Prasartseree et al.
Efficacy of Communication Skills Training of
Preclinical Medical Students via Health Literacy
Teaching to High School Students: A Pilot Study
Tissana Prasartseree, M.D.*, Pittaya Dankulchai, M.D.*, Yodying Dangprapai, M.D., Ph.D.**, Tanjira Jiranantakan,
M.D., MPH***, ****, *****
* Division of Radiation Oncology, Department of Radiology, **Department of Physiology, ***Department of Preventive and Social Medicine, Faculty
of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Tailand, **** Drug Health Services, Royal Price Alfred Hospital, Camperdown,
Australia, ***** Edith Collins Centre, Central Clinical School, Faculty of Medicine and Health, Te University of Sydney, Sydney, Australia
ABSTRACT
Objective: Communication Skills via Health Literacy (CSvHL) was a pilot elective communication skills training
(CST) course, which allowed preclinical medical students to gain communication competence through the experience
of being a health educator for high school students (HSSs). Te efficacy of CSvHL was explored.
Materials and Methods: All 10 medical students were prepared for their HSS-health-educator roles by participating
in several observation sessions at an outpatient department and via communication workshops. In-field health
education courses were subsequently delivered to HSSs by the medical students. Developments of the medical
students’ communication skills were fostered through loops of learning activities and regular feedbacks. Assessments
of the pre- and post-CSvHL communication skill levels by means of an OSCE, with adapted ComON Check were
evaluated by each medical student, a standardized patient, and three medical instructors.
Results: In general, the overall and category-specific average ComON Check scores of the whole class were significantly
improved afer the CSvHL course. Te 3 communication defects with the lowest scores in the pre-CSvHL assessments
were subsection division, summarization, and comprehension-check while counseling.
Conclusion: CSvHL was successfully established as a preclinical-year CST course. Te improvements in the ComON
Check scores reflected the transformative learning gained from the hands-on experience, individualized CST, and
360° feedback OSCE for communication skill assessment.
Keywords: Preclinical communication skills training (CST); early clinical exposure; health literacy; health educator;
transformative learning (Siriraj Med J 2021; 73: 532-540)
INTRODUCTION
institutes provide CST separately from basic clinical-skills
Communication skills training (CST) is essential
training (e.g., history taking and counseling) during the
for medical students since productive doctor-patient
preclinical years, whereas others expect communication
communication and multidisciplinary collaboration are
competence to be indirectly gained via clinical clerkships
required for qualified medical practitioners in their daily
(e.g., during ward rounds, bedside teaching, and medical
practice.1-4 However, CST is typically not specifically
report discussions) during the clinical years without any
delivered throughout the medical curriculum. Some explicit CST. It has been suggested that CST in clinical
Corresponding author: Tissana Prasartseree
E-mail: tissana.p@gmail.com
Received 7 May 2021 Revised 3 July 2021 Accepted 9 July 2021
532
Volume 73, No.8: 2021 Siriraj Medical Journal
Original Article SMJ
year clerkships should be promoted via a repetitive and
students (HSSs), the medical students were encouraged
supportive environment, with structured training that is
to identify and prepare relevant information and to
adaptable and tailored to medical-students.5,6 However,
practice their presentation and communication skills.
with promising expectations, carefully-selected clinical
Wong et al. postulated that medical students assuming
skills and topics might be introduced and taught sooner,
the role of health educators gain high levels of trust
as part of preclinical CST; this early exposure has the
and comfort from HSSs. More specifically, Wong and
potential to assist medical students to perform better
colleagues proposed that the unique position of medical
during their later clinical years.7-9
students-healthcare providers who are only slightly
Health literacy refers to the skills needed to
older than HSSs- allows them to foster trust via peer
obtain, interpret, and utilize health information10-12 and
relationships with HSSs rather than by adopting the
comprises a wide range of biomedical knowledge and life
more traditional authoritarian- role of a teacher.28 In
skills. It is an appropriate foundation topic to be taught
turn, the bonding enables the medical students to freely
and practiced during the preclinical years. Aspects of
prepare mini-health education courses for the HSSs
fundamental healthcare- such as smoking cessation and
that incorporate an active-learning teaching style and
diet control- can be selected to enable preclinical medical
are less stressful to deliver than with real-life patients.
students to practice the communication skills related to
Moreover, essential communication skills are intensified
patient counselling, despite lacking in-depth medical
through the preparation of the courses in that the medical
knowledge. Hess et al.13 reported on a pilot project at
students need to consider the level of the audience, the
Harvard Medical School that allowed medical students,
appropriate media to be utilized, and the language level
in collaboration with the medical librarian, to deliver a
to be employed. Te second aim of the CSvHL course was
short, plain-language, health-literacy presentation to
to enhance health literacy awareness, thereby motivating
adult, multi-ethnic learners. A post-intervention survey
the medical students to gain a comprehensive medical
revealed that 88% of those students had improved their
knowledge which could be applied in their future clinical
physician-patient communication skills, including adult
practice.10,19
learner interaction, health communication, and plain-
Tis study explored the effectiveness of the CST
language expression abilities. In another study by Milford
provided to the participating medical students by the
et al.14, preclinical first- and second-year medical students
CSvHL course.
were trained in pediatric obesity intervention strategies.
Tey were involved with Head Start children, parents,
MATERIALS AND METHODS
and staff in the conduct of pediatric-obesity education
The “Communication Skill via Health Literacy
programs and the setting of the related management goals
(CSvHL)” course provided a health-educator experience
for the families concerned. Pre- and post-intervention
for medical students and assessed their communication
surveys found that the students had made significant
skills (Fig 1). Below are details of the participants, the
improvements in confidence in their health-literacy
curricular learning activities, and the communication
knowledge and skills. Moreover, the sophistication of
skills assessments.
communication compositions (e.g., the pre-existing
knowledge and health behaviors of parents, patients, and
Participants
the community, doctor-patient interactions of empathy,
Medical students: Te participants comprised all
and family concerns) were also acknowledged by the
ten of the 2nd and the 3rd year medical students who
medical students. Hence, with such supporting evidence,
enrolled in the pilot CSvHL elective course in academic
involving medical students in the provision of health
year 2018. Tey completed an informed consent form,
education for patients or communities appears to have
in accordance with Siriraj Institutional Review Board
the potential to improve quality of care, enhance medical
protocol 580/2018 (EC1).
education, and develop communication skills.8,15-20
Medical instructors: Tree instructors- each with
Conducted in academic year 2018, Communication
10- to 15-years’ teaching experience- assumed the roles
Skills via Health Literacy (CSvHL) was a pilot elective
of advisors for the medical students. Tey were drawn
course for preclinical medical students. It had two major
from the Radiation Oncology Division of Radiology
aims. Te first was to develop the communication skills of
Department (PD); the Department of Preventive and
preclinical medical students via direct experience gained
Social Medicine (TJ); and the Department of Physiology
from teaching and facilitating health education at a high
and the Health Science Education Excellence Center
school.21-27 By teaching health education to high school
(YD). In addition, a 6th year medical student took on
Volume 73, No.8: 2021 Siriraj Medical Journal
533
Prasartseree et al.
Fig 1. Communication Skills via Health Literacy (CSvHL) scheme. Te three phases of the CSvHL course are illustrated. To determine
the communication skills improvements of the medical students, a pre-CSvHL assessment was conducted afer the Introduction, while a
post-CSvHL assessment was made before the Epilogue.
Abbreviations: OPD, outpatient department; OSCE, Objective Structured Clinical Examination.
the role of teaching assistant and curriculum developer
As to the second phase, the medical students developed
during the externship (TP).
their communications skills through hands-on experience.
High school students (HSSs): Fify female, 10th grade,
To this end, they were assigned to 2, in-field, health
Arts-Mathematics-program students from Satri Wat
education groups, with the 2nd and 3rd year students being
Rakhang School were included as the subjects for the
equally distributed between the groups. To promote
in-field health education program. Informed consent
engagement with the HSSs, icebreaking activities were
was obtained as per Siriraj Institutional Review Board
arranged to facilitate the introduction of the medical
protocol 580/2561 (EC1). Satri Wat Rakhang School is
students and their subsequent surveying of the topics
a girls’ school which is located near Siriraj Hospital. It
of interest to the HSSs. Each of the 2 education groups
was selected because of its accessibility.
was then requested to devise a health education session
for delivery to the HSSs that incorporated health literacy
CSvHL curriculum
as one of its learning points. Although the learning
Te course was divided into 3 phases: Introduction,
task was required to be interactive or activity-based, no
Communication Skills Training by Doing, and Epilogue
other limitation was placed on its design. Te loop of
(Fig 1).
presentation preparation, internal audit, and onstage HSS
In the introductory phase, the medical students
teaching activity lasted about 4 weeks for each education
were given an overview of the communication processes
group. While one group presented its teaching activity,
utilized in clinical practice via observation sessions at
the members of the other group helped the medical
the outpatient department, communication-workshop
instructor by playing the role of commentator in the
group activities, and mini-interactive lectures. Each of the
internal audit and facilitator in the onstage period. Group
aforementioned activities was 2- to 3-hours long, and they
and individual performance reflections and feedback were
were conducted once per week for 3 consecutive weeks.
given for every internal audit and on-stage presentation.
Te baseline communication skills of the students were
In the epilogue phase, a post-CSvHL communication
assessed at the end of the phase. Verbal and nonverbal
assessment was executed. During the following week,
communication-skill learning points were identified for
a group discussion about how the CSvHL course had
individual students, allowing the instructors to tailor the
improved the medical students’ communication skills
advice to be given to each student during the subsequent
was held as the end of the course.
lessons.
534
Volume 73, No.8: 2021 Siriraj Medical Journal
Original Article SMJ
Communication skills assessment and statistical analysis
For the pre-assessments executed afer the introductory
As depicted in Fig 1, pre- and post-CSvHL
phase, pairs of students were required to advise a 1st-
communication skills competency was assessed by an
trimester pregnant woman who wanted to quit smoking.
Objective Structured Clinical Examination. Relevant
As to the post-assessments, they were executed one
materials were given to the medical students one week
week afer completing the CSvHL course. For those
prior to each assessment to complement the clinical
assessments, the medical students had to individually
basics used in the OSCE. During a 5-minute session,
counsel a Type 1 diabetes mellitus patient on the choice
each medical student was required to take a short history
of an appropriate insulin pump injector. Te diabetic
to probe a standardized patient’s (SP’s) problem before
patient had a history of poor insulin-injection compliance
giving medical advice to the SP; 3 medical instructors
due to a hectic lifestyle stemming from her work as a
observed the interaction through one-way glass. Afer the
commercial designer. With both the pre- and post-
session, each student presented a 2-minute self-reflection
assessments, the simulated patient and the 3 instructors
of their performance before being given a 3-minute
were identical; they were blinded to the pre-assessment
feedback by the instructors and the SP on what worked
score before performing the post-CSvHL communication
well and areas for improvement.
assessment.
Te simulation scenarios developed by the 3 instructors
Selected categories from ComON Check29-31 namely,
and the teaching assistant covered all scoring criteria
the starting and ending of a conversation, the structure of
encompassed in the communication skills assessment.
a conversation, general communication skills, and overall
Only one experienced SP, who had an MSc in psychology
evaluation of a conversation (Fig 2) were evaluated by each
and was a postgraduate educator for 2 years, participated
medical student, the SP, and the 3 medical instructors.
in both the pre- and post-assessments. Te SP was well
A paired t-test of the pre- and post-assessment scores
prepared for the scenario performance, feedback, and
was performed. Statistical significance was deemed to
evaluation of the medical student.
be a p-value of 0.05 or less.
Fig 2. Adapted ComON Check.
Radziej et al. (2017). How to assess communication skills? Development of the rating scale ComON Check-Evaluation of communication
skills.11
Volume 73, No.8: 2021 Siriraj Medical Journal
535
Prasartseree et al.
RESULTS
An analysis of the communication skill assessments
In the 2 in-field learning activities, each medical
revealed that the average ComON Check score of the
student participated in one as an activity leader and the
whole class improved significantly (Fig 3). Compared with
other as a facilitator.
the overall scores, those given by the medical instructors
Te first group of medical students conducted an
tended to be low whereas the scores assigned by the SP
interactive lecture on weight control that was based on the
tended to be high. Te self-assessment scores showed
educational gaming platform, Kahoot! Te comprehension
the highest standard deviation. Te 3 categories with
of the HSSs about weight control (e.g., body composition,
the lowest scores in the pre-CSvHL assessments were B2
energy expenditure, nutrition facts, and diet-control
(setting subsections), D1 (concluding), and E5 (checking
strategies) were challenged with 10 multiple-choice
patient comprehension of a conversation). Te total
questions. Afer each question, additional discussion
pre-assessment scores of 3 medical students were less
was held to clarify the HSSs’ perceptions.
than half the ComON Check score when assessed by the
Te second group of medical students examined
medical instructors. In a comparison of the ComON Check
the mythology of abnormal menstruation using a small-
scores from the pre- and post-CSvHL assessments, most
group discussion approach, with the HSSs divided into
ComON Check categories assessed by the medical students,
groups of 5-7 students each. True and false information
the instructors, and the SP demonstrated a significant
on menstruation was drawn from social media sites (Line,
improvement. Te exceptions were A1 (appropriate
Instagram, Facebook, and a popular Tai web-board) and
initiation of a conversation), E2 (using appropriate
transformed into a series of statements. Each discussion
nonverbal communication during the consultation),
group had to decide whether to believe and share the
and E4 (offering the chance to ask questions during the
given information via social media or to follow the
consultation). Te scores for these 3 items improved
suggestions of the simulated advisories. Answers were
without statistical significance when evaluated by the
scored. Each social media statement was then reviewed
medical students. Similarly, the scores assigned by the
at length afer the activity, with the incorrect answers
SP for both E1 (using clear and appropriate wording)
of the HSSs being discussed. Te HSS group with the
and E2 went up, though with no significance. Te data
highest score received a small prize.
are presented in Fig 4 and Table 1.
Fig 3. Average ComON Check scores of the whole class.
Abbreviations: Asses, assessed; Med Instructor, medical instructor; SP, standardized patient
536
Volume 73, No.8: 2021 Siriraj Medical Journal
Original Article SMJ
Fig 4. Individual medical students’ ComON Check scores.
DISCUSSION
of the HSSs. Learning from the first group, the second
CSvHL was successfully established as a preclinical-
group decided to develop a more interactive activity and
year CST course. It is suggested that the significant
facilitated the in-action health decision-making.
improvements in the ComON Check scores resulted from
Moreover, with the pre-CSvHL communication
2 factors. Te first of these is the transformative learning
skills assessment being made from 3 perspectives: the
gained from the hands-on experience in communication
medical students, the SP, and the 3 mentors (a “360°
in various settings. Te second contributing factor is the
behavior-oriented feedback” approach34,35), the potential
individualized feedback and training provided by the
verbal and nonverbal communication-skill learning points
areas of improvements individually extracted from the
were identified. Tese points enabled the instructors to
pre-CSvHL communication skills assessments.
focus on the medical students’ performances and give
From the medical students’ perspectives, the learning
specific feedback. Tis approach was proved to be useful,
of communication skills proved to be challenging and
especially during the in-field activity, as the instructor
complex. Teir lack of clinical experience limited their
feedback enhanced the efficacy of the CST.36,37 Te end
communication abilities and their perspectives during the
result was that the medical students could communicate
communication skills training. In this pilot program, the
better, as evidenced by the improved ComON Check
hands-on experience of teaching the HSSs provided the
scores.
medical students with the opportunity to simultaneously
As to the communication skills assessments using
upskill and understand the learning process, to which the
the selected ComON Check categories, the relatively
communication mechanisms homogeneously relate. By being
low pre-CSvHL scores given by the medical instructors
cycled in each in-field learning activity, the communication
reflect the high expectations of medical professions,
components-learning objectives, communicator factors,
consistent with result of the prior study which lower
and recipient factors-were critically re-evaluated, leading
scores were given by the experienced SP.38 On the other
to a more effective teaching strategy. Tis was evident in
hand, the high scores given by the SP might signify that
the shif of the learning activity from an interactive lecture
the medical students who participated in the CSvHL
using a game-based learning platform to small group
course may have possessed good communication skills
discussions, which was considered as a sign of transformative
before their enrollment in the course. Tis suggests that
learning being experienced by the medical students.32,33
the study may have had a selection bias.
In the reflection and feedback session following the first
Other than the possibility of a selection bias, the
in-field activity, the interactive lecture was identified as
small sample size could have affected the statistical
having provided only health knowledge, being rather
significance of the improvements in the ComON Check
dull, and failing to achieve health literacy skill training
scores given by the medical students and SP. Moreover,
Volume 73, No.8: 2021 Siriraj Medical Journal
537
Prasartseree et al.
TABLE 1. Average ComON Check Scores ± standard deviations.
ComON Check categories
Overall assessments
Self-assessments
Medical instructor assessments
Standardized patient assessments
Pre-
Post-
P
Pre-
Post-
P
Pre-
Post-
P
Pre-
Post-
P
test
test
Change
(t-test)
test
test
Change
(t-test)
test
test
Change
(t-test)
test
test
Change
(t-test)
A Start of the conversation
A1 Does the physician initiate
3.1 ± 0.4
4.3 ± 0.5
1.2 ± 0.6
0.0002
3.3 ± 1.2
3.7 ± 0.8
0.4 ± 1.4
0.2113
2.9 ± 0.4
4.5 ± 0.4
1.6 ± 0.4
< 0.0001
3.6 ± 0.5
4.5 ± 0.9
0.9 ± 1.2
0.0271
the conversation appropriately?
A2 Does the physician manage to get
3.1 ± 0.2
4.5 ± 0.3
1.4 ± 0.3
< 0.0001
3.4 ± 0.8
4.1 ± 0.5
0.7 ± 0.8
0.0124
2.8 ± 0.4
4.5 ± 0.3
1.8 ± 0.5
< 0.0001
3.8 ± 0.4
4.7 ± 0.6
0.9 ± 0.8
0.0050
an idea of the patient’s perspective at the
beginning of, or during the consultation?
B Structure of conversation
B1 Does the physician actively give
2.8 ± 0.4
4.2 ± 0.3
1.4 ± 0.5
< 0.0001
2.8 ± 0.7
3.9 ± 0.7
1.1 ± 1.0
0.0058
2.6 ± 0.5
4.1 ± 0.3
1.5 ± 0.5
< 0.0001
3.5 ± 0.5
4.7 ± 0.6
1.2 ± 0.9
0.0013
structure to the conversation (set an
agenda of central topics)?
B2 Does the physician set sub-
2.8 ± 0.4
4.1 ± 0.3
1.3 ± 0.4
< 0.0001
2.7 ± 0.9
3.9 ± 0.8
1.2 ± 0.9
0.0112
2.5 ± 0.4
4.1 ± 0.3
1.6 ± 0.5
< 0.0001
3.7 ± 0.5
4.6 ± 0.5
0.9 ± 0.5
0.0004
sections in the course of the
conversation (in detail)?
D End of conversation
D1 Does the physician summarize the
2.7 ± 0.5
4.2 ± 0.4
1.5 ± 0.5
< 0.0001
2.2 ± 1.0
4.0 ± 1.0
1.8 ± 0.9
< 0.0001
2.5 ± 0.7
4.1 ± 0.4
1.6 ± 0.7
< 0.0001
3.7 ± 0.5
4.7 ± 0.5
1.0 ± 0.8
0.0019
content of the consultation and do they
close the conversation appropriately?
E General communication skills
E1 Does the physician use clear and
3.1 ± 0.4
4.3 ± 0.2
1.1 ± 0.3
< 0.0001
2.9 ± 0.7
3.7 ± 0.5
0.8 ± 0.7
0.0054
2.9 ± 0.4
4.4 ± 0.3
1.5 ± 0.5
< 0.0001
4.0 ± 0.6
4.4 ± 0.5
0.4 ± 0.7
0.0519
appropriate words during the conversation?
E2 Does the physician use appropriate
3.2 ± 0.4
4.1 ± 0.3
0.8 ± 0.3
< 0.0001
3.2 ± 1.0
3.4 ± 0.7
0.2 ± 1.2
0.3097
2.9 ± 0.5
4.2 ± 0.4
1.3 ± 0.5
< 0.0001
4.2 ± 0.4
4.3 ± 0.5
0.1 ± 0.5
0.2955
non-verbal communication during the
consultation?
E3 Does the physician adjust his pace
3.0 ± 0.4
4.2 ± 0.3
1.2 ± 0.3
< 0.0001
2.8 ± 0.7
3.5 ± 0.7
0.7 ± 0.8
0.0124
2.8 ± 0.4
4.3 ± 0.4
1.5 ± 0.3
< 0.0001
3.7 ± 0.8
4.5 ± 0.5
0.8 ± 0.9
0.0112
during the consultation, and does he
make appropriate pauses?
E4 Does the physician offer the patient the
2.9 ± 0.5
4.2 ± 0.4
1.3 ± 0.6
< 0.0001
3.1 ± 1.2
3.7 ± 0.6
0.6 ± 1.0
0.0557
2.6 ± 0.6
4.1 ± 0.5
1.5 ± 0.7
< 0.0001
3.6 ± 0.8
4.8 ± 0.4
1.2 ± 0.7
0.0005
chance to ask questions during the consultation?
E5 Does the physician check whether the
2.7 ± 0.5
4.2 ± 0.5
1.5 ± 0.5
< 0.0001
2.4 ± 1.2
3.8 ± 1.2
1.4 ± 0.7
< 0.0001
2.4 ± 0.6
4.1 ± 0.4
1.7 ± 0.7
< 0.0001
3.8 ± 0.7
4.7 ± 0.5
0.9 ± 0.7
0.0019
patient has understood the consultation?
F Overall evaluation
F1 How do you assess the communication
3.0 ± 0.4
4.3 ± 0.3
1.4 ± 0.4
< 0.0001
2.7 ± 0.9
3.9 ± 0.5
1.2 ± 1.2
0.0065
2.7 ± 0.5
4.3 ± 0.3
1.6 ± 0.5
< 0.0001
4.0 ± 0.6
4.9 ± 0.3
0.9 ± 0.7
0.0019
skills of the physician in this conversation?
Sum ComON Check Score
32.4 ± 3.4
46.5 ± 2.4
14.1 ± 2.6
< 0.0001
31.5 ± 7.1
41.2 ± 4.1
9.7 ± 4.7
< 0.0001
29.6 ± 4.3
46.9 ± 3.0
17.3 ± 3.8
< 0.0001
41.6 ± 3.9
50.8 ± 3.0
9.2 ± 3.5
< 0.0001
538
Volume 73, No.8: 2021 Siriraj Medical Journal
Original Article SMJ
only the short-term outcomes of the communication
REFERENCES
skills improvement were explored, and the target group of
1.
Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey
the in-field learning activity was HSSs, not real patients.
P, et al. Interventions for improving medical students’ interpersonal
communication in medical consultations. Cochrane Database
Both limitations were accepted while the study was
Syst Rev. 2021 Feb 8;2:CD012418.
being designed: doing so kept an appropriate teacher-
2.
Zimmermann A, Baerwald C, Fuchs M, Girbardt C, Götze
per-student ratio and enabled the course to be run with
H, Hempel G, et al. Te Longitudinal Communication Curriculum
a limited number of instructors.
at Leipzig University, Medical Faculty - implementation and
Te 3 communication defects with the lowest scores
first experiences. GMS J Med Educ. 2021;38(3):Doc58.
in the pre-CSvHL assessment (subsection division,
3.
Gebhardt C, Mehnert-Teuerkauf A, Hartung T, Zimmermann
A, Glaesmer H, Götze H. COMSKIL: a communication skills
summarization, and comprehension checking while
training program for medical students. GMS J Med Educ. 2021;
counseling) should be highlighted in the counseling part
38(4):Doc83.
of a future CST course. Including an Objective Structured
4.
Shiraly R, Mahdaviazad H, Pakdin A. Doctor-patient communication
Clinical Examination and seeking SP feedback are also
skills: a survey on knowledge and practice of Iranian family
considered crucial.9,35,39-45 To achieve improvements in
physicians. BMC Fam Pract. 2021 Jun 24;22(1):130.
medical students’ communication skills and, potentially,
5.
Junod P, Sommer J, Louis-Simonet M, Nendaz M. Teaching
communication skills: beyond wishful thinking. Swiss Med
their eventual medical performance, both features
Wkly [Internet]. 2015 Feb 9 [cited 2021 Jul 3]; Available from:
should be incorporated in the CST.1,7 Furthermore,
the identification of the long-term outcomes-such as
6.
Rosenbaum ME. Dis-integration of communication in healthcare
sustained communication-skills improvement and overall
education: Workplace learning challenges and opportunities.
clinical proficiency-should be explored. Even though
Patient Educ Couns. 2017 Nov;100(11):2054-61.
the pilot CSvHL course may be a promising vehicle for
7.
Yedidia MJ. Effect of Communications Training on Medical
Student Performance. JAMA. 2003 Sep 3;290(9):1157.
preclinical CST, a larger class may alter its efficacy by
8.
Joe Grizella Runtu FM, Ardhia SH, Lokeswara AW, Friska D.
limiting the mentor-per-medical-student ratio and the
Shaping effective communication skills in first-year medical
in-field activities. Teacher-learner adjustment is therefore
students through community diagnosis exercise. JPMA J Pak
mandatory to achieve the optimal learning outcomes in
Med Assoc. 2021 Feb;71(Suppl 2)(2):S37-41.
any altered circumstances.
9.
Jacobs NN, Calvo L, Dieringer A, Hall A, Danko R. Motivational
Interviewing Training: A Case-Based Curriculum for Preclinical
Medical Students. MedEdPORTAL J Teach Learn Resour.
CONCLUSION
2021 Feb 12;17:11104.
Te pilot CSvHL was proved to be successful as a
10.
Nutbeam D. Defining, measuring and improving health literacy.
preclinical-year CST course for a small class size. Te
Health Eval Promot. 2015;42(4):450-6.
improvements in the ComON Check scores reflected the
11.
Ancker JS, Grossman LV, Benda NC. Health Literacy 2030: Is It
transformative learning gained via hands-on experience
Time to Redefine the Term? J Gen Intern Med. 2020 Aug;35(8):
and individualized CST. For assessment purposes, an
2427-30.
12.
Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington
Objective Structured Clinical Examination and 360°
F, et al. Updating Health Literacy for Healthy People 2030:
feedback are crucial. Teacher-learner adjustment is
Defining Its Importance for a New Decade in Public Health.
advised for larger CST classes to ensure that there is an
J Public Health Manag Pract JPHMP. 2021 Mar 12;
appropriate mentor-per-medical-student ratio for the
13.
Hess J, Whelan JS. Making health literacy real: adult literacy
in-field activities.
and medical students teach each other. J Med Libr Assoc JMLA.
2009 Jul;97(3):221-4.
14.
Milford E, Morrison K, Teutsch C, Nelson BB, Herman A, King
Practical points:
M, et al. Out of the classroom and into the community: medical
- Communication Skills via Health Literacy (CSvHL)
students consolidate learning about health literacy through
provides the experience of being a health educator
collaboration with Head Start. BMC Med Educ. 2016 Dec;16(1):121.
for high school students (HSSs).
15.
Vijn TW, Fluit CRMG, Kremer JAM, Beune T, Faber MJ,
- Transformative learning gained from the hands-
Wollersheim H. Involving Medical Students in Providing
on experience, individualized CST, and 360°
Patient Education for Real Patients: A Scoping Review. J Gen
Intern Med. 2017 Sep;32(9):1031-43.
feedback OSCE is crucial for communication
16.
Hamso M, Ramsdell A, Balmer D, Boquin C. Medical students
skill improvement.
as teachers at CoSMO, Columbia University’s student-run clinic:
- Te 3 communication defects in medical students
A pilot study and literature review. Med Teach. 2012 Mar;
from this study were subsection division,
34(3):e189-97.
summarization, and comprehension-check while
17.
Amorosa JMH, Mellman LA, Graham MJ. Medical students
counseling.
as teachers: How preclinical teaching opportunities can create
Volume 73, No.8: 2021 Siriraj Medical Journal
539
Prasartseree et al.
an early awareness of the role of physician as teacher. Med
health professions: a scoping review. Med Educ. 2019 Jun;53(6):
Teach. 2011 Feb;33(2):137-44.
547-58.
18.
Dandavino M, Snell L, Wiseman J. Why medical students
34.
Engerer C, Berberat PO, Dinkel A, Rudolph B, Sattel H, Wuensch
should learn how to teach. Med Teach. 2007 Jan;29(6):558-65.
A. Integrating 360° behavior-orientated feedback in communication
19.
Spengler E, Schechter M, Pina P, Rhim HJH. You Can Teach
skills training for medical undergraduates: concept, acceptance
Every Patient: A Health Literacy and Clear Communication
and students’ self-ratings of communication competence.
Curriculum for Pediatric Clerkship Students. MedEdPORTAL
BMC Med Educ. 2016 Dec;16(1):271.
J Teach Learn Resour. 2021 Jan 22;17:11086.
35.
Talwalkar JS, Fortin AH, Morrison LJ, Kliger A, Rosenthal DI,
20.
Tayade MC, Latti RG. Effectiveness of early clinical exposure
Murtha T, et al. An Advanced Communication Skills Workshop
in medical education: Settings and scientific theories - Review.
Using Standardized Patients for Senior Medical Students.
J Educ Health Promot. 2021;10:117.
MedEdPORTAL J Teach Learn Resour. 2021 May 27;17:11163.
21.
Smith C, Goss HR, Issartel J, Belton S. Health Literacy in
36.
Engerer C, Berberat PO, Dinkel A, Rudolph B, Sattel H, Wuensch
Schools? A Systematic Review of Health-Related Interventions
A. Specific feedback makes medical students better communicators.
Aimed at Disadvantaged Adolescents. Child Basel Switz. 2021
BMC Med Educ. 2019 Dec;19(1):51.
Feb 25;8(3):176.
37.
Niglio de Figueiredo M, Krippeit L, Ihorst G, Sattel H, Bylund CL,
22.
Chrissini MK, Panagiotakos DB. Health literacy as a determinant
Joos A, et al. ComOn-Coaching: Te effect of a varied number
of childhood and adult obesity: a systematic review. Int J
of coaching sessions on transfer into clinical practice following
Adolesc Med Health. 2021 Feb 12;33(3):9-39.
communication skills training in oncology: Results of a
23.
Guo S, Yu X, Davis E, Armstrong R, Naccarella L. Health
randomized controlled trial. Gilligan C, editor. PLOS ONE.
Literacy: An Interactive Outcome Among Secondary Students
2018 Oct 5;13(10):e0205315.
in Beijing. Health Lit Res Pract. 2021 Jan 11;5(1):e1-14.
38.
Roshal JA, Chefitz D, Terregino CA, Petrova A. Comparison of
24.
Jafari A, Tavakoly Sany SB, Peyman N. Te Status of Health
self and simulated patient assessments of first-year medical
Literacy in Students Aged 6 to 18 Old Years: A Systematic
students’ Interpersonal and Communication Skills (ICS)
Review Study. Iran J Public Health. 2021 Mar;50(3):448-58.
during Objective Structured Clinical Examinations (OSCE).
25.
Ayaz-Alkaya S, Kulakçı-Altıntaş H. Nutrition-Exercise Behaviors,
BMC Med Educ. 2021 Feb 17;21(1):107.
Health Literacy Level, and Related Factors in Adolescents in
39.
Geoffroy PA, Delyon J, Strullu M, Dinh AT, Duboc H, Zafrani
Turkey. J Sch Health. 2021 Jun 22. doi: 10.1111/josh.13057. Online
L, et al. Standardized Patients or Conventional Lecture for
ahead of print.
Teaching Communication Skills to Undergraduate Medical
26.
Mao Y, Xie T, Zhang N. Chinese Students’ Health Literacy
Students: A Randomized Controlled Study. Psychiatry Investig.
Level and Its Associated Factors: A Meta-Analysis. Int J Environ
2020 Apr 15;17(4):299-305.
Res Public Health. 2020 Dec 29;18(1):E204.
40.
Bloom-Feshbach K, Casey D, Schulson L, Gliatto P, Gifos
27.
Macleod D, Wass V, Laird S, McKeown J. GP lead medical
J, Karani R. Health Literacy in Transitions of Care: An Innovative
student visits to primary schools can provide a valuable learning
Objective Structured Clinical Examination for Fourth-Year
experience for both students and pupils. Educ Prim Care Off
Medical Students in an Internship Preparation Course. J Gen
Publ Assoc Course Organ Natl Assoc GP Tutors World Organ
Intern Med. 2016 Feb;31(2):242-6.
Fam Dr. 2021 Apr 23;1-5.
41.
Herchenröther J, Tiedemann E, Vogel H, Simmenroth A.
28.
Wong VSS, Naguwa GS. Te School Health Education Program
Which teaching method is more effective in a communication
(SHEP): medical students as health educators. Hawaii Med J.
course - role-playing versus simulated patients, taught by tutors or
2010 Mar;69(3):60-64.
faculty staff? A randomized trial. GMS J Med Educ. 2021;38(3):Doc54.
29.
Radziej K, Loechner J, Engerer C, Niglio de Figueiredo M, Freund
42.
Pless A, Hari R, Brem B, Woermamm U, Schnabel KP. Using
J, Sattel H, et al. How to assess communication skills? Development
self and peer video annotations of simulated patient encounters
of the rating scale ComOn Check: Evaluation of communication
in communication training to facilitate the reflection of
skills. Med Educ Online. 2017 Jan;22(1):1392823.
communication skills: an implementation study. GMS J Med
30.
Stubenrauch S, Schneid E-M, Wünsch A, Helmes A, Bertz H,
Educ. 2021;38(3):Doc55.
Fritzsche K, et al. Development and evaluation of a checklist
43.
Agago TA, Wonde SG, Bramo SS, Asaminew T. Simulated
assessing communication skills of oncologists: the COM-
Patient-Based Communication Skills Training for Undergraduate
ON-Checklist: Te COM-ON-Checklist. J Eval Clin Pract.
Medical Students at a University in Ethiopia. Adv Med Educ
2012 Apr;18(2):225-30.
Pract. 2021;12:713-21.
31.
Niglio de Figueiredo M, Krippeit L, Freund J, Ihorst G, Joos
44.
Mlika M, Ben Amor A, Mezni F. Improving the communicational
A, Bengel J, et al. Assessing Communication Skills in Real
skills in medicine using role play: a study about 28 students in
Medical Encounters in Oncology: Development and Validation of
the second cycle of medical studies. Tunis Med. 2021 Feb;99(2):
the ComOn-Coaching Rating Scales. J Cancer Educ. 2019 Feb;
201-6.
34(1):73-81.
45.
Przymuszała P, Marciniak-Stępak P, Cerbin-Koczorowska M,
32.
Saxena A. Transformative learning: premise, promise and
Borowczyk M, Cieślak K, Szlanga L, et al. ’Difficult Conversations
challenges. Med Educ. 2019 Jun;53(6):534-6.
with Patients’-A Modified Group Objective Structured Clinical
33.
Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis
Experience for Medical Students. Int J Environ Res Public
C, McNamee L, et al. Transformative learning as pedagogy for the
Health. 2021 May 27;18(11):5772.
540
Volume 73, No.8: 2021 Siriraj Medical Journal
