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Monitoring communication with patients: analyzing judgments of satisfaction (JOS)

机译：监控与患者的沟通：分析满意度判断（JOS）

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Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi10.1037/0096-3445.126.4.349, 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.
机译：医学生努力实践在医学院学习的沟通技巧。为了改善我们的教学设计，更好地了解这种缺乏转移的原因是基础。因此，我们通过征求对自己的历史记录技能的自我评估来探索学生的认知，这种自我创造被称为“满意度判断（JOS）”。我们的认知心理学方法是在Koriat的提示使用框架（J Exp Psychol Gen 126：349-370。doi10.1037 / 0096-3445.126.4.349，1997）的指导下进行的，该假设基于内部和外部提示会告知学习者的元认知。判断，从而引导他们采取行动。基于不适当提示的判断将导致无效行为。因此，学生无法充分掌握这些技能或在类似情况下正确地运用它们。为了进行分析，我们让524名医学专业的本科生从他们的视频模拟病人的遭遇中选择了满意或不满意的场景，并解释了原因。取样二十份转录本用于定向内容分析。我们发现，约有三分之一的学生判断集中在内容上（JOS-a型）;约一半的沟通技巧（JOS-b型）;约有百分之十的人针对所利用技能的适当性（JOS-type-c）。缺乏对适当性的反思可以解释为什么学生会遇到适应新情况的问题。形成类型c判断的主要是高水平的学生;表现欠佳的人倾向于做出a型和b型判断。将来的研究将受益于我们改良版本的Koriat框架的使用，以便进一步探索表现出色和表现欠佳的医学生在沟通技能培训期间形成JOS的方式有何不同。

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