Video-Based, Worked-Out Examples in Medical Education: Effects of Model Features on Anxiety and Communication Skills

• In Event: Emotions in Medical Education: Causes and Effects

Abstract

Rationale. Communication between medical doctors and patients (e.g., breaking bad news situations) is a complex skill to be acquired by medical students. Such breaking bad news situations are highly emotional. A high level of anxiety in medical doctors, however, may have negative effects on quality of communication.

Worked-out examples have been broadly applied to support acquisition of skills (Renkl, 1997). Some studies indicate that learners can benefit especially if these examples are erroneous (Heitzmann, 2014). Videos allow modeling of communication behavior. Videos, however, put a strong emphasis on features of the subject that models the behavior. In line with Bandura (1965), status of the model and similarity with the learner may affect learning from observation.

Against this background, the following research question is examined: To what extent do correctness examples (erroneous vs. correct) and the status the model (similar/student vs. higher/professor) affect communication skills and anxiety in the context of learning with video-based, worked-out examples in medical education?

Method. In a one-factorial, pre-post design three conditions were realized: erroneous similar status model, correct similar status model, and correct higher status model. The sample included100 medical students at LMU Munich; participants were randomly assigned to one of the three conditions.

Thirty minutes were given for the video-based, worked-out example that lasted 11 minutes. Learners received detailed written analyses of the doctor’s acting. The erroneous similar status model was a student who showed average communication skills, but made some obvious errors during the communication with the patient. The correct similar status model was a student as well, but showed no obvious errors during the communication phase. The correct higher status model, finally, also showed no obvious errors, but was a professor. All three were equal with respect to provided information.

Communication skills were measured using a simulation with a standardized patient that took place after the video-based, worked-out example learning phase. Anxiety regarding the BBN situation was measured with adapted items from Test Emotions Questionnaire (Pekrun, et al., 2004) with sufficient reliability before and after the learning phase.

Results. With respect to skills, the results show significant differences between the correct similar status model and both other conditions. The student model with no obvious errors led to best performance in the simulation. With respect to anxiety, all learners showed a significant decrease of anxiety between pre and post-test. A significant interaction effect indicates that the decrease is stronger in the correct similar status model than in the erroneous similar status model. No interaction effect between pre-post measure and status of the model were found.

Significance. Our results provide evidence that video-based, worked-out examples can foster complex skills regarding communication in the context of medical education. Furthermore, the correctness of the example as well as the similarity with the learner has certain effects on skill acquisition. With respect to the reduction of anxiety, the correctness of the example seems to be more important than the similarity with the learner.

Authors

• Karsten Stegmann, University of Munich

• Lena Hofmann

• Frank Fischer, Ludwig Maximilian University of Munich

• Matthias Siebeck