gms | German Medical Science

Introduction: Although trainings improve students’ communication skills, they still have difficulties in communicating skillfully in clinical settings [1]. It has been proposed to explain this lack of transfer as a problem in metacognitive processing. Using unsuitable cues for monitoring actions in a complex situation prohibits effective behavior adaptations and thus competency development. It has been shown that in monitoring history taking students use cues such as observable behavior emitted from patient and student (OB/P/S), information in student’s memory (IM) and student’s subjective feelings (SF) and proxy judgments (PJ) emerging out of the experience of performing [2]. To learn about cues suitability we hypothesize in accordance with literature [3] that students performing high in the skills domain differ in their usage of cues compared to students performing low. As defined by communication models [4] we hypothesize that high performing students will use more patient-emitted cues in monitoring their behavior.

Method: Forty second year medical students in first consultation skills training verbalizing their metacognitive self-judgments using their last training patient encounter as stimulus material. This material was analyzed using directed content analysis.

Results: 40 Students selected 144 sequences to provide self-judgments. Those contained 259 expressions elaborating the self-judgments. Coding dimensions and codes as previously defined proved to be applicable to the extension sample. Preliminary results indicate that high performers provide not only more expressions to elaborate their self-judgment but also integrate more cues into their elaborations. They also indicated more sequences to judge their performing of a process skill, and they use patient emitted cues for deriving their judgments twice as much.

Discussion: Results signifies patient-emitted cues as suitable cues for deriving a metacognitive self-judgments of one’s performance in communicating with patients. If stimulating their usage will help low performing students to improve have to be shown by further research.