gms | German Medical Science

Background: Appropriate physician communication is associated with positive patient­-related outcomes [1]. Thus, communication is an essential part of most medical education curricula. In Switzerland communication skills are also tested in the Federal Licensing Examination [2]. As students are requested to apply communication principles properly, training with simulated patients is strongly recommended [3]. However, to enable the students to benefit from this training, they must first familiarise with (the application of) those communication principles.

Aim: In this randomised field study, a worked example approach [4] was implemented in a web-based learning environment. The aim was to facilitate the students’ acquisition of communication skills with respect to breaking bad news to patients.

Methods: N=116 fourth year medical students were randomly allocated to one of three learning conditions (LC) with either written worked examples (LC1), video-based worked examples (LC2), or video-based worked examples with content-dependent cues (LC3). All examples provided exactly the same information with respect to the learning contents (breaking bad news); they only differed in presentation. The cues were short text labels. Every cue displayed the rationale for a respective sequence within the example (e.g. "giving knowledge to the patient"). Learning outcomes were derived from the students’ first attempt to break bad news to a simulated patient (up to 10 points).

Results: Participants from LC3 attained the highest performance scores (MLC3=3.53 > MLC2=1.79 > MLC1=1.61). However, results did not differ between the groups at the 5% significance level (F=1.85, p=0.17).

Take home message: When only referring to the inferential statistics, conditions did not impact the learners’ performance differently. Nevertheless, enriching worked examples with content-related cues seems to be a promising approach to foster novices’ communication skills. Hence, further investigation is needed.