Effective doctor-patient communication has various medical benefits. For example, effective communication can improve both patient adherence [1] and healthcare outcomes such as the reduction of pain and blood pressure [2]. To improve the communication skills of future doctors, optimizing communication education is essential in medical schools.
Medical interviews with simulated patients (SPs) constitute a mainstream tool in communication education for medical students [3]. Simulation education with SPs provides simulated medical interviews with SPs with peer-to-peer, SP, and teacher feedback [3]. These experiences promote self-reflection among students on communication skills. Receiving feedback is a useful way for students to understand themselves objectively, what they do well and what they do poorly, and how they can communicate more effectively in the next time. Such an understanding will lead to improved self-efficacy. Although a previous study showed that simulation education using SPs contributes to improving communication skills [4], comparative studies in communication education with and without SPs have not presented enough evidence to indicate that the use of SPs contributes to improving students’ communication skills [5]. Therefore, it is necessary to examine how simulation education with SPs enhances communication ability.
Self-efficacy influences the occurrence of appropriate communication [6]. It refers to the recognition of one’s ability to successfully perform necessary actions in a given situation [7]. High self-efficacy, may be associated with an increase in the probability of appropriate medical communication during medical interviews. An effective medical interview led by high self-efficacy may result in the improvement of patient adherence. In contrast, if self-efficacy is low, performance during the interview may be affected, and this may, in turn, affect patient adherence. Low self-efficacy will reduce patient adherence by increasing patient anxiety and leading to a lack of understanding, as they are not effectively able to communicate in conversations about their illness and behaviour change. Thus, it is important to improve communication skills and increase self-efficacy regarding communication ability.
Few studies have examined whether self-efficacy improves as a result of simulation education with SPs. Following medical interviews with SPs, medical students who received SP feedback had both increased neurological examination scores [8] and higher self-evaluations [9] when compared to those who did not receive feedback. However, self-efficacy was not used as a measurement index in these studies.
The only study that assessed the self-efficacy of medical students was Pasold et al. [10], which was set in the context of an eating disorder scenario. The students underwent assessments both before and after a lecture on eating disorders, and before and after simulation education, which included simulated interviews with SPs and feedback sessions. While no change was observed in student self-efficacy before and after the lecture, improvements were observed after they underwent a round of simulation education. As no assessment was conducted between simulation interviews with SPs and feedback sessions, it is unclear which contributed toward the improvement. In a study by Dzulkarnain et al., while conducting a simulated interview with SPs with hearing impairments, auditory history taking skills improved in the group that received feedback from the SPs than in the group that did not [11]. In addition, Brouwers et al. reported that the students who conducted a medical interview to tell bad news perceived the feedback from doctors, SPs and peers as useful information for them [12]. Therefore, it is necessary to evaluate whether the improvement in self-efficacy is an effect of the simulated interview itself or the feedback that follows.
By clarifying this, it is possible to determine the necessity of feedback sessions following simulated interviews with SPs. If self-efficacy increases only through interviews, the need for feedback sessions will be reduced. If self-efficacy is improved by conducting a feedback session, it is necessary not only to perform simulated interviews, but to also have feedback sessions. The purpose of this study is to clarify at which point self-efficacy in medical interview performance increases, when both simulated interviews and feedback discussions are conducted.