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Korean J Med Educ. 2017 Dec;29(4):241-251. doi: 10.3946/kjme.2017.70. Epub 2017 Nov 29.

Verbal communication of students with high patient-physician interaction scores in a clinical performance examination assessed by standardized patients.

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Department of Medical Education and Institute for Medical Humanities, Inje University College of Medicine, Busan, Korea.
Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Emergency Medicine, Dong-A University Hospital, Busan, Korea.



Standardized patients (SPs) tend to rate medical students' communication skills subjectively and comprehensively, in contrast to such objective skill set defined in the clinical performance examination (CPX). Meanwhile, medical school instructors have a different approach in their evaluation of students' communication skills. We aim to analyze medical students' verbal communication skills using objective methods, and to determine the contributing factors of a patient-physician interaction (PPI) score.


Students with high- and low-ranking scores for PPI in CPX were selected. The Roter interaction analysis system was used to compare verbal communication behaviors of the students and SPs. Patient-centeredness scores (PCSs), physician's verbal dominance, and number of utterances were compared between the two groups.


PCSs and physician's verbal dominance had no difference between the groups. The number of utterances during the limited time of 5 minutes of CPX was higher for the high-ranking students. They tended to employ more paraphrase/check for understanding, and closed questions for psychosocial state and open questions for medical condition. The SPs interviewed by high-ranking students gave more medical information and requested for more services.


In the case of the routine checkup, smooth conversations with more frequent utterances were detected in the high-ranking students. More medical information exchange and requests for services by SPs were higher for the high-ranking students. Medical communication instructors should keep in mind that our results could be indicators of a high PPI score.


Communication; Medical education; Medical students; Verbal behavior

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