santos D, Marco VF, Lin J, et al. Enhancing medical student-interpreter collaboration in an urban free clinic. Family Medicine 2019;51(7):593-7. - PubMed
Pati 2010 {published data only}
    1. Pati S. Enhancing empathy among medical students towards psychosocial needs of cancer patients and their families through micro-skills interview training. Psycho-Oncology 2010;19:S197.
Qureshi 2020 {published data only}
    1. Qureshi AA, Zehra T. Simulated patient's feedback to improve communication skills of clerkship students. BMC Medical Education 2020;20(1):15. - PMC - PubMed
Rae 1973 {published data only}
    1. Rae WA, Willis DJ. Effectiveness of discussion, modeling and experiential-simulation in training empathy skills to medical students. Unknown (ERIC) 1973;Unknown:22.
Smith 2019 {published data only}
    1. Smith C, Likourezos A, Schiller J. Focused teaching improves medical student professionalism and data gathering skills in the emergency department. Cureus 2019;11(9):e5765. - PMC - PubMed
Sobana 2020 {published data only}
    1. Sobana R, Jaiganesh K, Parthasarathy S, Patric TKS, Sunitha P, Dharmara J, et al. Simulation for training in communication skills: active participant vs. active observer - An interventional case control study. Asian Journal of Pharmaceutical Research and Health Care 2020;11(2-4):63-7.
Spiess 1988 {published data only}
    1. Spiess K, Mutschlechner R, Bilek H. Supportive psychotherapy by supervised medical students in different internistic patient groups. Klinische Wochenschrift 1988;66(Suppl 13):47.
Thompson 2012 {published data only}
    1. Thompson L, Prommer E, Lower J. Delivering bad news: improving communication skills training of medical students and residents through the use of second life technology. Journal of Pain and Symptom Management 2012;43(2):452-3.

Additional references

Abbe 2013
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Alelwani 2014
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Alliger 1989
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Al‐Mously 2014
    1. Al-Mously N, Mabil NM, Al-Babtain SA, Fouad Abbas MA. Undergraduate medical students’ perceptions on the quality of feedback received during clinical rotations. Medical Teacher 2014;36(S1):s17-23. - PubMed
Aper 2015
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