Reflection, confrontation, and validation are major techniques in skills that are used in building, maintaining, and steering communication between two or more persons, that is, in “interpersonal skills” (or “interpersonal competence”) (1). Simulated videotaped presentations have, for the most part, been integrated into interpersonal skills-training at the residency level, rather than in basic medical education programs (2–4). We aimed to study how fifth-year medical students assess their learning in simulated situations. Finland's degree program in medicine leads to the degree of Licenciate of Medicine, which corresponds to M.D. degrees in Anglo-American countries. Medical studies are prescheduled and the training is organized in such a manner that, with full-time attendance, the degree can be taken in 6 years.

A total of 126 students took part in the teaching sessions, which were composed of three phases: First, the students attended a lecture on key concepts (reflection, confrontation, validation); second, the students were divided into patient–doctor pairs. Each pair performed in an imaginary surgery situation, and a conversation between doctor and patient was videotaped. Third, the students assessed their learning by answering open questions, which were analyzed with inductive content-analysis (5). Here, we report on how the students responded to the question, “If there was something you learned during this interactive teaching, what was it?”

Content analysis was started by reading through the answers several times. Then, they were condensed into short statements (e.g., from “I learned to remain silent better than before when with a patient,” to “use of silence.”). The condensed statements were listed and categorized so that statements with the same meaning were grouped within the same category. For example, answers in which students mentioned that they had learned ways of coping with problematic situations or acquisition of useful tips on interviewing techniques were combined into one subcategory: “Tips, means, and ways of doing things.” Correspondingly, statements concerning gestures, facial expressions, or postures formed a subcategory: “Significance of eye contact and body language.” Subcategories were linked into main categories. The final categories were formed on the basis of the factors linking the main categories (Figure 1).

A total of 126 students took part in the interpersonal-skills teaching sessions. Of these, 107 (83%) returned the questionnaire within the prescribed time. In reading through the answers, it became evident that certain types of descriptions were systematically included. Answers included references to internal matters (thoughts and feelings) and external matters (gestures, facial expressions, techniques). The main categories were not necessarily exclusive; there was some overlap between them. For example, the answer “Confrontation is not good while on call in a health care center” includes both an external component (confrontation as a method) and an internal component (assessment of the method).

The majority of medical students taking part in the study learned to reflect on their actions, a finding that is coincident with previous findings (6). Also, answers based on technical rationality were associated with interpersonal-skills techniques (open questions, confrontation, and reflection as a technique).

Answers related to learning internal matters included direct self-reflection (e.g., “I learned to think about communication”). Internal-learning answers also included elements of self-validation, in which case the student's sense of competence was likely to have increased (e.g., “I received confirmation of my own ways of doing things”). Assessment of their own actions expanded students' perceptions of their impact in a communicative situation (self-reflection). Some found that their sense of competence was strengthened (self-validation). One limitation of the study was that the content analysis was based on one question only. It is also possible that our material of analysis (short paraphrased descriptions) was not sufficient to grasp the subtle nuances of interpersonal skills.

However, the use of videotaping provides an opportunity for self-evaluation, as well as the possibility of receiving feedback from others. Thus, an entry-level doctor's sense of competence associated with interpersonal skills can be increased. Future studies, with follow-up measures, should consider the use of control groups. Controlled studies comprising medical students with and without interpersonal-skills training courses are called for in order to obtain more specific information regarding the effects of this training.