2019, Cilt 9, Sayı 3, Sayfa(lar) 488-491
The Effect of Communication Skills Course Given to Faculty of Medicine on Face Recognition Test
Mehmet ÜZEL1, Zennure ADIGÜZEL ŞAHİN1, Selman DEMİRCİ1, Gözde GÜLTEKİN2, Özlem Serpil ÇAKMAKKAYA3, Fatma Güler KAHRAMAN YILDIRIM1
1Istanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
2Keşan State Hospital, Department of Psychiatry, Edirne, Turkey
3Istanbul University - Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Medical Education, Istanbul, Turkey
Keywords: Communication skills, Medical education, Face recognation, Physician-patient communication
Successful physician-patient communication is very important in diagnosis and treatment processes. Understanding the facial reflections
of emotions will contribute positively to this communication. To be able to manage doctor-patient communication well and to provide
a good health care service, we think that medical faculty students and other health department students should be given communication
skills training in their education life. The Facial Emotion Recognition Test was applied to 211 second grade students at Istanbul University-
Cerrahpaşa, Cerrahpaşa Medical Faculty before and after communication skills lesson. Before the test, seven different emotional face
expressions (happy, surprised, fearful, sad, angry, disgusted and neutral) were introduced and 49 photos with facial expressions from
different people were showed to each participant. Participants were asked to recognize facial emotion expressions. Pre-lesson, the highest
mean accuracy rate of recognized facial emotion was happy while the lowest was fear. The participants recognized sad and fearful
emotions more accurately after the lesson. Sad and fearful emotions give information about some feelings of the patient. And being
able to understand these feelings by the physicians make a good background for a good physician-doctor communication. Therefore, it is
important to get communication skills training in terms of health care. Taking this education as a student can be quite effective.
Communicating is a social need of every human being. Good
communication is important in getting and / or giving health
care as much as it is important in social life. This is why
DiMatteos good patient-doctor relationship facilitates more
effective health care delivery, as emphasized by DiMatteo,
The best tool on the way to treatment is good patient-doctor
communication (Hargie, Dickson, Boohan, & Hughes, 1998).
The physician is one of the most educated and interchangeable
factors related to communication skills, with numerous factors
that can influence patient-doctor communication (Kleinman,
2008). While communication is divided into verbal and nonverbal,
face expressions are important in nonverbal communication.
Patients anatomical structures on the face can give
information about the patients character (Kosif, 2018). Also,
The patients facial expressions, states and movements, speech
and tonalities can help the doctor in understanding the
patients complaints. Therefore, doctors should be trained to
know the patients feelings correctly and learn how to manage
the situation in the face of difficult speech. If doctors are
already trained to be able to acquire or develop these skills
while they are medical faculty students, the yield on health
care services will surely be higher.
Medical faculty second grade students are given training in
communication skills in practical hands (short sketches, games
and theoretical knowledge) in groups of 25 students. In this
study, students who received this test were compared with
their pre-test and post-test results by applying the test of
recognition of their emotions from the face expression. It was
researched whether the given communication skills training
contributed to the ability to understand the feelings of the
person who is important in communication.
The study was conducted with medicine students attended
communication skills lesson from Medical Faculty between
April - October 2017. The communication skills lessons are
taught by instructors who have taken courses in this area. In
these lessons, theoretical knowledge about communication
skills is explained and the lessons are practiced (short sketches
and games) (Sullivan, Maagarick, Bergthold, & McInthosh, 1995). All participants were mentally healthy. Three hundred
twelve students were asked to participate to the study. Upon
giving written informed consent anonymously, all students
were performed the test although 101 students were not
completed the test procedure so were eliminated. Totally, test
group included 211 students. The study was approved by the
local ethics committee.
Communication Skills Lesson
The lessons are interactive and taught role plays with using
effects of vocal and facial emotions on meaning. Also importance
of verbal and non-verbal communication is emphasized.
The effects of word tones on the meaning of the word, the
different meanings of different face expressions, the different
meanings, the importance of nonverbal communication, the
exaggeration of personality in communication are taught with
the short sketches. These are given from lecturers who were
well-trained about these issues.
The Facial Emotion Recognition Test was performed two times
as before and after the three-hour lesson while without giving
any feedback. The test was constructed using a set of photographs
from Ekman and Friesens book Pictures of Facial Affect
(Ekman & Friesen, 1976). The test included the photos of four
male and four female models (a total of 56 photos) with happy,
surprised, fearful, sad, angry, disgusted and neutral facial expressions.
All photos were shown to each participant and participants
were asked to recognize facial emotion expressions. At
first, we had a trial session, which was composed of the first
seven photos and included each emotional facial expression
that was presented in the same order for each participant. A
total of 49 photos were used for the data analyses in the study.
All participants were tested individually in a classroom.
The statistical analyses were performed using Statistical Package
for Social Sciences (SPSS) version 22 for Windows. Descriptive
analyses were presented using mean ± standard deviation
for numeric values. The variables were investigated using
Kolmogrov-Smirnov to determine whether or not they are
normally distributed. Student-t test for normally distributed
data and MannWhitney U test for non-normally distributed data were performed. A 5% type-I error level was used to infer
Pre-lesson, the highest mean accuracy rate of recognized facial
emotion was happy (99.28%) while the lowest accurately
recognized facial expression was fear (53.85%). Pre-lesson,
accuracy rate for sad emotion was 63.42%, angry emotion was
80.0%, suprised emotion was 90.28%, disgusted emotion was
72.57%, neutral emotion was 91.28%. Also post-lesson, the
highest mean accuracy rate of recognized facial emotion was
happy (99.42%) while the lowest accurately recognized facial
expression was fear (60.0%). Post-lesson, accuracy rates for
happy emotion was 99.42%, sad emotion was 70.28%, fear
emotion was 60.0%, angry emotion was 83.14%, suprised
emotion was 89.42%, disgusted emotion was 74.0% and neutral
emotion was 92.14%. Participants recognized significantly
more accurate sad (p=0.000) and fearful (p=0.003) emotions
after lesson although there were no significant differences
among mean accuracy rates in recognizing happy (p=0.701),
angry (p=0.085), surprised (p=0.536), disgust (p=0.441) and
neutral (p=0.552) facial emotion expressions between prelesson
and post-lesson (Table 1
Good communication between the patient and the doctor also
increases patient trust. Previous studies indicate that patient
and doctor satisfaction increases, medical errors and emotional
stress are reduced when effective communication is established
between the patient and the doctor (Price, Windish,
Magaziner, & Cooper, 2008; Yu et al. 2017). Sometimes the
correct understanding of emotions in patient-doctor communication
can become the most important factor on the way to
diagnosis and treatment (Riess & Kraft-Todd, 2014). The most
reliable tool in recognizing emotions is face expressions (Leppanen,
2006). Emotions can affect persons behavior (Duclos et
al., 1989). The facial expression can reflect both the emotions
and the personality of the person (Mergl et al., 2006).
In this study, pre-lesson, the highest mean accuracy rate of
recognized facial emotion was happy (99.28%) while the lowest accurately recognized facial expression was fear (53.85%).
These results are similar with results of Gultekin et al. (2016)
(99.14% / 47.71% respectively). Happiness is approved as a
positive emotion. Recognition of happy faces was preserved
even in patients with schizophrenia and euthymic bipolar disorder
(Demirbuga et al., 2013; Demirel et al., 2014). Fear recognition
is more difficult and has been reported to be frequently
confused with surprised face expression in healthy people (Tse,
Yan, Bond, Chan, & Tam, 2011; Ekman, 1999). It has also been
observed that aggressive people attribute fear faces when they
are presented with vague emotional faces (Weiss et al., 2006).
In this study, it is seen that the rate of accurate recognition,
even in the form of fear, which is an expression that is hard
to recognize, has increased significantly after communication
skills training. Also participants recognized sad emotion more
accurately after lesson (Table 1). Recognizing these emotions
may contribute to understanding the patient and arranging
treatment. For example, there is sad expression on the face of
a patient with pain. And, in the case of patients without knowledge
of the disease, there is more fear expression. So, it is very
important to know these expressions.
Commonly, special training to identify patients emotional
cues is not in medical education curriculum. The importance of
communication skills in medical education is emphasized not
only by practitioners but also by researchers working to improve
the education programs (Hargie et al., 1998; Kleinman,
2008). The place of communication skills education in medical
education should be re-evaluated.
• As a professional requirement, communication skills training
should be taken in the professions where people are
• Communication skills training will be very useful in order
to provide a better health service in a difficult and tiring
• The fact that the first step of this education is given to the
doctor candidates who have not yet started their career,
raises awareness and we think it will be more beneficial.
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