Reflective teaching of medical communication skills with DiViDU: assessing the level of student reflection on recorded consultations with simulated patients

Patient Educ Couns. 2009 Feb;74(2):142-9. doi: 10.1016/j.pec.2008.10.009. Epub 2008 Dec 4.


Objective: Acquisition of effective, goal-oriented communication skills requires both practicing skills and reflective thinking. Reflection is a cyclic process of perceiving and analysing communication behaviour in terms of goals and effects and designing improved actions. Based on Korthagen's ALACT reflection model, communication training on history taking was designed. Objectives were to develop rating criteria for assessment of the students' level of reflection and to collect student evaluations of the reflective cycle components in the communication training.

Methods: All second year medical students recorded a consultation with a simulated patient. In DiViDU, a web-based ICT program, students reviewed the video, identified and marked three key events, attached written reflections and provided peer-feedback. Students' written reflections were rated on four reflection categories. A reflection-level score was based on a frequency count of the number of categories used over three reflections. Students filled out an evaluation questionnaire on components of the communication training.

Results: Data were analyzed of 304 (90.6%) students. The four reflection categories Observations, Motives, Effects and Goals of behaviour were used in 7-38%. Most students phrased undirected questions for improvement (93%). The average reflection score was 2.1 (S.D. 2.0). All training components were considered instructive. Acting was preferred most. Reviewing video was considered instructive. Self-reflection was considered more difficult than providing written feedback to the reflections of peers.

Conclusion: Reflection on communication behaviour can be systematically implemented and measured in a structured way. Reflection levels were low, probably indicating a limited notion of goal-oriented attributes of communication skills.

Practice implications: Early introduction of critical self-reflection facilitates acceptance of an important ability for physicians for continued life-long learning and becoming mindful practitioners.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Clinical Competence* / standards
  • Communication*
  • Computer-Assisted Instruction
  • Education, Medical, Undergraduate / methods
  • Educational Measurement / methods
  • Humans
  • Internet
  • Medical History Taking
  • Models, Educational
  • Motivation
  • Netherlands
  • Patient Simulation*
  • Peer Group
  • Program Evaluation
  • Self-Assessment
  • Students, Medical / psychology*
  • Surveys and Questionnaires
  • Thinking*
  • Videotape Recording / methods*