Introduction : The aim of this study was to determine the applicability and efficacy of a tool for improving medical students’ ability to recognize the facial expressions of emotions. Material and methods : We conducted a controlled intervention study with 98 medical students. The control group underwent a 45-minute class whose content was not targeted at the rehabilitation objective, while the intervention group was trained to recognize emotions through tutorials and games on eye, face and microexpression recognition using https://www.e-motionaltraining.com/ program. All participants were assessed before and after the intervention with Ekman Faces Test. Results : When comparing the scores between the groups, we observed significant preintervention postintervention improvements in the intervention group in the emotions of anger ( p < 0.001), sadness ( p = 0.031) and fear ( p = 0.007). Moreover , when comparing the students who performed pretest at Q1 vs. Q4 there were significant differences in change scores in happiness and anger ( p = 0.005 and p = 0.003, respectively), with the students who achieved lower results in the initial assessment (Q1), thereby showing greater improvement. Conclusions : We can conclude that training medical students in recognizing facial emotions as part of their routine classroom training is feasible. The participants who most benefited were those who initially had lower scores in emotion recognition.
KeywordsEmpathyMedical StudentsNonverbal Communication
Achinard, M. (2000). Doctor’s and Patients’ Facial Expressions and Suicide Reattempt Risk Assessment. Journal of Psychiatric Research, 34, 261-262. https://doi.org/10.1016/S0022-3956(00)00011-X
Becker, M. H., & Maiman, L. A. (1975). Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations. Medical Care, 13, 10-24. https://doi.org/10.1097/00005650-197501000-00002
Eide, H., Quera, V., & Finset, A. (2003). Exploring Rare Patient Behaviour with Sequential Analysis: An Illustration. Epidemiology and Psychiatric Sciences, 12, 109-114. https://doi.org/10.1017/S1121189X00006175
Ekman, P. (2004). Emotions Revealed: Recognising Facial Expression. British Medical Journal Careers, 75-76. http://archive.student.bmj.com/issues/04/04/education/140.php
Endres, J., & Laidlaw, A. (2009). Micro-Expression Recognition Training in Medical Students: A Pilot Study. BMC Medical Education, 9, 47. https://doi.org/10.1186/1472-6920-9-47
Haxby, J., Hoffman, E., & Gobbini, M. (2002). Human Neural Systems for Face Recognition and Social Communication. Biological Psychiatry, 51, 59-67. https://doi.org/10.1016/S0006-3223(01)01330-0
Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C. et al. (2011). Physicians’ Empathy and Clinical Outcomes for Diabetic Patients. Academic Medicine, 86, 359-364. https://doi.org/10.1097/ACM.0b013e3182086fe1
Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 9, e94207. https://doi.org/10.1371/journal.pone.0094207
Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004). The Effects of Physician Empathy on Patient Satisfaction and Compliance. Evaluation & the Health Professions, 27, 237-251.
Kraft-Todd, G. T., Reinero, D. A., Kelley, J. M., Heberlein, A. S., Baer, L., & Riess, H. (2017). Empathic Nonverbal Behavior Increases Ratings of Both Warmth and Competence in a Medical Context. PLoS ONE, 12, e0177758. https://doi.org/10.1371/journal.pone.0177758
Langewitz, W., Nübling, M., & Weber, H. (2003) A Theory-Based Approach to Analysing Conversation Sequences. Epidemiology and Psychiatric Sciences, 12, 103-108. https://doi.org/10.1017/S1121189X00006163
Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M. et al. (2001). Preferences of Patients Forpatient Centred Approach to Consultation in Primary Care: Observational Study. BMJ, 322, 468-472. https://doi.org/10.1136/bmj.322.7284.468
Lockwood, P. L. (2016). The Anatomy of Empathy: Vicarious Experience and Disorders of Social Cognition. Behavioural Brain Research, 311, 255-266. https://doi.org/10.1016/j.bbr.2016.05.048
Marono Souto, Y., Vázquez Campo, M., Díaz Llenderrozas, F., Rodríguez álvarez, M., Mateos, R., & García Caballero, A. (2018). Randomized Clinical Trial with e-MotionalTraining® 1.0 for Social Cognition Rehabilitation in Schizophrenia. Frontiers in Psychiatry, 9, 40. https://doi.org/10.3389/fpsyt.2018.00040
McCabe, R., Heath, C., Burns, T., & Priebe, S. (2002). Engagement of Patients with Psychosis in the Consultation: Conversation Analytic Study. BMJ, 325, 1148-1151. https://doi.org/10.1136/bmj.325.7373.1148
Mead, N., & Bower, P. (2000) Patient-Centredness: A Conceptual Framework and Review of the Empirical Literature. Social Science & Medicine, 51, 1087-1110. https://doi.org/10.1016/S0277-9536(00)00098-8
Mentes, J., Teer, J., & Cadogan, M. (2004). The Pain Experience of Cognitively Impaired Nursing Home Residents: Perceptions of Family Members and Certified Nursing Assistants. Pain Management Nursing, 5, 118-125. https://doi.org/10.1016/j.pmn.2004.01.001
Mercer, S. W., & Reynolds, W. J. (2002). Empathy and Quality of Care. The British Journal of General Practice, 52, S9.
Norfolk, T., Birdi, K., & Walsh, D. (2007). The Role of Empathy in Establishing Rapport Patient Centered Care on Outcomes. The Journal of Family Practice, 49, 796-804.
Riess, H., & Kraft-Todd, G. (2014). E.M.P.A.T.H.Y.: A Tool to Enhance Nonverbal Communication between Clinicians and Their Patients. Academic Medicine, 89, 1108-1112. https://doi.org/10.1097/ACM.0000000000000287
Rimondini, M., Del Piccolo, L., Goss, C., Mazzi, M. A., Paccaloni, M. et al. (2004). The Handling of Patient Cues and Expressed Emotions in Psychiatric Interviews after a Communication Skills Training. Patient Education and Counseling, 55, 311-312.
Squier, R. W. (1990) A Model of Empathic Understanding and Adherence to Treatment Regimens in Practitioner-Patient Relationships. Social Science & Medicine, 30, 325-339. https://doi.org/10.1016/0277-9536(90)90188-X
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J. et al. (2000). The Impact of Consultation: A New Model. Medical Education, 41, 690-697.
Tamblyn, R., Abrhamowicz, M., Dauphinee, D., Wenghofer, E., Jacques, A., Klass, D., Smee, S., Blackmore, D., Winslade, N., Girard, N. et al. (2007). Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities. The Journal of the American Medical Association, 298, 993-1001. https://doi.org/10.1001/jama.298.9.993
Van den Brink-Muinen, A., & Caris-Verhallen, W. (2003). Doctors’ Responses to Patients’ Concerns: Testing the Use of Sequential Analysis. Epidemiology and Psychiatric Sciences, 12, 92-97. https://doi.org/10.1017/S1121189X0000614X
Van Dulmen, S., & van den Brink-Muinen, A. (2004). Patients’ Preferences and Experiences in Handling Emotions: A Study on Communication Sequences in Primary Care Medical Visits. Patient Education and Counseling, 55, 149-152.
Van Dulmen, S., Nübling, M., & Langewitz, W. (2003). Doctor’s Responses to Patients’ Concerns; An Exploration of Communication Sequences in Gynaecology. Epidemiology and Psychiatric Sciences, 12, 98-102. https://doi.org/10.1017/S1121189X00006151
Vázquez-Campo, M., Marono, Y., Lahera, G., Mateos, R., & García-Caballero, A. (2016). e-Motional Training®: Pilot Study on a Novel Online Training Program on Social Cognition for Patients with Schizophrenia. Schizophrenia Research: Cognition, 4, 10-17. https://doi.org/10.1016/j.scog.2015.11.007
West, C. P., Huschka, M. M., Novotny, P. J., Sloan, J. A., Kolars, J. C., Habermann, T. M. et al. (2006). Association of Perceived Medical Errors with Resident Distress and Empathy: A Prospective Longitudinal Study. JAMA: The Journal of the American Medical Association, 296, 1071-1078. https://doi.org/10.1001/jama.296.9.1071
Young, A., Perrett, D., Calder, A., Sprengelmeyer, R., & Ekman, P. (2002). Facial Expressions of Emotion—Stimuli and Tests (FEEST). Bury St Edmunds, Inglaterra: Thames Valley Test Company.
Zachariae, R., Pedersen, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B. et al. (2003). Association of Perceived Physician Communication Style with Patient Satisfaction, Distress, Cancer-Related Self-Efficacy, and Perceived Control over the Disease. British Journal of Cancer, 88, 658-665. https://doi.org/10.1038/sj.bjc.6600798
Zimmermann, C., Del Piccolo, L., & Mazzi, M. A. (2003). Patient Cues and Medical Interviewing in General Practice: Examples of the Application of Sequential Analysis. Epidemiology and Psychiatric Sciences, 12, 115-123. https://doi.org/10.1017/S1121189X00006187