Relationships of trainee dentists’ empathy and communication characteristics with simulated patients’ assessment in medical interviews

Objectives We aimed to clarify the characteristics of communication between trainee dentists and simulated patients (SPs) and to examine how the level of trainee dentists’ self-reported empathy influences assessment by SPs in medical interviews. Materials and methods The study involved 100 trainee dentists at Okayama University Hospital and eight SPs. The trainee dentists conducted initial interviews with the SPs after completing the Japanese version of the Jefferson Scale of Empathy. Their interviews were recorded and analyzed using the Roter Interaction Analysis System. The SPs assessed the trainees’ communication immediately after each interview. The trainee dentists were classified into two groups (more positive and less positive groups) according to SP assessment scores. Results Compared with the less positive trainees, the more positive trainees scored higher on the [Emotional expression] and lower on the [Medical data gathering] Roter Interaction Analysis System categories. There was no difference in [Dental data gathering] between the two groups. The SPs of more positive trainees had higher rates of [Positive talk] and [Emotional expression] and lower rates of [Medical information giving] and [Dental information giving]. The trainees with more positive ratings from SPs had significantly higher Jefferson Scale of Empathy total scores. Conclusion The results of this study suggest that responding to the SPs’ emotions is a relevant characteristic of dentist–SP communication to SPs’ positive assessment in medical interviews. Further, trainees’ self-reported empathy was related with the SPs’ assessment of trainees’ communication, which indicated that patient satisfaction can be improved by increasing the dentist’s empathy. Thus, an empathic attitude among dentists is a significant determinant of patient satisfaction.


Introduction 30
Effective communication is a critical determinant of delivering better care to patients. Extensive 31 medical literature has suggested that a good relationship between physicians and patients has 32 positive effects on patient outcomes, such as increasing patient satisfaction [1,2], reducing 33 anxiety/distress [3], and increased adherence to treatment [4]. Empathy is also considered to be an were a significant predictive factor of dental fear [9]. In addition, a negative interpersonal 43 relationship between dentists and patients, such as patients' negative beliefs and dislike of dentists, 44 was one of the major explanatory factors for missed and cancelled dental appointments [10].

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Muirhead et al. [11] found that older people who expressed a lack of trust and confidence in their 46 dentists tended to report worse dental conditions, such as difficulty pronouncing words, painful mouth aches, and feeling uncomfortable while eating. Furthermore, empathy in dentistry also seems 48 to be associated with patient outcomes, especially increasing adherence to and success of treatment.

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Bernson et al. [12] analyzed interviews with patients who experienced dental-related fear and 50 concluded that empathy was among the main attributes that made dental care accessible to them.

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Sarnat et al. [13] also found that an empathic approach by dentists was correlated with patients' 52 cooperative behavior during treatment and the success of treatment.

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Good dentist-patient communication is essential to the delivery of dental care. However,

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The trainee dentists were classified into two groups (i.e., the more positive and less 83 positive groups) based on the median SP assessment score (11.0) of trainees' communication.

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Measures 86 Assessment sheet: SP assessment of trainee dentists' communication 87 The assessment sheet (

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The average correlation was 0.77 (0.56-0.95) for the trainee dentists and 0.76 (0.61-0.90) for the 120 SPs, which confirmed the reliability of the coding.

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The percentage rates of the trainees' and SPs' utterances for each category were

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The JSE includes 20 items answered on a 7-point Likert-type scale (1 = strongly disagree, 133 7 = strongly agree) with a total score range of 20-140. Half of the items are reverse scored. A higher 134 score shows a more empathic orientation toward patient care (Table 3).

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136 Physicians should try to stand in their patients' shoes when providing care to them.
10 Patients value a physician's understanding of their feelings, which is therapeutic in its own right. 14 I believe that emotion has no place in the treatment of medical illness.
15 Empathy is a therapeutic skill without which the physician's success is limited.

SP assessment of trainee dentists' communication
148 The mean total score was 11.2 (SD = 2.9, range 2-15). The trainee dentists whose SP 149 assessment scores were ≥12 were classified as the more positive group (n = 47), and those who 150 scored <12 were classified as the less positive group (n = 53).

Percentage rates of the trainees' and SPs' utterances
154 The mean percentage rates of the trainees' and SPs' utterances for the clusters are given in

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Tables 4 and 5, respectively. We express the cluster names in brackets in this study. Compared with the trainee dentists whose SP assessment was less positive, those with more positive assessments had Length of the medical interview 180 The mean interview length was 8m34s (SD = 2m30s, range 3m43s-17m56s). The mean 181 length of the interviews of more positive trainee dentists was significantly longer than that of the less 182 positive ones (9m34s vs 7m40s).

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The results indicate that SPs regarded trainees whose interviews had longer duration more 184 favorably.

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In this study, we explored the characteristics of dentist-SP communication that influence 188 SP assessment in initial medical interviews. We also examined how the trainee dentists' level of 189 self-reported empathy influences their assessments by SPs.

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Trainee dentists who received higher ratings from SPs were more emotionally expressive, that the SPs in our study expressed concerns might reflect this finding.

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In the dental context, the relationship between dentist communication and patient 204 satisfaction does not seem to be simple. Sondell et al. [27] reported that dentist communication was 205 associated with patient satisfaction only immediately after a specific visit but not with overall patient 206 satisfaction in the longer term in prosthodontic patients. Even though the specific dimensions of 207 dentist-patient communication that impacted patient satisfaction were not detected in this study, this 208 may imply that observable dentist-patient communication may not be directly related to treatment 209 outcomes, which reflect many characteristics of dentistry. A consultation in dentistry almost always 210 corresponds with a subsequent invasive procedure, and manual skills also affect treatment success,

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The three functions of medical interviews are 1) relationship building between health provider 16 232 and patient, 2) assessment of patients' problems, and 3) management of patients' problems [29].

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Each function is equally important, but establishing rapport tends to precede data gathering. In the 234 context of dentistry, where verbal communication by patients is often restricted during oral 235 treatment, consultation prior to the treatment plays an important role in the dentist's understanding 236 of the patient's psychosocial problems, such as concern, anxiety, and expectation, especially when 237 an invasive procedure is expected. 274 self-reported cognitive empathy was related with SPs' assessment of the trainees' communication.

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These findings add to a body of literature that indicates that promoting empathic attitudes is a 276 significant aspect of the dental education curriculum.

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The authors express their appreciation to all of the trainee dentists and SPs who agreed to 280 participate in the study. The authors also thank the residents who assisted with implementation of the 281 simulated medical interviews. We thank Richard Lipkin, PhD, from Edanz Group 282 (www.edanzediting.com/ac) for editing a draft of this manuscript.