Learning to Listen: Mixed-Methods Study of Medical Students’ Perspectives on Communication Training

Learning to Listen: Mixed-Methods Study of Medical Students’ Perspectives on Communication Training | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning to Listen: Mixed-Methods Study of Medical Students’ Perspectives on Communication Training Adrianna Helena Senczyszyn, Maria Błaszkiewicz, Krzysztof Kujawa, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8726989/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Communication skills and empathy are core competencies in medical practice, yet their effective integration into medical curricula remains inconsistent. While experiential workshops are increasingly implemented, evidence regarding their specific impact and alignment with students’ needs is mixed. Exploring students’ perspectives alongside quantitative outcomes may provide valuable insight into how such training is experienced and how it can be optimized. Objectives This study aimed to examine medical students’ experiences and perceptions of a compulsory communication skills workshop delivered within a medical psychology course, and to assess changes in self-perceived communication competence, empathy, and self-reflection through a mixed-methods approach. Methods A convergent exploratory mixed-methods design was employed. The quantitative component followed a quasi-experimental pretest–posttest design with a wait-list control group. Second-year medical students (N = 142) completed self-report measures of communication competence (SPCC; PPCCS), empathy (EAS), and self-reflection (SRIS) before the workshop and four weeks later. Nonparametric repeated-measures ANOVA was used to examine time, group, and interaction effects. Qualitative data were obtained through a focus group interview with twelve participants and analyzed using thematic analysis. Results Quantitative analyses revealed small improvements over time in self-perceived communication competence, empathy, and self-reflection in both groups. A significant group × time interaction was observed only for overall physician-patient communication competence (PPCCS Total), indicating a greater increase in the experimental group. All effect sizes were small. Qualitative findings provided contextual depth, identifying two overarching themes: perceived effects and unmet needs. Students highlighted enhanced awareness of diverse perspectives, personal boundaries, and communication as a teachable professional skill, as well as strong engagement with practice-based learning methods. At the same time, they reported unmet needs related to earlier and more continuous integration of communication training, inconsistent role modeling during clinical placements, and insufficient preparation for interprofessional teamwork. Conclusions A brief experiential communication workshop embedded in a compulsory medical psychology course was associated with small short-term increases in self-perceived physician–patient communication competence, while changes in empathy and self-reflection were comparable in the intervention and wait-list control groups. Students’ narratives underscored the educational value of experiential learning while revealing structural gaps in curriculum timing, role modeling, and team-based communication training. These findings support the need for longitudinal, clinically aligned communication curricula that integrate experiential methods, structured reflection, and consistent empathic role modeling across medical education. medical education communication skills empathy curriculum development Figures Figure 1 Figure 2 1. Introduction Effective communication and empathy are widely recognized as fundamental competencies in medical practice, closely linked to better patient outcomes and safer care [1]. Strong communication skills have been shown to improve patients’ adherence to treatment plans, enhance satisfaction with care, and are associated with reduced medical errors [2]. Likewise, physician empathy, the ability to understand a patient’s feelings and perspective, positively influences health outcomes [1]. For example, higher clinician empathy has been associated with shorter illness durations and improved chronic disease indicators in patients [3]. Given these benefits, medical education bodies now emphasize communication and empathy training as core elements of the curriculum. Many accreditation standards explicitly require that medical programs provide formal instruction in interpersonal communication with patients, families, and colleagues. Accordingly, contemporary medical students are expected not only to master biomedical knowledge but also to develop the communication skills and human understanding essential for patient-centered care. Despite broad consensus on its importance, teaching communication in medical schools has historically faced challenges. In the past, communication training was not fully integrated into many curricula and infrequently evaluated using rigorous outcome measures [4]. Over the past two decades, educational initiatives have increasingly sought to address this gap. Pioneering programs have demonstrated that a structured communication skills curriculum can significantly improve students’ abilities to build rapport, information exchange, and shared decision-making with patients [4]. For instance, a meta-analysis of medical humanities programs by Zhang et al. demonstrated a significant increase in empathy among medical students, with the strongest effects observed in short-term interventions lasting less than four months [5]. Additionally, a review of clinical role-play interventions showed that supervised role-playing not only promoted reflection and insight among students acting as patients and therapists but also benefited peers observing the sessions, ultimately enhancing students’ involvement, self-efficacy, and empathic abilities in mental health practice [6]. These successes, along with guidelines from accrediting bodies, have prompted many institutions to introduce communication workshops, courses, or longitudinal modules early in training. However, the scope and timing of such training still vary widely. In many programs, communication is taught in a single stand-alone course or at discrete points (e.g., a workshop on breaking bad news), rather than reinforced continuously across all years [2]. Fully integrated curricula – combining didactics, experiential practice, and ongoing assessment throughout medical school – remain the exception rather than the norm [2]. This inconsistency in curricular integration means that students’ exposure to communication skills training can be fragmented, potentially limiting its impact. Moreover, students are not a homogeneous group, and their values and priorities evolve, and generational differences may shape how they approach learning, interpersonal relationships, and patient expectations. This underscores the importance of exploring students’ voices to capture what makes communication training meaningful and effective for them. A particularly critical aspect of communication training is fostering empathy and relational skills in future physicians. Empathy is widely regarded as a teachable professional skill, yet evidence consistently shows a worrying trend: medical students’ empathy tends to decline during their education [3]. A landmark review of 18 studies found significant decreases in self-reported empathy by the time students reach clinical training, attributing this erosion to distress (e.g., burnout, low sense of well-being, depression) and aspects of the “hidden curriculum” (mistreatment by superiors or mentors, loss of idealism, enthusiasm, and humanity when confronted with clinical reality, reduced contact with family, and high workload) [1]. In other words, the culture of medical training, including observing cynical or brusque role models, can undermine the humanistic attitudes that students bring in. Indeed, the absence of empathic role models and the emphasis on efficiency over understanding are thought to be major contributors to empathy loss [3]. These concerns have driven calls for a more intentional approach to teaching empathy, on par with other clinical skills. Listening to how students themselves interpret these challenges is crucial, since their lived experiences offer unique insights into how empathy can be sustained and strengthened within the realities of medical education. In light of these trends and challenges, the present study aimed to explore medical students’ experiences and perceptions of communication training delivered within a compulsory psychology course. We adopted an exploratory mixed-methods design to gain a holistic understanding of how students interpret the value, timing, and relevance of such training in their curriculum. The workshop examined in this study was grounded in this educational framework: it followed the Calgary-Cambridge framework for the medical interview and used experiential methods such as role-play, peer feedback, and guided reflection to teach structured communication, empathy, and reflective practice. Quantitative data were collected to provide contextual information about self-perceived communication competence, empathy, and self-reflection, while the qualitative component – based on a focus group – offered deeper insight into students’ subjective experiences. By integrating these perspectives, the study sought to illuminate how communication workshops are received by learners, what educational needs they reveal, and how medical curricula can more effectively foster empathy and interpersonal competence. 2. Materials and methods 2.1 Study design This study employed a convergent exploratory mixed-methods design, combining quantitative and qualitative approaches to evaluate the impact of communication training within a medical psychology course for second-year medical students. Quantitative and qualitative data were analyzed independently and integrated during the interpretation phase to provide a comprehensive understanding of the students’ experiences and perceptions of the training. The quantitative component followed a quasi-experimental, pretest-posttest design with a wait-list control group. Students were quasi-randomly assigned by the university scheduling system to attend the communication workshop either in the first or second half of the semester. The experimental group participated in the training during the first half, while the wait-list control group completed the training in the second half. Quantitative data were collected at two time points: before the workshop (T1) and four weeks later (T2). The qualitative component consisted of a focus group interview conducted after all workshop sessions had concluded. Focus group participants received a psychiatry textbook as compensation for their time. The study was approved by the Bioethics Committee of Wroclaw Medical University, Poland (approval no. KB/602/2024). All participants provided informed consent before participating in the study. The study was conducted in accordance with the Declaration of Helsinki. 2. 2. Measurements A battery of self-report questionnaires was administered at two time points (T1 and T2) to assess communication-related competencies, empathy, and self-reflection among participants. The following tools were used: 1. Self-Perceived Communication Competence (SPCC) is a 12-item self-report measure assessing individuals’ perceived communication competence across various contexts (e.g., public speaking, group discussions, dyadic conversations) and with different interlocutors (strangers, acquaintances, friends). Respondents rate their competence on a scale from 0 to 100. The scale yields a total score and several context-specific sub-scores. It demonstrates high internal consistency (α = .92) and good validity [7]. 2. The Empathy Assessment Scale (EAS) is a 13-item self-report measure assessing empathy in three domains: social interaction, cognitive behavior, and emotional identification. Items are rated on a 5-point Likert scale. The scale provides a total score and three subscale scores. It demonstrates good internal consistency (α = .85) and strong factorial and concurrent validity [8]. 3. Self-Reflection and Insight Scale (SRIS) is a 20-item self-report instrument designed to measure individuals’ readiness for self-directed change through metacognitive processes. It includes three subscales: Need for Self-Reflection, Engagement in Self-Reflection, and Insight. Items are rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The scale has demonstrated good internal consistency (α = 0.83–0.87) and factorial validity in medical student populations. It is used to assess self-regulatory capacities relevant to professional development in medical education [9]. 4. Physician-Patient Communication Competence Scale (PPCCS) is a 10-item self-report measure developed for this study to assess perceived communication competence, emotional awareness, assertiveness, conflict-resolution skills, and attitudes toward the importance of communication in clinical practice. Responses are given on a 5-point Likert scale, with higher scores reflecting greater competence. Internal consistency was acceptable [Cronbach’s α = 0.72; 95% CI (0.67, 0.76), Feldt’s method; R psych package]. See Supplementary File 1. 2.3. Workshop description The intervention consisted of a six-hour interactive workshop, delivered in two sessions, as part of a compulsory medical psychology course for second-year medical students. The workshop was conceptually based on the Calgary-Cambridge approach to the medical interview, which emphasizes structured communication, empathy, and reflective practice as core elements of clinical competence. It focused on developing key clinical communication skills through experiential methods, including role-play, peer feedback, and guided reflection. Workshop content addressed active listening, paraphrasing, nonverbal communication, professional boundaries, and common interpersonal challenges in the doctor-patient relationship. 2.4 Data analysis 2.4.1 Quantitative data Descriptive statistics and comparison between two groups using the t-test and the Mann-Whitney U test were performed using Statistica 13 [10]. When homogeneity of variance was violated (Levene’s test), the t-test was performed using the Welch correction. Due to significant deviations from normal distribution in several variables, a non-parametric repeated-measures ANOVA (for making between- and within-group comparisons) was conducted using the ‘ez’ package (version 4.4-0) [11] run in R version 4.5.1 [12] This approach allowed testing the main effects of time (within-subjects) and group (between-subjects), and the group × time interaction. Descriptive statistics, including means, standard deviations, medians, quartiles, and counts with percentages, were reported where appropriate. 2.4.2 Qualitative data A single focus group discussion was conducted with twelve second-year medical students who had participated in the communication workshop. Participation was voluntary. The interview guide used for the focus group was developed specifically for the purposes of this study and is available as Supplementary Material (Supplementary File 2). The session was audio-recorded and transcribed verbatim by a member of the research team experienced in preparing qualitative materials. Before analysis, transcripts were anonymized and carefully proofread. Reviewing the transcript served as the initial phase of data familiarization. Qualitative data were analyzed by two independent researchers who had not been involved in any previous stages of the study. A thematic analysis approach was applied, combining both inductive and deductive [13] strategies to address the primary analytical question: How do medical students interpret the value of communication skills training following their participation in medical communication workshops? Initially, both researchers independently coded the transcript, identifying meaning units through inductive analysis. The codes were then discussed and synthesized into a shared codebook. Subsequently, the entire dataset was reanalyzed using the developed codebook in a deductive manner. Through iterative discussion, the researchers grouped the codes into themes and sub-themes, which were refined and named by consensus. All steps of the process, including transcription, coding, and analysis, were carried out in Polish. Selected quotes were translated from Polish into English by both researchers independently, then compared and discussed to ensure semantic accuracy. 3. Results 3.1 Quantitative data 3.1.1. Participants’ demographics A total of 142 second-year medical students took part, including 94 in the experimental group (EG) and 48 in the control group (CG). The mean age was 20.61 years (SD = 2.10; range: 18–32) in EG and 19.83 years (SD = 0.63; range: 19–22) in CG. In EG, 61.7% were male and 38.3% female; in CG, 62.9% were male and 37.1% female. Most participants had no children (EG = 1.1%, CG = 0%) and had siblings (EG = 83.0%, CG = 83.3%). In EG, 54.3% reported being in a partnership, compared to 52.1% in CG. At the time of data collection, 25.5% of EG and 16.7% of CG reported currently attending psychotherapy (see Table 1). 3.1.2 Baseline group comparisons At baseline (T0), the experimental (EG) and control (CG) groups were comparable on most self-report measures. Significant differences were observed in two variables, both favoring the control group. Specifically, the CG demonstrated higher overall empathy (EAS Total; Cohen’s d = 0.47, p = 0.014) and higher emotional identification with others (EAS Emotional Identification; rbc = 0.20, p = 0.048). No other baseline differences were detected between the groups (see Table 2). 3.1.3 Pre-post intervention change Across the study period, several statistically significant changes were observed. The experimental group demonstrated a greater increase in overall self-perceived communication competence, reflected in a significant group × time interaction for PPCCS Total (p = .002). As illustrated in Figure 1 (boxplots), PPCCS Total scores increased more strongly in the experimental group than in the control group. In contrast, both groups showed comparable changes over time in general communication competence (SPCC Total; p = .048) and in specific contexts, including public interactions (SPCC Public; p < .001), meetings (p = .001), and interactions with strangers (p = .048), with no significant group × time interactions. Significant main effects of time were also observed for overall empathy (EAS Total; p = .015) and social-interaction empathy (p = .033), whereas cognitive and emotional components of empathy did not show intervention-specific changes. Similarly, need for self-reflection (SRIS Need for Self-Reflection) decreased over time (p < .001) and insight increased modestly (p = .034) in both groups, with no moderating effects of group. Although several effects reached statistical significance, their magnitude was small. Across outcomes, effect size estimates (generalized eta squared, ges) did not exceed 0.03, indicating limited practical impact. Overall, the only clear intervention-specific effect was the greater improvement in overall self-perceived communication competence (PPCCS Total) in the experimental group compared with the control group (see Figure 1 and Table 3). Table 3. Effects of time (T1 vs T2), group (EG vs CG), and their interaction on study variables according to nonparametric repeated-measures ANOVA (ezANOVA). Significant effects (p < .05) are marked with an asterisk. Variable Effect F (1, 140) p ges PPCCS_TOTAL Group 0.24 0.626 0.0014 Time 24.30 < 0.001* 0.0334 Group × Time 9.59 0.002* 0.0135 SPCC_TOTAL Group 0.50 0.481 0.0031 Time 3.98 0.048* 0.0040 Group × Time 0.08 0.783 0.0001 SPCC_PUBLIC Group 0.96 0.330 0.0056 Time 12.22 < 0.001* 0.0149 Group × Time 0.04 0.837 0.0001 SPCC_MEETING Group 0.61 0.435 0.0037 Time 10.68 0.001* 0.0107 Group × Time 0.01 0.927 0.0001 SPCC_GROUP Group 0.60 0.438 0.0034 Time 1.17 0.282 0.0018 Group × Time 0.06 0.799 0.0001 SPCC_DYAD Group 0.02 0.899 0.0001 Time 2.53 0.114 0.0026 Group × Time 0.73 0.395 0.0007 SPCC_STRANGER Group 0.63 0.429 0.0037 Time 3.97 0.048* 0.0046 Group × Time 0.97 0.326 0.0011 SPCC_ACQUAINTANCE Group 1.96 0.164 0.0111 Time 1.80 0.182 0.0025 Group × Time 0.03 0.858 0.0001 SPCC_FRIENDS Group 3.17 0.077 0.0192 Time 1.92 0.168 0.0019 Group × Time 0.83 0.363 0.0008 EAS_TOTAL Group 6.18 0.014* 0.0363 Time 6.08 0.015* 0.0064 Group × Time 0.00 0.992 0.0001 EAS_COGNITIVE_BEHAVIOR Group 1.66 0.200 0.0095 Time 2.17 0.143 0.003 Group × Time 0.29 0.594 0.0004 EAS_EMOTIONAL_IDENTIFICATION Group 4.95 0.028 0.009537 Time 1.87 0.174 0.0297 Group × Time 0.01 0.907 0.0018 EAS_SOCIAL_INTERACTION Group 2.64 0.110 0.015 Time 4.00 0.033 0.0055 Group × Time 0.13 0.702 0.0002 SRIS_INSIGHT Group 0.52 0.473 0.0031 Time 4.56 0.034 0.0053 Group × Time 0.46 0.498 0.0005 SRIS_ENGAGEMENT_SELF_REFLECTION Group 0.76 0.379 0.0041 Time 0.83 0.376 0.0014 Group × Time 1.25 0.279 0.0021 SRIS_NEED_SELF_REFLECTION Group 0.71 0.402 0.0033 Time 16.37 < 0.001 0.0379 Group × Time 0.44 0.507 0.0011 Notes: F – test statistic; p – level of statistical significance; ges – generalized eta squared (effect size). Significant effects (p < .05) are marked with an asterisk. 3.3 Qualitative data Thematic analysis identified two overarching themes: (1) students’ experiences encompassing perceived outcomes and reflections on the learning process, and (2) participants’ unmet needs. 3.3.1. Effects Effect 1: Group integration: balancing connection and discomfort One of the notable outcomes of the workshop was the opportunity for students to get to know each other on a deeper level. The sessions facilitated interpersonal connections and created space for emotional sharing, which some participants found beneficial and even therapeutic. However, this dynamic was not universally welcomed. While some students appreciated the chance to build closer relationships, a few found the atmosphere artificial or awkward, especially when the workshop resembled elements of group therapy. “I started to know and understand some people in the group better after these classes.” “It felt a bit like group therapy – and not everyone likes that.” “On one hand, it was nice that we could open up, but not everyone was ready for that.” Effect 2: Recognizing diverse perspectives and personal boundaries The workshops encouraged students to reflect not only on communication with patients, but also on their own internal attitudes, needs, and limitations. Many participants reported a new awareness of how differently the same interaction can be interpreted by different people. This realization fostered greater openness to others’ viewpoints and, simultaneously, helped students better understand and respect their own boundaries. For some, the sessions challenged deeply rooted assumptions about the need to always appear competent. Instead, they began to appreciate the value of self-awareness in clinical communication. “For me, the most important thing was realizing how differently the same situation can be perceived.” “I understood that I have my boundaries and I don’t have to agree to everything to be empathetic.” “For the first time, I thought that I don’t always have to be 'the smartest' – but I learnt, it’s okay not to know something.” “I saw that everyone has a different communication style – it was eye-opening.” Effect 3: Acquiring communication competence The workshops enhanced students’ understanding of communication as a professional, teachable skill, extending far beyond everyday conversation. They learned to value listening and emotional attunement, discovered the power of open-ended questions, and became more aware of the impact of nonverbal cues. This deepened awareness translated into a sense of preparedness for future patient interactions and reframed communication as an integral part of medical competence . “I learned that communication isn’t just about speaking, but also about listening and recognizing emotions.” “Thanks to the workshops, I better understand how to talk to a patient so they feel safe.” “I found out that open-ended questions can completely change the conversation.” “I was surprised by how important nonverbal communication is – I had never thought about it before.” Process reflection: Engagement and practice-based learning Beyond the perceived learning outcomes, students emphasized the workshop’s format as a crucial factor shaping their engagement and motivation. They appreciated the interactive, practice-oriented nature of the sessions, which contrasted sharply with traditional lectures. Role-plays, peer feedback, and real-life scenarios created a safe environment to experiment and learn from mistakes. Many participants described the experience as their first encounter with an educational method that felt directly relevant to clinical work. The experiential format helped bridge the gap between theory and practice, making the learning process more relevant and memorable. “What I liked most was that it wasn’t just theory – we practiced real situations.” “Everyone’s engagement made these classes different from regular lectures.” “Thanks to the exercises, I could rehearse difficult conversations without pressure.” “It was the first time I felt I was learning something I’d actually use during clinical placements.” 3.3.2 Unmet needs Unmet Need 1: Communication background before clinical practice Students’ reflections highlighted a strong need for better alignment between communication training and clinical practice. While the workshops were perceived as valuable, their timing was often criticized. Many participants felt that such classes would have been more helpful if scheduled earlier, ideally just before or during clinical placements. Several students had already completed medical volunteering/short-term clinical placement without prior formal training in communication and recognized this as a missed opportunity. Although the workshop partially fulfilled the long-standing demand for structured communication education, its placement in the curriculum was seen as suboptimal, revealing both an unmet need and a step in the right direction. “These classes would make more sense if they were closer to our clinical placements.” “It’s good that something like this was included, but I’m not sure it was the best timing.” “Too late – I had already done my placements and lacked these skills back then.” “It’s great that we finally had this, because there was nothing about communication before.” Unmet Need 2: Consistent role modeling in clinical communication Students repeatedly emphasized how impactful and memorable it was when clinicians shared real-life experiences, especially stories about communication mistakes or emotionally difficult encounters. These practitioner narratives were valued not only for their authenticity but also for making communication principles feel applicable and meaningful. There was a strong desire for more such examples from practicing doctors, integrated more systematically into medical training. At the same time, however, students expressed disappointment and concern about a frequent disconnect between what they were taught in communication workshops and what they observed during clinical placements. In some cases, physicians served as negative role models, treating communication as a legal safeguard rather than a relational skill, or promoting a hierarchical, paternalistic dynamic with patients. This contradiction left some students confused, disillusioned, or frustrated, particularly when they encountered instructors who openly dismissed the importance of empathy or collaboration. “What helped me most was when the doctor talked about their own communication mistake. (…) It speaks to me much more when someone with experience explains what it’s really like.” “You just remember these kinds of real-life stories. They really stick with you. (…) One of our lecturers often gave examples from his experience with patients. It wasn’t just about diseases – it actually helped us understand how to communicate and what kinds of questions to ask so patients really understand what we mean.” “In my opinion, some classes present very toxic situations. This year, we had one particular class with a certain instructor. And the doctor–patient relationship, in my view, was presented completely differently than what we were taught in psychology... The doctor, for example, is basically like a god; he’s the master, and the patient is supposed to just listen.” “I personally had a class with a professor who basically just explained how not to get sued. We were discussing what to say so you wouldn’t be sued... I even had another class where the main topic was what a doctor should do to avoid being sued. That’s what it all revolved around. Like, you should do something, but don’t actually do it, just write it down in a way that no one can sue you. (…) “If someone doesn’t have clinical experience and hears things like that from doctors, it can really mess with their head.” Unmet Need 3: Preparation for team-based medical practice Students acknowledged that the workshop offered a rare and valuable opportunity to reflect on the collaborative nature of clinical work. For many, it was the first time they had explicitly considered the doctor’s role within a broader healthcare team. Exercises involving teamwork highlighted the interdependence of roles and the importance of communication not only with patients, but also with nurses, technicians, and fellow physicians. Despite these insights, students felt that this area remains largely neglected in their education. They expressed a clear wish for more training that mirrors the realities of hospital environments, where teamwork, shared decision-making, and interprofessional communication are essential. There was a recurring sense that medical education too often focuses on the individual rather than the collective, and that more interdisciplinary, scenario-based learning would better prepare them for future clinical practice. “It was nice that we could also look at it from the perspective of other medical professions.” “I realized that as doctors, we don’t work alone – we work in teams.” “Communication within a team is something no one had taught us before.” “There were exercises that required teamwork – they revealed our different roles.” 4. Discussion and implications for medical education This mixed-methods study evaluated a compulsory communication skills workshop using a quantitative pre–post design with a wait-list control group. Quantitative analyses revealed small but statistically significant changes over time across several domains of self-perceived communication competence, empathy, and self-reflection, observed in both groups. A single intervention-specific effect emerged for overall physician–patient communication competence, which improved more in the experimental group, although all effect sizes were small, indicating limited practical impact. Notably, there is still no standardized empathy-training curriculum, and existing interventions, ranging from reflective writing to mindfulness or patient shadowing, have yielded mixed effects [14,15]. The observed time-related changes in both groups are consistent with prior findings suggesting that communication awareness and empathy may fluctuate even in the absence of targeted interventions, potentially reflecting test–retest effects or the role of reflection itself as a learning stimulus. The qualitative analysis added depth by capturing students’ perspectives. Two overarching themes were identified following the workshop: students’ experiences encompassing perceived outcomes and reflections on the learning process, and unmet needs. One of the first effects was the workshop’s impact on group dynamics. Rather than representing an outcome in itself, group integration appears to function as a mechanism that enables experiential communication learning. Interactive small-group formats have been shown to foster collaboration, team-building, and empathy in healthcare education [16]; however, students’ ambivalence toward the “group therapy” atmosphere suggests that emotional openness may simultaneously facilitate learning and pose a psychological challenge. This tension highlights the importance of skilled facilitation to balance trust-building with emotional safety in compulsory workshops. Another key outcome was that students became more aware of how differently individuals may interpret the same interaction, and they began reflecting on their own needs and limits. This increased awareness of divergent perspectives may reflect an early stage of professional identity development, in which communication competence shifts from performance-based accuracy toward relational and reflective sensitivity. Effective communication training has been shown to rely on self-awareness and interpersonal reflection rather than technical skill alone [17], and students’ emphasis on personal boundaries suggests that empathy was understood as a regulated professional stance rather than emotional overinvolvement. Such reframing may counteract unrealistic expectations of constant competence that can undermine teamwork and empathic engagement [18]. Rather than constituting an outcome per se, students’ reflections highlight experiential learning as a central process mechanism shaping engagement and perceived relevance of communication training. They valued role-play, active participation, and rehearsal of challenging conversations in a safe environment, which contrasted with the passivity of traditional lectures. This suggests that experiential methods may function as enabling conditions for learning, rather than as direct indicators of skill acquisition. Evidence from medical education consistently shows that simulation and role-play enhance engagement, retention, and transfer of communication skills to clinical contexts (Bosse et al., 2012; Lane & Rollnick, 2007;Yedidia et al., 2003b). From a pedagogical perspective, these process-related reflections help explain why students perceived the training as meaningful despite modest short-term quantitative effects. Finally, the workshop helped students reconceptualize communication as a structured clinical skill rather than a casual or intuitive ability. Participants reported gaining insight into techniques such as active listening, emotional attunement, the use of open-ended questions, and awareness of nonverbal cues, core components of patient-centered communication. This reframing represents a pedagogical shift in how communication is positioned within medical training: from an assumed interpersonal trait to a deliberately taught and practiced clinical competence. Medical educators argue that communication should be taught with the same rigor as any medical procedure (Antila et al., 2024), and students’ reflections suggest that formal instruction can legitimize communication as a core element of professional identity rather than an optional “soft skill”. Importantly, this shift appears to enhance learners’ perceived preparedness for patient encounters, reinforcing the notion that communication skills are learnable and improvable through structured training [22]. In this sense, even brief interventions may contribute to repositioning communication as an integral component of clinical competence alongside biomedical knowledge. Despite these positive experiences, students voiced frustration about the timing of the workshop within the curriculum, particularly when it followed initial clinical exposure. This concern points to curricular sequencing as a structural determinant of training effectiveness rather than a limitation of the workshop content itself. Communication training is most impactful when learners can immediately apply newly acquired skills in authentic clinical contexts [23], and longitudinal curricula spanning preclinical and clinical phases have been shown to enhance readiness and confidence (Rasenberg et al., 2023;Nagpal et al., 2023). Students’ reflections suggest that delayed exposure to formal communication training may result in missed opportunities for situated learning, in which early clinical encounters occur without adequate communicative scaffolding. Viewed in this light, the call to position communication training closer to, or integrated within, clinical placements reflect learners’ sensitivity to alignment between educational input and experiential demand. Another unmet need concerned inconsistencies between formally taught communication principles and behaviors modeled during clinical training. This discrepancy highlights the hidden curriculum as a powerful contextual force that may moderate or even counteract the effects of formal communication training. While students valued clinicians’ authentic narratives about communication challenges, exposure to paternalistic or legally defensive interaction styles risks undermining patient-centered ideals. Such contradictions have been repeatedly identified as contributors to empathy erosion and professional disillusionment during medical education (Hojat et al., 2009; Howick et al., 2023; Neumann et al., 2011). From a developmental perspective, role modeling operates as an implicit learning mechanism through which norms of communication are internalized, often more strongly than through explicit instruction. Lastly, participants highlighted the limited emphasis on interprofessional communication within their training, noting that the workshop offered a rare opportunity to reflect on teamwork in healthcare settings. This finding reveals a curricular blind spot in preparing students for collaborative clinical practice, where effective communication extends beyond the doctor–patient dyad. Interprofessional education has been shown to improve role clarity, teamwork, and mutual respect across healthcare professions (Heier et al., 2024). Students’ reflections suggest that even brief, targeted exposure can initiate awareness of shared responsibility and the communicative demands of team-based care. Embedding interprofessional communication scenarios earlier and more systematically may therefore better align medical training with the realities of contemporary healthcare delivery. 4.1 Recommendations Based on our findings and converging evidence from prior research, we propose several recommendations to inform the design of medical communication curricula tailored to students’ needs. Figure 2 presents a conceptual model outlining the proposed sequencing of communication skills development throughout the medical program. Begin with integration activities that build safety and openness. As an enabling condition for experiential communication learning, early group-based integration should be explicitly incorporated into the design of communication workshops. Structured integration activities at the outset can help establish psychological safety by allowing students to reflect on their own needs, anxieties, and communicative roles within the group. Such preparatory processes support openness to experiential methods and increase tolerance for vulnerability inherent in role-play and feedback-based learning. Evidence suggests that students frequently experience heightened anxiety or discomfort during emotionally charged exercises, peer evaluation, or simulated clinical interactions [29], and when these affective responses are insufficiently addressed, they may hinder engagement or foster resistance toward communication training [29]. Accordingly, integration activities should be understood not as optional “warm-up” exercises but as pedagogical scaffolding that normalizes mistakes, protects personal boundaries, and creates conditions for effective skills acquisition. Our findings suggest that students’ appreciation of experiential formats is closely tied to the perceived safety of the learning environment, underscoring the importance of deliberate integration phases in compulsory communication curricula. Frame communication as a professional, teachable skill. Communication training should explicitly frame communication as a professional, teachable clinical competence rather than an assumed interpersonal trait. Students’ reflections suggest that exercises focused on paraphrasing, nonverbal communication, and the use of open-ended questions help demystify communication into structured, learnable components. Positioning communication in this way may legitimize deliberate practice and feedback as integral to professional development, rather than as optional or “soft” skills. Importantly, students also conceptualized communication as a team-based competence essential for collaboration across professional roles. Accordingly, curricula may benefit from incorporating interdisciplinary, simulation-based training modules that allow learners from different healthcare professions to practice communication together, exchange perspectives, and rehearse collaborative scenarios reflective of real clinical environments. Treat communication as an everyday clinical practice. Communication training should be embedded within everyday clinical practice rather than positioned as an isolated curricular component. Students’ reflections underscore the educational value of observing and reflecting on clinicians’ real interactions with patients, including both effective communication and acknowledged failures. Such authentic clinical narratives appear to function as powerful learning mechanisms, shaping students’ understanding of professional norms and expectations. At the same time, inconsistencies between formally taught communication principles and behaviors observed in clinical settings reflect the influence of the hidden curriculum (Hojat et al., 2009; Neumann et al., 2011). Aligning communication training with routine clinical supervision, bedside teaching, and reflective discussion may help reduce this discrepancy and reinforce communication as an integral, everyday aspect of clinical work rather than an abstract ideal. 4. Integrate structured reflection into the continuum of clinical training. Structured reflection should be integrated longitudinally across the medical curriculum, with particular emphasis on transitional phases of training. Students’ accounts indicate a need for dedicated spaces to process emotionally challenging patient encounters, especially prior to entering routine clinical practice and before the transition to independent professional roles. Regularly scheduled debriefing and reflective sessions may support the development of emotional regulation, professional boundaries, and reflective capacity, allowing learners to revisit difficult experiences, articulate emerging professional concerns, and consider strategies for sustaining empathy and well-being. Evidence suggests that embedding reflection within clinical training can strengthen empathic engagement and serve a protective function against burnout [31,32]. Positioning reflection as a continuous practice rather than a one-time intervention may therefore enhance its developmental and preventive value. 4.2. Limitations This study has several limitations that should be considered when interpreting the findings. First, it was conducted at a single institution and embedded within one compulsory medical psychology course, which limits the generalizability of the results across different curricula, cultural contexts, and stages of medical training. In addition, the relatively short follow-up period of four weeks precludes conclusions about the durability or longer-term educational impact of the observed changes. Second, the study employed a quasi-experimental design without randomization, with group allocation determined by scheduling constraints. This limits causal inference and may have contributed to baseline differences between groups that could not be fully controlled, despite the use of pre–post comparisons. Third, the quantitative outcomes relied exclusively on self-report measures (SPCC, EAS, SRIS, and PPCCS), which are inherently vulnerable to social desirability bias and may reflect changes in awareness or attitudes rather than observable behavioral change. No objective performance-based assessments, such as OSCE ratings, standardized patient evaluations, or patient feedback, were included, limiting conclusions about actual communication behavior in clinical contexts. The qualitative component also presents several limitations. Students’ expectations and attitudes toward communication training were not explored before participation, which may have constrained the interpretation of post-workshop reflections. Furthermore, qualitative data were collected from a single focus group (n = 12), potentially introducing selection bias toward more engaged or motivated participants. Additional strategies to enhance qualitative rigor, such as member checking or triangulation with other data sources (e.g., classroom observations, reflective journals, or faculty perspectives), were not employed. Finally, although workshop facilitators followed a predefined curriculum, they occasionally introduced additional, individualized topics in response to group dynamics and emerging needs. This variability may be viewed as a limitation, as it reduced the uniformity of the intervention across groups. At the same time, such flexibility reflects the experiential nature of the training and may have enabled the capture of a broader range of student perspectives. Moreover, because ward-based teaching and clinical supervision were not directly observed, interpretations related to the hidden curriculum and role modeling are based solely on students’ accounts rather than triangulated observational data. 5. Conclusions In a compulsory second-year medical psychology course, a brief experiential communication workshop was associated with modest improvements in self-perceived communication competence, empathy, and self-reflection at the whole-sample level, with no clear intervention-specific effects relative to a wait-list control. These findings suggest that short-term changes may reflect broader developmental or contextual influences rather than isolated training effects. Qualitative insights sugested that the educational value of the workshop lay less in measurable short-term outcomes and more in how students experienced the learning process. Experiential formats supported engagement, reflection, and the reframing of communication as a professional, teachable clinical skill, while also revealing structural gaps related to curricular timing, role modeling, and preparation for interprofessional practice. Taken together, the results support integrating communication training as a longitudinal component of medical education, embedded within clinical contexts, supported by psychological safety and structured reflection, and reinforced through consistent role modeling. Future research should focus on longitudinal and implementation-oriented designs that examine how timing, learning climate, and the hidden curriculum shape the translation of communication training into sustained, observable clinical practice. Abbreviations SPCC – Self-Perceived Communication Competence PPCCS – Physician-Patient Communication Competence Scale EAS – Empathy Assessment Scale SRIS – Self-Reflection and Insight Scale EG – Experimental Group CG – Control Group Declarations Ethics approval and consent to participate The study was approved by the Bioethics Committee of Wroclaw Medical University, Poland (approval no. KB/602/2024). All participants provided informed consent before participation. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors’ contributions AS: study conception and design, workshop design and delivery, data collection, qualitative and quantitative analysis, manuscript drafting. MB: data collection, interpretation of qualitative results. KK: statistical analysis and interpretation of quantitative data. BS: contribution to data collection and manuscript revision. DS: supervision of the study, contribution to study design, and critical revision of the manuscript. All authors read and approved the final manuscript. Acknowledgements We are grateful to Professor Renata Wallner, Dr Tomasz Bielawski, and Ms Katarzyna Nowak, MSc, for their valuable support in data collection. References Antila, A. K., Lindblom, S., Louhiala, P., & Pyörälä, E. (2024). Creating a safe space: medical students’ perspectives on using actor simulations for learning communication skills. BMC Medical Education , 24 (1), 1225-. https://doi.org/10.1186/S12909-024-06184-6 Baerheim, A., Hjortdahl, P., Holen, A., Anvik, T., Fasmer, O. B., Grimstad, H., Gude, T., Risberg, T., & Vaglum, P. (2007). Curriculum factors influencing knowledge of communication skills among medical students. BMC Medical Education , 7 , 35. https://doi.org/10.1186/1472-6920-7-35 Bosse, H. M., Schultz, J. H., Nickel, M., Lutz, T., Möltner, A., Jünger, J., Huwendiek, S., & Nikendei, C. (2012). The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial. Patient Education and Counseling , 87 (3), 300–306. https://doi.org/10.1016/J.PEC.2011.10.007 Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic Analysis. Handbook of Research Methods in Health Social Sciences , 843–860. https://doi.org/10.1007/978-981-10-5251-4_103 Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Facilitating small group learning in the health professions. BMC Medical Education , 20 (2), 457-. https://doi.org/10.1186/S12909-020-02282-3 Choudhary, A., & Gupta, V. 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The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine , 84 (9), 1182–1191. https://doi.org/10.1097/ACM.0B013E3181B17E55 Howick, J., Dudko, M., Feng, S. N., Ahmed, A. A., Alluri, N., Nockels, K., Winter, R., & Holland, R. (2023). Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies. BMC Medical Education , 23 (1), 270-. https://doi.org/10.1186/S12909-023-04165-9 Lane, C., & Rollnick, S. (2007). The use of simulated patients and role-play in communication skills training: a review of the literature to August 2005. Patient Education and Counseling , 67 (1–2), 13–20. https://doi.org/10.1016/J.PEC.2007.02.011 Malakcioglu, C. (2022). Empathy Assessment Scale. Northern Clinics of Istanbul , 9 (4), 358. https://doi.org/10.14744/NCI.2022.55649 McCroskey, J. C., & McCroskey, L. L. (1988). Self‐report as an approach to measuring communication competence. 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Effect of Reflective Writing on Burnout in Medical Trainees. MedEdPublish , 7 , 237. https://doi.org/10.15694/MEP.2018.0000237.1 Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., Haramati, A., & Scheffer, C. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine , 86 (8), 996–1009. https://doi.org/10.1097/ACM.0B013E318221E615 Patel, S., Pelletier-Bui, A., Smith, S., Roberts, M. B., Kilgannon, H., Trzeciak, S., & Roberts, B. W. (2019). Curricula for empathy and compassion training in medical education: A systematic review. PLOS ONE , 14 (8), e0221412. https://doi.org/10.1371/JOURNAL.PONE.0221412 Peterson, E. B., Boland, K. A., Bryant, K. A., McKinley, T. F., Porter, M. B., Potter, K. E., & Calhoun, A. W. (2016). Development of a Comprehensive Communication Skills Curriculum for Pediatrics Residents. Journal of Graduate Medical Education , 8 (5), 739. https://doi.org/10.4300/JGME-D-15-00485.1 Promoting Collaborative and Teamwork Competency in Medical Students | Harvard Medical School Professional, Corporate, and Continuing Education . (n.d.). Retrieved November 15, 2025, from https://learn.hms.harvard.edu/insights/all-insights/promoting-collaborative-and-teamwork-competency-medical-students R: The R Project for Statistical Computing . (n.d.). Retrieved December 12, 2025, from https://www.r-project.org/ Rasenberg, E., Brand, G., & van Weel-Baumgarten, E. (2023). Integrating medical and practical skills in communication skills training: Do students feel it supports them with transfer from classroom to practice? PEC Innovation , 2 , 100158. https://doi.org/10.1016/J.PECINN.2023.100158 Roberts, C., & Stark, P. (2008). Readiness for self-directed change in professional behaviours: factorial validation of the Self-reflection and Insight Scale. Medical Education , 42 (11), 1054–1063. https://doi.org/10.1111/J.1365-2923.2008.03156.X Rønning, S. B., & Bjørkly, S. (2019). The use of clinical role-play and reflection in learning therapeutic communication skills in mental health education: an integrative review. Advances in Medical Education and Practice , 10 , 415–425. https://doi.org/10.2147/AMEP.S202115 Ruiz-Moral, R., Gracia de Leonardo, C., Caballero Martínez, F., & Monge Martín, D. (2019). Medical students’ perceptions towards learning communication skills: a qualitative study following the 2-year training programme. International Journal of Medical Education , 10 , 90–97. https://doi.org/10.5116/IJME.5CBD.7E96 Schoenfeld-Tacher, R. M., Kogan, L. R., Meyer-Parsons, B., Royal, K. D., & Shaw, J. R. (2015). Educational Research Report: Changes in Students’ Levels of Empathy during the Didactic Portion of a Veterinary Program. Journal of Veterinary Medical Education , 42 (3), 194–205. https://doi.org/10.3138/JVME.0115-007R TIBCO Statistica® Document Management System 13.3.0 . (n.d.). Retrieved December 12, 2025, from https://docs.tibco.com/products/tibco-statistica-document-management-system-13-3-0 Yedidia, M. J., Gillespie, C. C., Kachur, E., Schwartz, M. D., Ockene, J., Chepaitis, A. E., Snyder, C. W., Lazare, A., & Lipkin, M. (2003a). Effect of Communications Training on Medical Student Performance. JAMA , 290 (9), 1157–1165. https://doi.org/10.1001/JAMA.290.9.1157 Zhang, X., Pang, H. fang, & Duan, Z. (2023). Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC Medical Education , 23 (1), 925-. https://doi.org/10.1186/S12909-023-04932-8/FIGURES/5 Additional Declarations No competing interests reported. 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.03).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8726989/v1/ea07ba35a8a7c6309ebb8dba.png"},{"id":104175048,"identity":"87327ff9-9b02-4fa0-a01a-79fbab083eb5","added_by":"auto","created_at":"2026-03-08 16:24:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":228468,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual model outlining the proposed sequencing of communication skills development throughout the medical program.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8726989/v1/f369f144ea0f0823188611e5.png"},{"id":104403966,"identity":"553a744b-4bfe-409c-9411-066ebbd50a96","added_by":"auto","created_at":"2026-03-11 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Introduction","content":"\u003cp\u003eEffective communication and empathy are widely recognized as fundamental competencies in medical practice, closely linked to better patient outcomes and safer care [1]. Strong communication skills have been shown to improve patients\u0026rsquo; adherence to treatment plans, enhance satisfaction with care, and are associated with reduced medical errors [2]. Likewise, physician empathy, the ability to understand a patient\u0026rsquo;s feelings and perspective, positively influences health outcomes [1]. For example, higher clinician empathy has been associated with shorter illness durations and improved chronic disease indicators in patients [3]. Given these benefits, medical education bodies now emphasize communication and empathy training as core elements of the curriculum. Many accreditation standards explicitly require that medical programs provide formal instruction in interpersonal communication with patients, families, and colleagues. Accordingly, contemporary medical students are expected not only to master biomedical knowledge but also to develop the communication skills and human understanding essential for patient-centered care.\u003c/p\u003e \u003cp\u003eDespite broad consensus on its importance, teaching communication in medical schools has historically faced challenges. In the past, communication training was not fully integrated into many curricula and infrequently evaluated using rigorous outcome measures [4]. Over the past two decades, educational initiatives have increasingly sought to address this gap. Pioneering programs have demonstrated that a structured communication skills curriculum can significantly improve students\u0026rsquo; abilities to build rapport, information exchange, and shared decision-making with patients [4]. For instance, a meta-analysis of medical humanities programs by Zhang et al. demonstrated a significant increase in empathy among medical students, with the strongest effects observed in short-term interventions lasting less than four months [5]. Additionally, a review of clinical role-play interventions showed that supervised role-playing not only promoted reflection and insight among students acting as patients and therapists but also benefited peers observing the sessions, ultimately enhancing students\u0026rsquo; involvement, self-efficacy, and empathic abilities in mental health practice [6].\u003c/p\u003e \u003cp\u003e These successes, along with guidelines from accrediting bodies, have prompted many institutions to introduce communication workshops, courses, or longitudinal modules early in training. However, the scope and timing of such training still vary widely. In many programs, communication is taught in a single stand-alone course or at discrete points (e.g., a workshop on breaking bad news), rather than reinforced continuously across all years [2]. Fully integrated curricula \u0026ndash; combining didactics, experiential practice, and ongoing assessment throughout medical school \u0026ndash; remain the exception rather than the norm [2]. This inconsistency in curricular integration means that students\u0026rsquo; exposure to communication skills training can be fragmented, potentially limiting its impact. Moreover, students are not a homogeneous group, and their values and priorities evolve, and generational differences may shape how they approach learning, interpersonal relationships, and patient expectations. This underscores the importance of exploring students\u0026rsquo; voices to capture what makes communication training meaningful and effective for them.\u003c/p\u003e \u003cp\u003eA particularly critical aspect of communication training is fostering empathy and relational skills in future physicians. Empathy is widely regarded as a teachable professional skill, yet evidence consistently shows a worrying trend: medical students\u0026rsquo; empathy tends to decline during their education [3]. A landmark review of 18 studies found significant decreases in self-reported empathy by the time students reach clinical training, attributing this erosion to distress (e.g., burnout, low sense of well-being, depression) and aspects of the \u0026ldquo;hidden curriculum\u0026rdquo; (mistreatment by superiors or mentors, loss of idealism, enthusiasm, and humanity when confronted with clinical reality, reduced contact with family, and high workload) [1]. In other words, the culture of medical training, including observing cynical or brusque role models, can undermine the humanistic attitudes that students bring in. Indeed, the absence of empathic role models and the emphasis on efficiency over understanding are thought to be major contributors to empathy loss [3]. These concerns have driven calls for a more intentional approach to teaching empathy, on par with other clinical skills. Listening to how students themselves interpret these challenges is crucial, since their lived experiences offer unique insights into how empathy can be sustained and strengthened within the realities of medical education.\u003c/p\u003e \u003cp\u003eIn light of these trends and challenges, the present study aimed to explore medical students\u0026rsquo; experiences and perceptions of communication training delivered within a compulsory psychology course. We adopted an exploratory mixed-methods design to gain a holistic understanding of how students interpret the value, timing, and relevance of such training in their curriculum. The workshop examined in this study was grounded in this educational framework: it followed the Calgary-Cambridge framework for the medical interview and used experiential methods such as role-play, peer feedback, and guided reflection to teach structured communication, empathy, and reflective practice. Quantitative data were collected to provide contextual information about self-perceived communication competence, empathy, and self-reflection, while the qualitative component \u0026ndash; based on a focus group \u0026ndash; offered deeper insight into students\u0026rsquo; subjective experiences. By integrating these perspectives, the study sought to illuminate how communication workshops are received by learners, what educational needs they reveal, and how medical curricula can more effectively foster empathy and interpersonal competence.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a convergent exploratory mixed-methods design, combining quantitative and qualitative approaches to evaluate the impact of communication training within a medical psychology course for second-year medical students. Quantitative and qualitative data were analyzed independently and integrated during the interpretation phase to provide a comprehensive understanding of the students\u0026rsquo; experiences and perceptions of the training. The quantitative component followed a quasi-experimental, pretest-posttest design with a wait-list control group. Students were quasi-randomly assigned by the university scheduling system to attend the communication workshop either in the first or second half of the semester. The experimental group participated in the training during the first half, while the wait-list control group completed the training in the second half. Quantitative data were collected at two time points: before the workshop (T1) and four weeks later (T2). The qualitative component consisted of a focus group interview conducted after all workshop sessions had concluded. Focus group participants received a psychiatry textbook as compensation for their time. The study was approved by the Bioethics Committee of Wroclaw Medical University, Poland (approval no. KB/602/2024). All participants provided informed consent before participating in the study. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. 2. Measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA battery of self-report questionnaires was administered at two time points (T1 and T2) to assess communication-related competencies, empathy, and self-reflection among participants. The following tools were used:\u003c/p\u003e\n\u003cp\u003e1. Self-Perceived Communication Competence (SPCC) is a 12-item self-report measure assessing individuals\u0026rsquo; perceived communication competence across various contexts (e.g., public speaking, group discussions, dyadic conversations) and with different interlocutors (strangers, acquaintances, friends). Respondents rate their competence on a scale from 0 to 100. The scale yields a total score and several context-specific sub-scores. It demonstrates high internal consistency (\u0026alpha; = .92) and good validity [7].\u003c/p\u003e\n\u003cp\u003e2. The Empathy Assessment Scale (EAS) is a 13-item self-report measure assessing empathy in three domains: social interaction, cognitive behavior, and emotional identification. Items are rated on a 5-point Likert scale. The scale provides a total score and three subscale scores. It demonstrates good internal consistency (\u0026alpha; = .85) and strong factorial and concurrent validity [8].\u003c/p\u003e\n\u003cp\u003e3. Self-Reflection and Insight Scale (SRIS) is a 20-item self-report instrument designed to measure individuals\u0026rsquo; readiness for self-directed change through metacognitive processes. It includes three subscales: Need for Self-Reflection, Engagement in Self-Reflection, and Insight. Items are rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The scale has demonstrated good internal consistency (\u0026alpha; = 0.83\u0026ndash;0.87) and factorial validity in medical student populations. It is used to assess self-regulatory capacities relevant to professional development in medical education [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4. Physician-Patient Communication Competence Scale (PPCCS) is a 10-item self-report measure \u003cstrong\u003edeveloped for this study\u003c/strong\u003e to assess perceived communication competence, emotional awareness, assertiveness, conflict-resolution skills, and attitudes toward the importance of communication in clinical practice. Responses are given on a 5-point Likert scale, with higher scores reflecting greater competence. Internal consistency was acceptable [Cronbach\u0026rsquo;s \u0026alpha; = 0.72; 95% CI (0.67, 0.76), Feldt\u0026rsquo;s method; R \u003cem\u003epsych\u003c/em\u003e package]. See Supplementary File 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Workshop description\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention consisted of a six-hour interactive workshop, delivered in two sessions, as part of a compulsory medical psychology course for second-year medical students.\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eThe workshop was conceptually based on the Calgary-Cambridge approach to the medical interview, which emphasizes structured communication, empathy, and reflective practice as core elements of clinical competence.\u0026nbsp;\u003c/strong\u003eIt focused on developing key clinical communication skills through experiential methods, including role-play, peer feedback, and guided reflection. Workshop content addressed active listening, paraphrasing, nonverbal communication, professional boundaries, and common interpersonal challenges in the doctor-patient relationship.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1 Quantitative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics and comparison between two groups using the t-test and the Mann-Whitney U test were performed using Statistica 13 [10]. When homogeneity of variance was violated (Levene\u0026rsquo;s test), the t-test was performed using the Welch correction. Due to significant deviations from normal distribution in several variables, a non-parametric repeated-measures ANOVA (for making between- and within-group comparisons) was conducted using the \u0026lsquo;ez\u0026rsquo; package (version 4.4-0) [11] \u0026nbsp;run in R version 4.5.1 [12] This approach allowed testing the main effects of time (within-subjects) and group (between-subjects), and the group \u0026times; time interaction. Descriptive statistics, including means, standard deviations, medians, quartiles, and counts with percentages, were reported where appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2 Qualitative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA single focus group discussion was conducted with twelve second-year medical students who had participated in the communication workshop. Participation was voluntary. The interview guide used for the focus group was developed specifically for the purposes of this study and is available as Supplementary Material (Supplementary File 2). The session was audio-recorded and transcribed verbatim by a member of the research team experienced in preparing qualitative materials. Before analysis, transcripts were anonymized and carefully proofread. Reviewing the transcript served as the initial phase of data familiarization. Qualitative data were analyzed by two independent researchers who had not been involved in any previous stages of the study. A thematic analysis approach was applied, combining both inductive and deductive [13] strategies to address the primary analytical question: How do medical students interpret the value of communication skills training following their participation in medical communication workshops? Initially, both researchers independently coded the transcript, identifying meaning units through inductive analysis. The codes were then discussed and synthesized into a shared codebook. Subsequently, the entire dataset was reanalyzed using the developed codebook in a deductive manner. Through iterative discussion, the researchers grouped the codes into themes and sub-themes, which were refined and named by consensus. All steps of the process, including transcription, coding, and analysis, were carried out in Polish. Selected quotes were translated from Polish into English by both researchers independently, then compared and discussed to ensure semantic accuracy.\u0026nbsp;\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Quantitative data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.1. Participants\u0026rsquo; demographics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 142 second-year medical students took part, including 94 in the experimental group (EG) and 48 in the control group (CG). The mean age was 20.61 years (SD = 2.10; range: 18\u0026ndash;32) in EG and 19.83 years (SD = 0.63; range: 19\u0026ndash;22) in CG. In EG, 61.7% were male and 38.3% female; in CG, 62.9% were male and 37.1% female. Most participants had no children (EG = 1.1%, CG = 0%) and had siblings (EG = 83.0%, CG = 83.3%). In EG, 54.3% reported being in a partnership, compared to 52.1% in CG. At the time of data collection, 25.5% of EG and 16.7% of CG reported currently attending psychotherapy (see Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1772640130.png\" width=\"997\" height=\"532\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.2 Baseline group comparisons\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt baseline (T0), the experimental (EG) and control (CG) groups were comparable on most self-report measures. Significant differences were observed in two variables, both favoring the control group. Specifically, the CG demonstrated higher overall empathy (EAS Total; Cohen\u0026rsquo;s d = 0.47, \u003cem\u003ep\u003c/em\u003e = 0.014) and higher emotional identification with others (EAS Emotional Identification; rbc = 0.20, \u003cem\u003ep\u003c/em\u003e = 0.048). No other baseline differences were detected between the groups (see Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1772640200.png\" width=\"1084\" height=\"715\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1.3 Pre-post intervention change\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcross the study period, several statistically significant changes were observed. The experimental group demonstrated a greater increase in overall self-perceived communication competence, reflected in a significant group \u0026times; time interaction for PPCCS Total (p = .002). As illustrated in Figure 1 (boxplots), PPCCS Total scores increased more strongly in the experimental group than in the control group. In contrast, both groups showed comparable changes over time in general communication competence (SPCC Total; p = .048) and in specific contexts, including public interactions (SPCC Public; p \u0026lt; .001), meetings (p = .001), and interactions with strangers (p = .048), with no significant group \u0026times; time interactions. Significant main effects of time were also observed for overall empathy (EAS Total; p = .015) and social-interaction empathy (p = .033), whereas cognitive and emotional components of empathy did not show intervention-specific changes. Similarly, need for self-reflection (SRIS Need for Self-Reflection) decreased over time (p \u0026lt; .001) and insight increased modestly (p = .034) in both groups, with no moderating effects of group. Although several effects reached statistical significance, their magnitude was small. Across outcomes, effect size estimates (generalized eta squared, ges) did not exceed 0.03, indicating limited practical impact. Overall, the only clear intervention-specific effect was the greater improvement in overall self-perceived communication competence (PPCCS Total) in the experimental group compared with the control group (see Figure 1 and Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Effects of time (T1 vs T2), group (EG vs CG), and their interaction on study variables according to nonparametric repeated-measures ANOVA (ezANOVA). Significant effects (p \u0026lt; .05) are marked with an asterisk.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 274px;\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cstrong\u003eF (1, 140)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cstrong\u003eges\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003ePPCCS_TOTAL\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.24\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.626\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0014\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e24.30\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u0026lt; 0.001*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0334\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e9.59\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.002*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0135\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_TOTAL\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.50\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.481\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0031\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e3.98\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.048*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0040\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.08\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.783\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_PUBLIC\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.330\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0056\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e12.22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u0026lt; 0.001*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0149\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.04\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.837\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_MEETING\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.61\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.435\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0037\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e10.68\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.001*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0107\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.01\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.927\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_GROUP\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.60\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.438\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0034\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.282\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0018\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.06\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.799\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_DYAD\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.02\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.899\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e2.53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.114\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0026\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.73\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.395\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0007\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_STRANGER\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.429\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0037\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e3.97\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.048*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0046\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.97\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.326\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0011\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_ACQUAINTANCE\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.164\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0111\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.80\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.182\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0025\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.03\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.858\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSPCC_FRIENDS\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e3.17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.077\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0192\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.92\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.168\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0019\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.83\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.363\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0008\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eEAS_TOTAL\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e6.18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.014*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0363\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e6.08\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.015*\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0064\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.00\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.992\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eEAS_COGNITIVE_BEHAVIOR\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.66\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.200\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0095\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e2.17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.143\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.003\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.29\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.594\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0004\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eEAS_EMOTIONAL_IDENTIFICATION\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e4.95\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.028\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.009537\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.87\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.174\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0297\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.01\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.907\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0018\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eEAS_SOCIAL_INTERACTION\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e2.64\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.110\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.015\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e4.00\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.033\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0055\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.702\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0002\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSRIS_INSIGHT\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.52\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.473\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0031\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e4.56\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.034\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0053\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.46\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.498\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0005\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSRIS_ENGAGEMENT_SELF_REFLECTION\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.76\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.379\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0041\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.83\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.376\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0014\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e1.25\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.279\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0021\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 274px;\"\u003e\u003cstrong\u003eSRIS_NEED_SELF_REFLECTION\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.71\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.402\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0033\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eTime\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e16.37\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u0026lt; 0.001\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0379\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003eGroup \u0026times; Time\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.44\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e0.507\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e0.0011\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e F \u0026ndash; test statistic; p \u0026ndash; level of statistical significance; ges \u0026ndash; generalized eta squared (effect size). Significant effects (p \u0026lt; .05) are marked with an asterisk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Qualitative data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis identified two overarching themes: (1) students\u0026rsquo; experiences encompassing perceived outcomes and reflections on the learning process, and (2) participants\u0026rsquo; unmet needs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.1. Effects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect 1: Group integration: balancing connection and discomfort\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the notable outcomes of the workshop was the opportunity for students to get to know each other on a deeper level. The sessions facilitated interpersonal connections and created space for emotional sharing, which some participants found beneficial and even therapeutic. However, this dynamic was not universally welcomed. While some students appreciated the chance to build closer relationships, a few found the atmosphere artificial or awkward, especially when the workshop resembled elements of group therapy.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I started to know and understand some people in the group better after these classes.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It felt a bit like group therapy \u0026ndash; and not everyone likes that.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;On one hand, it was nice that we could open up, but not everyone was ready for that.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect 2: Recognizing diverse perspectives and personal boundaries\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe workshops encouraged students to reflect not only on communication with patients, but also on their own internal attitudes, needs, and limitations. Many participants reported a new awareness of how differently the same interaction can be interpreted by different people. This realization fostered greater openness to others\u0026rsquo; viewpoints and, simultaneously, helped students better understand and respect their own boundaries. For some, the sessions challenged deeply rooted assumptions about the need to always appear competent. Instead, they began to appreciate the value of self-awareness in clinical communication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;For me, the most important thing was realizing how differently the same situation can be perceived.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I understood that I have my boundaries and I don\u0026rsquo;t have to agree to everything to be empathetic.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;For the first time, I thought that I don\u0026rsquo;t always have to be \u0026apos;the smartest\u0026apos; \u0026ndash; but I learnt, it\u0026rsquo;s okay not to know something.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I saw that everyone has a different communication style \u0026ndash; it was eye-opening.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect 3: Acquiring communication competence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe workshops enhanced students\u0026rsquo; understanding of communication as a professional, teachable skill, extending far beyond everyday conversation. They learned to value listening and emotional attunement, discovered the power of open-ended questions, and became more aware of the impact of nonverbal cues. This deepened awareness translated into a sense of preparedness for future patient interactions and reframed communication as an integral part of medical competence\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I learned that communication isn\u0026rsquo;t just about speaking, but also about listening and recognizing emotions.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Thanks to the workshops, I better understand how to talk to a patient so they feel safe.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I found out that open-ended questions can completely change the conversation.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was surprised by how important nonverbal communication is \u0026ndash; I had never thought about it before.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcess reflection: Engagement and practice-based learning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeyond the perceived learning outcomes, students emphasized the workshop\u0026rsquo;s format as a crucial factor shaping their engagement and motivation. They appreciated the interactive, practice-oriented nature of the sessions, which contrasted sharply with traditional lectures. Role-plays, peer feedback, and real-life scenarios created a safe environment to experiment and learn from mistakes. Many participants described the experience as their first encounter with an educational method that felt directly relevant to clinical work. The experiential format helped bridge the gap between theory and practice, making the learning process more relevant and memorable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;What I liked most was that it wasn\u0026rsquo;t just theory \u0026ndash; we practiced real situations.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Everyone\u0026rsquo;s engagement made these classes different from regular lectures.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Thanks to the exercises, I could rehearse difficult conversations without pressure.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was the first time I felt I was learning something I\u0026rsquo;d actually use during clinical placements.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.2 Unmet needs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnmet Need 1:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCommunication background before clinical practice\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents\u0026rsquo; reflections highlighted a strong need for better alignment between communication training and clinical practice. While the workshops were perceived as valuable, their timing was often criticized. Many participants felt that such classes would have been more helpful if scheduled earlier, ideally just before or during clinical placements. Several students had already completed medical volunteering/short-term clinical placement without prior formal training in communication and recognized this as a missed opportunity. Although the workshop partially fulfilled the long-standing demand for structured communication education, its placement in the curriculum was seen as suboptimal, revealing both an unmet need and a step in the right direction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;These classes would make more sense if they were closer to our clinical placements.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s good that something like this was included, but I\u0026rsquo;m not sure it was the best timing.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Too late \u0026ndash; I had already done my placements and lacked these skills back then.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s great that we finally had this, because there was nothing about communication before.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnmet Need 2: Consistent role modeling in clinical communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents repeatedly emphasized how impactful and memorable it was when clinicians shared real-life experiences, especially stories about communication mistakes or emotionally difficult encounters. These practitioner narratives were valued not only for their authenticity but also for making communication principles feel applicable and meaningful. There was a strong desire for more such examples from practicing doctors, integrated more systematically into medical training. At the same time, however, students expressed disappointment and concern about a frequent disconnect between what they were taught in communication workshops and what they observed during clinical placements. In some cases, physicians served as negative role models, treating communication as a legal safeguard rather than a relational skill, or promoting a hierarchical, paternalistic dynamic with patients. This contradiction left some students confused, disillusioned, or frustrated, particularly when they encountered instructors who openly dismissed the importance of empathy or collaboration.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;What helped me most was when the doctor talked about their own communication mistake. (\u0026hellip;) It speaks to me much more when someone with experience explains what it\u0026rsquo;s really like.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You just remember these kinds of real-life stories. They really stick with you.\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u0026hellip;) \u003cem\u003eOne of our lecturers often gave examples from his experience with patients. It wasn\u0026rsquo;t just about diseases \u0026ndash; it actually helped us understand how to communicate and what kinds of questions to ask so patients really understand what we mean.\u0026rdquo;\u003c/em\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;In my opinion, some classes present very toxic situations. This year, we had one particular class with a certain instructor. And the doctor\u0026ndash;patient relationship, in my view, was presented completely differently than what we were taught in psychology... The doctor, for example, is basically like a god; he\u0026rsquo;s the master, and the patient is supposed to just listen.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I personally had a class with a professor who basically just explained how not to get sued. We were discussing what to say so you wouldn\u0026rsquo;t be sued... I even had another class where the main topic was what a doctor should do to avoid being sued. That\u0026rsquo;s what it all revolved around. Like, you should do something, but don\u0026rsquo;t actually do it, just write it down in a way that no one can sue you. (\u0026hellip;) \u0026ldquo;If someone doesn\u0026rsquo;t have clinical experience and hears things like that from doctors, it can really mess with their head.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnmet Need 3: Preparation for team-based medical practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudents acknowledged that the workshop offered a rare and valuable opportunity to reflect on the collaborative nature of clinical work. For many, it was the first time they had explicitly considered the doctor\u0026rsquo;s role within a broader healthcare team. Exercises involving teamwork highlighted the interdependence of roles and the importance of communication not only with patients, but also with nurses, technicians, and fellow physicians.\u003c/p\u003e\n\u003cp\u003eDespite these insights, students felt that this area remains largely neglected in their education. They expressed a clear wish for more training that mirrors the realities of hospital environments, where teamwork, shared decision-making, and interprofessional communication are essential. There was a recurring sense that medical education too often focuses on the individual rather than the collective, and that more interdisciplinary, scenario-based learning would better prepare them for future clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was nice that we could also look at it from the perspective of other medical professions.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I realized that as doctors, we don\u0026rsquo;t work alone \u0026ndash; we work in teams.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Communication within a team is something no one had taught us before.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There were exercises that required teamwork \u0026ndash; they revealed our different roles.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e"},{"header":"4. Discussion and implications for medical education","content":"\u003cp\u003eThis mixed-methods study evaluated a compulsory communication skills workshop using a quantitative pre\u0026ndash;post design with a wait-list control group. Quantitative analyses revealed small but statistically significant changes over time across several domains of self-perceived communication competence, empathy, and self-reflection, observed in both groups. A single intervention-specific effect emerged for overall physician\u0026ndash;patient communication competence, which improved more in the experimental group, although all effect sizes were small, indicating limited practical impact. Notably, there is still no standardized empathy-training curriculum, and existing interventions, ranging from reflective writing to mindfulness or patient shadowing, have yielded mixed effects [14,15]. The observed time-related changes in both groups are consistent with prior findings suggesting that communication awareness and empathy may fluctuate even in the absence of targeted interventions, potentially reflecting test\u0026ndash;retest effects or the role of reflection itself as a learning stimulus.\u003c/p\u003e\n\u003cp\u003eThe qualitative analysis added depth by capturing students\u0026rsquo; perspectives. Two overarching themes were identified following the workshop:\u0026nbsp;students\u0026rsquo; experiences encompassing perceived outcomes and reflections on the learning process,\u0026nbsp;and unmet needs. One of the first effects was the workshop\u0026rsquo;s impact on group dynamics.\u0026nbsp;Rather than representing an outcome in itself, group integration appears to function as a\u0026nbsp;\u003cem\u003emechanism\u003c/em\u003e that enables experiential communication learning.\u0026nbsp;Interactive small-group formats have been shown to foster collaboration, team-building, and empathy in healthcare education [16];\u0026nbsp;however,\u0026nbsp;students\u0026rsquo; ambivalence toward the \u0026ldquo;group therapy\u0026rdquo; atmosphere suggests that emotional openness may simultaneously facilitate learning and pose a psychological challenge.\u0026nbsp;This tension highlights the importance of skilled facilitation to balance trust-building with emotional safety in compulsory workshops.\u003c/p\u003e\n\u003cp\u003eAnother key outcome was that students became more aware of how differently individuals may interpret the same interaction, and they began reflecting on their own needs and limits. This increased awareness of divergent perspectives may reflect an early stage of professional identity development, in which communication competence shifts from performance-based accuracy toward relational and reflective sensitivity. Effective communication training has been shown to rely on self-awareness and interpersonal reflection rather than technical skill alone [17], and\u0026nbsp;students\u0026rsquo; emphasis on personal boundaries suggests that empathy was understood as a regulated professional stance rather than emotional overinvolvement. Such reframing may counteract unrealistic expectations of constant competence that can undermine teamwork and empathic engagement [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRather than constituting an outcome per se, students\u0026rsquo; reflections highlight experiential learning as a central\u0026nbsp;\u003cem\u003eprocess mechanism\u003c/em\u003e\u0026nbsp;shaping engagement and perceived relevance of communication training. They valued role-play, active participation, and rehearsal of challenging conversations in a safe environment, which contrasted with the passivity of traditional lectures. This suggests that experiential methods may function as enabling conditions for learning, rather than as direct indicators of skill acquisition. Evidence from medical education consistently shows that simulation and role-play enhance engagement, retention, and transfer of communication skills to clinical contexts (Bosse et al., 2012; Lane \u0026amp; Rollnick, 2007;Yedidia et al., 2003b). From a pedagogical perspective, these process-related reflections help explain why students perceived the training as meaningful despite modest short-term quantitative effects.\u003c/p\u003e\n\u003cp\u003eFinally, the workshop helped students reconceptualize communication as a structured clinical skill rather than a casual or intuitive ability. Participants reported gaining insight into techniques such as active listening, emotional attunement, the use of open-ended questions, and awareness of nonverbal cues, core components of patient-centered communication. This reframing represents a pedagogical shift in how communication is positioned within medical training: from an assumed interpersonal trait to a deliberately taught and practiced clinical competence. Medical educators argue that communication should be taught with the same rigor as any medical procedure (Antila et al., 2024), and students\u0026rsquo; reflections suggest that formal instruction can legitimize communication as a core element of professional identity rather than an optional \u0026ldquo;soft skill\u0026rdquo;. Importantly, this shift appears to enhance learners\u0026rsquo; perceived preparedness for patient encounters, reinforcing the notion that communication skills are learnable and improvable through structured training [22]. In this sense, even brief interventions may contribute to repositioning communication as an integral component of clinical competence alongside biomedical knowledge.\u003c/p\u003e\n\u003cp\u003eDespite these positive experiences, students voiced frustration about the timing of the workshop within the curriculum, particularly when it followed initial clinical exposure. This concern points to curricular sequencing as a structural determinant of training effectiveness rather than a limitation of the workshop content itself.\u0026nbsp;Communication training is most impactful when learners can immediately apply newly acquired skills in authentic clinical contexts\u0026nbsp;[23], and longitudinal curricula spanning preclinical and clinical phases have been shown to enhance readiness and confidence (Rasenberg et al., 2023;Nagpal et al., 2023). Students\u0026rsquo; reflections suggest that delayed exposure to formal communication training may result in missed opportunities for situated learning, in which early clinical encounters occur without adequate communicative scaffolding. Viewed in this light, the call to position communication training closer to, or integrated within, clinical placements reflect learners\u0026rsquo; sensitivity to alignment between educational input and experiential demand.\u003c/p\u003e\n\u003cp\u003eAnother unmet need concerned inconsistencies between formally taught communication principles and behaviors modeled during clinical training. This discrepancy highlights the hidden curriculum as a powerful contextual force that may moderate or even counteract the effects of formal communication training. While students valued clinicians\u0026rsquo; authentic narratives about communication challenges, exposure to paternalistic or legally defensive interaction styles risks undermining patient-centered ideals. Such contradictions have been repeatedly identified as contributors to empathy erosion and professional disillusionment during medical education (Hojat et al., 2009; Howick et al., 2023; Neumann et al., 2011). From a developmental perspective, role modeling operates as an implicit learning mechanism through which norms of communication are internalized, often more strongly than through explicit instruction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLastly, participants highlighted the limited emphasis on interprofessional communication within their training, noting that the workshop offered a rare opportunity to reflect on teamwork in healthcare settings. This finding reveals a curricular blind spot in preparing students for collaborative clinical practice, where effective communication extends beyond the doctor\u0026ndash;patient dyad. Interprofessional education has been shown to improve role clarity, teamwork, and mutual respect across healthcare professions (Heier et al., 2024). Students\u0026rsquo; reflections suggest that even brief, targeted exposure can initiate awareness of shared responsibility and the communicative demands of team-based care.\u0026nbsp;Embedding interprofessional communication scenarios earlier and more systematically may therefore better align medical training with the realities of contemporary healthcare delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on our findings and converging evidence from prior research, we propose several recommendations to inform the design of medical communication curricula tailored to students\u0026rsquo; needs. Figure 2 presents a conceptual model outlining the proposed sequencing of communication skills development throughout the medical program.\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eBegin with integration activities that build safety and openness.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAs an enabling condition for experiential communication learning, early group-based integration should be explicitly incorporated into the design of communication workshops. Structured integration activities at the outset can help establish psychological safety by allowing students to reflect on their own needs, anxieties, and communicative roles within the group.\u0026nbsp;Such preparatory processes support openness to experiential methods and increase tolerance for vulnerability inherent in role-play and feedback-based learning.\u0026nbsp;Evidence suggests that students frequently experience heightened anxiety or discomfort during emotionally charged exercises, peer evaluation, or simulated clinical interactions\u0026nbsp;[29],\u0026nbsp;and\u0026nbsp;when these affective responses are insufficiently addressed, they may hinder engagement or foster resistance toward communication training\u0026nbsp;[29].\u0026nbsp;Accordingly, integration activities should be understood not as optional \u0026ldquo;warm-up\u0026rdquo; exercises but as pedagogical scaffolding that normalizes mistakes, protects personal boundaries, and creates conditions for effective skills acquisition. Our findings suggest that students\u0026rsquo; appreciation of experiential formats is closely tied to the perceived safety of the learning environment, underscoring the importance of deliberate integration phases in compulsory communication curricula.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eFrame communication as a professional, teachable skill.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eCommunication training should explicitly frame communication as a professional, teachable clinical competence rather than an assumed interpersonal trait. Students\u0026rsquo; reflections suggest that exercises focused on paraphrasing, nonverbal communication, and the use of open-ended questions help demystify communication into structured, learnable components. Positioning communication in this way may legitimize deliberate practice and feedback as integral to professional development, rather than as optional or \u0026ldquo;soft\u0026rdquo; skills.\u0026nbsp;Importantly, students also conceptualized communication as a team-based competence essential for collaboration across professional roles. Accordingly, curricula may benefit from incorporating interdisciplinary, simulation-based training modules that allow learners from different healthcare professions to practice communication together, exchange perspectives, and rehearse collaborative scenarios reflective of real clinical environments.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli style=\"font-weight: bold;\"\u003e\u003cstrong\u003eTreat communication as an everyday clinical practice.\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eCommunication training should be embedded within everyday clinical practice rather than positioned as an isolated curricular component. Students\u0026rsquo; reflections underscore the educational value of observing and reflecting on clinicians\u0026rsquo; real interactions with patients, including both effective communication and acknowledged failures. Such authentic clinical narratives appear to function as powerful learning mechanisms, shaping students\u0026rsquo; understanding of professional norms and expectations.\u003cbr\u003e\u0026nbsp;At the same time, inconsistencies between formally taught communication principles and behaviors observed in clinical settings reflect the influence of the hidden curriculum (Hojat et al., 2009; Neumann et al., 2011). Aligning communication training with routine clinical supervision, bedside teaching, and reflective discussion may help reduce this discrepancy and reinforce communication as an integral, everyday aspect of clinical work rather than an abstract ideal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Integrate structured reflection into the continuum of clinical training.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStructured reflection should be integrated longitudinally across the medical curriculum, with particular emphasis on transitional phases of training. Students\u0026rsquo; accounts indicate a need for dedicated spaces to process emotionally challenging patient encounters, especially prior to entering routine clinical practice and before the transition to independent professional roles.\u003c/p\u003e\n\u003cp\u003eRegularly scheduled debriefing and reflective sessions may support the development of emotional regulation, professional boundaries, and reflective capacity, allowing learners to revisit difficult experiences, articulate emerging professional concerns, and consider strategies for sustaining empathy and well-being. Evidence suggests that embedding reflection within clinical training can strengthen empathic engagement and serve a protective function against burnout [31,32].\u0026nbsp;Positioning reflection as a continuous practice rather than a one-time intervention may therefore enhance its developmental and preventive value.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2. Limitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations that should be considered when interpreting the findings.\u0026nbsp;First, it was conducted at a single institution and embedded within one compulsory medical psychology course, which limits the generalizability of the results across different curricula, cultural contexts, and stages of medical training. In addition, the relatively short follow-up period of four weeks precludes conclusions about the durability or longer-term educational impact of the observed changes.\u003c/p\u003e\n\u003cp\u003eSecond, the study employed a quasi-experimental design without randomization, with group allocation determined by scheduling constraints. This limits causal inference and may have contributed to baseline differences between groups that could not be fully controlled, despite the use of pre\u0026ndash;post comparisons.\u003c/p\u003e\n\u003cp\u003eThird, the quantitative outcomes relied exclusively on self-report measures (SPCC, EAS, SRIS, and PPCCS), which are inherently vulnerable to social desirability bias and may reflect changes in awareness or attitudes rather than observable behavioral change. No objective performance-based assessments, such as OSCE ratings, standardized patient evaluations, or patient feedback, were included, limiting conclusions about actual communication behavior in clinical contexts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe qualitative component also presents several\u0026nbsp;limitations. Students\u0026rsquo; expectations and attitudes toward communication training were not explored before participation,\u0026nbsp;which may have constrained the interpretation of post-workshop reflections. Furthermore, qualitative data were collected from a single focus group (n = 12), potentially introducing selection bias toward more engaged or motivated participants. Additional strategies to enhance qualitative rigor, such as member checking or triangulation with other data sources (e.g., classroom observations, reflective journals, or faculty perspectives), were not employed.\u003c/p\u003e\n\u003cp\u003eFinally, although workshop facilitators followed a predefined curriculum, they occasionally introduced additional, individualized topics in response to group dynamics and emerging needs. This variability may be viewed as a limitation, as it reduced the uniformity of the intervention across groups. At the same time, such flexibility reflects the experiential nature of the training and may have enabled the capture of a broader range of student perspectives. Moreover, because ward-based teaching and clinical supervision were not directly observed, interpretations related to the hidden curriculum and role modeling are based solely on students\u0026rsquo; accounts rather than triangulated observational data.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn a compulsory second-year medical psychology course, a brief experiential communication workshop was associated with modest improvements in self-perceived communication competence, empathy, and self-reflection at the whole-sample level, with no clear intervention-specific effects relative to a wait-list control. These findings suggest that short-term changes may reflect broader developmental or contextual influences rather than isolated training effects. Qualitative insights sugested that the educational value of the workshop lay less in measurable short-term outcomes and more in how students experienced the learning process. Experiential formats supported engagement, reflection, and the reframing of communication as a professional, teachable clinical skill, while also revealing structural gaps related to curricular timing, role modeling, and preparation for interprofessional practice.\u003c/p\u003e \u003cp\u003eTaken together, the results support integrating communication training as a longitudinal component of medical education, embedded within clinical contexts, supported by psychological safety and structured reflection, and reinforced through consistent role modeling. Future research should focus on longitudinal and implementation-oriented designs that examine how timing, learning climate, and the hidden curriculum shape the translation of communication training into sustained, observable clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSPCC \u0026ndash; Self-Perceived Communication Competence\u003c/p\u003e\n\u003cp\u003ePPCCS \u0026ndash; Physician-Patient Communication Competence Scale\u003c/p\u003e\n\u003cp\u003eEAS \u0026ndash; Empathy Assessment Scale\u003c/p\u003e\n\u003cp\u003eSRIS \u0026ndash; Self-Reflection and Insight Scale\u003c/p\u003e\n\u003cp\u003eEG \u0026ndash; Experimental Group\u003c/p\u003e\n\u003cp\u003eCG \u0026ndash; Control Group\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Bioethics Committee of Wroclaw Medical University, Poland (approval no. KB/602/2024). All participants provided informed consent before participation. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAS: study conception and design, workshop design and delivery, data collection, qualitative and quantitative analysis, manuscript drafting.\u003c/p\u003e\n\u003cp\u003eMB: data collection, interpretation of qualitative results.\u003c/p\u003e\n\u003cp\u003eKK: statistical analysis and interpretation of quantitative data.\u003c/p\u003e\n\u003cp\u003eBS: contribution to data collection and manuscript revision.\u003c/p\u003e\n\u003cp\u003eDS: supervision of the study, contribution to study design, and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Professor Renata Wallner, Dr Tomasz Bielawski, and Ms Katarzyna Nowak, MSc, for their valuable support in data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAntila, A. 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Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(1), 925-. https://doi.org/10.1186/S12909-023-04932-8/FIGURES/5\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"medical education, communication skills, empathy, curriculum development","lastPublishedDoi":"10.21203/rs.3.rs-8726989/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8726989/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommunication skills and empathy are core competencies in medical practice, yet their effective integration into medical curricula remains inconsistent. While experiential workshops are increasingly implemented, evidence regarding their specific impact and alignment with students\u0026rsquo; needs is mixed. Exploring students\u0026rsquo; perspectives alongside quantitative outcomes may provide valuable insight into how such training is experienced and how it can be optimized.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to examine medical students\u0026rsquo; experiences and perceptions of a compulsory communication skills workshop delivered within a medical psychology course, and to assess changes in self-perceived communication competence, empathy, and self-reflection through a mixed-methods approach.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convergent exploratory mixed-methods design was employed. The quantitative component followed a quasi-experimental pretest\u0026ndash;posttest design with a wait-list control group. Second-year medical students (N\u0026thinsp;=\u0026thinsp;142) completed self-report measures of communication competence (SPCC; PPCCS), empathy (EAS), and self-reflection (SRIS) before the workshop and four weeks later. Nonparametric repeated-measures ANOVA was used to examine time, group, and interaction effects. Qualitative data were obtained through a focus group interview with twelve participants and analyzed using thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eQuantitative analyses revealed small improvements over time in self-perceived communication competence, empathy, and self-reflection in both groups. A significant group \u0026times; time interaction was observed only for overall physician-patient communication competence (PPCCS Total), indicating a greater increase in the experimental group. All effect sizes were small. Qualitative findings provided contextual depth, identifying two overarching themes: perceived effects and unmet needs. Students highlighted enhanced awareness of diverse perspectives, personal boundaries, and communication as a teachable professional skill, as well as strong engagement with practice-based learning methods. At the same time, they reported unmet needs related to earlier and more continuous integration of communication training, inconsistent role modeling during clinical placements, and insufficient preparation for interprofessional teamwork.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA brief experiential communication workshop embedded in a compulsory medical psychology course was associated with small short-term increases in self-perceived physician\u0026ndash;patient communication competence, while changes in empathy and self-reflection were comparable in the intervention and wait-list control groups. Students\u0026rsquo; narratives underscored the educational value of experiential learning while revealing structural gaps in curriculum timing, role modeling, and team-based communication training. These findings support the need for longitudinal, clinically aligned communication curricula that integrate experiential methods, structured reflection, and consistent empathic role modeling across medical education.\u003c/p\u003e","manuscriptTitle":"Learning to Listen: Mixed-Methods Study of Medical Students’ Perspectives on Communication Training","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 16:24:45","doi":"10.21203/rs.3.rs-8726989/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-13T06:57:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-05T20:09:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332356675516663998963123795765683819724","date":"2026-03-05T12:40:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T18:03:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278674235795593960019209227858228326562","date":"2026-03-02T17:33:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-27T02:18:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-16T08:37:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-06T05:56:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T20:38:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-02-05T20:33:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cb8fd552-7a40-460a-9256-a8c524f533e0","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T00:23:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 16:24:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8726989","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8726989","identity":"rs-8726989","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}