Objective: This study reports effects of a 'bottom-up' pedagogy using doctor-patient conversation transcripts to improve medical students' use of open questions in soliciting patient problems. Methods: We implemented an innovative approach involving students reviewing transcripts of medical interviews, skills practice using role-play and standardized patients (SPs), and reflection on these practices. We analyzed three open question categories (general, biomedical, and psychosocial) used by 27 Taiwanese medical students from two SP interviews, conducted before and after training. Results: Across the full encounter, use of general and psychosocial open questions increased significantly after training (from 27 to 92 general questions and 15 to 33 psychosocial questions). The high rates of narrowly focused opening questions (52% of initial position questions, 74% of second position questions, and 85% of third position questions) prior to training were reduced to 11%, 15%, and 15% respectively after training. Students also shifted from a micro (narrow) to a macro (broad) pattern of questioning. Conclusion: The 'bottom-up' approach facilitated by using conversation transcripts is effective in improving communication skills. Practice implications: By carefully reviewing transcripts of their own performance as part of an overall communication training package, beginning medical students can become more patient-centered in soliciting patient problems.
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