
Effective doctor-patient communication skills training optimizes functional organization of intrinsic brain architecture: a resting-state functional MRI study
Bing Zhang, Ling Ni, Fangfang Wang, Weiping Li, Xin Zhang, Xiaohua Gu, Zuzana Nedelska, Fei Chen, Kun Wang, Bin Zhu, Renyuan Liu, Jun Xu, Jinfan Wang
Journal of Biomedical Research ›› 2017, Vol. 31 ›› Issue (6) : 486-493.
Effective doctor-patient communication skills training optimizes functional organization of intrinsic brain architecture: a resting-state functional MRI study
We studied the influence of doctor-patient communication skills training on brain functional architecture using resting-state functional MRI (rs-fMRI) with a regional homogeneity (ReHo) method. Ten medical students participated in the study. A 1-year long doctor-patient communication skills training program was conducted. Rs-fMRI data were collected at baseline, one month and one year after training. There was a significant increase in the communication skills test average scores between baseline and 1-month duration of training (P<0.001). After one month of communication skills training, medical students had decreased ReHo in the right superior temporal gyrus compared with the baseline. After one year of communication skills training, students had increased ReHo in multiple regions and decreased ReHo in several regions (P<0.05, Alphasim corrected). The change of ReHo values in the superior temporal gyrus negatively correlated with the change of communication skills scale score between one month after communication skills training and baseline (r=–0.734, P= 0.036). The training program we used can be an effective approach of improving doctor-patient communication skills, and the training resulted in functional plasticity of the brain's architecture toward optimizing locally functional organization.
brain architecture / function / resting-state functional MRI (rs-fMRI) / doctor-patient communication
Tab.1 Doctor-patient communication skills training schedule employed in this study |
Item | Content/dedicated time |
---|---|
Training course | 1. Theoretical knowledge included lectures and group discussion twice a week (80 minutes for each session), a total of four weeks 2. Scenario simulation using standardized patient actor once a week (120 minutes for each session) , a total of two weeks |
Clinical practice with hospitalized patients | 3. Clinical practice with hospitalized patients six days a week, a total of four weeks 4. Evaluation of communication skills measured using in-house developed scales 5.Clinical practice without theoretical knowledge study (the next 11 months) |
Tab.2 The content of 11 questions in the communication skills scale |
1. Do you think this student is good at communicating with other students? |
---|
2. Do you think this student is good at communicating with teachers or healthcare providers? |
3. Do you think this student is good at communicating with patients and their families? |
4. Do you think this student is good at communicating with strangers? |
5. Do you think this student likes expressing himself or herself in class or at the meeting? |
6. Do you think this student usually pays attention to polite manners? |
7. Do you think the people who know this student understand his thoughts and emotions? |
8. What do you think of this student's oral expression ability? |
9. Do you think this student is rich in body language (expression, movement, tone, etc)? |
10. Do you think this student often complains about patients or social environment? |
11. What do you think of this student's ability to control his or her emotions? |
Tab.3 Demographic characteristics and communication skills scale score of each subject |
baseline (n=10) | 1-month after training (n=10) | 1-year after training (n=9) | P- value | |
---|---|---|---|---|
Gender (M/F) | 6/4 | 6/4 | 5/4 | |
Age (y,±SD) | 25±2 | 25±2 | 24±2 | |
Education(y±SD) | 17±1.32 | 17±1.32 | 17±1.18 | |
Scale for each subject | ||||
Subject 1 | 28 | 34 | ||
Subject 2 | 31 | 33 | ||
Subject 3 | 28 | 34 | ||
Subject 4 | 31 | 35 | ||
Subject 5 | 33 | 35 | ||
Subject 6 | 30 | 33 | ||
Subject 7 | 30 | 33 | ||
Subject 8 | 32 | 35 | ||
Subject 9 | 31 | 33 | ||
Subject 10 | 30 | 34 | ||
Scale (±SD) | 30.40±1.58 | 33.90±0.88 | <0.001* |
Values are expressed as mean±SD. *The P value was obtained by paired t-test in comparison with the communication skills scale score between baseline and 1-month after training. |
Tab.4 Brain regions showing ReHo differences from baseline and after one month and one year of communication skills training. |
Brain region | MNI coordinates (mm) | Vol (mm 3) | Maximal T-value |
---|---|---|---|
(x, y, z) | |||
One month vs. baseline STG (R) One year vs. baseline | 54, 6, 6 | 1,215 | −7.1268 |
IFG (R) | 48, 15, 37 | 3,888 | 6.9362 |
ACC (L) | −15, 42, 18 | 891 | 6.921 |
MFG (L) | −15, 42, 15 | 1,890 | 6.921 |
Thalamus (L) | −12, −22, 15 | 1,998 | 7.0368 |
Thalamus (R) | −12, −22, 15 | 1,782 | 7.0368 |
Amygdala (L) | −30, −15, −24 | 864 | 3.3554 |
Insula (R) | 40, −13, 15 | 1,782 | 10.274 |
MidFG (R) | 47, 14, 40 | 2,187 | 10.274 |
SFG (R) | 21, −9, 69 | 2,727 | 6.921 |
PCC | 15, −48, 21 | 1,485 | −6.6008 |
Parahippocampal | 26, −12, −30 | 999 | −7.965 |
Parahippocampal | −24, −12, −27 | 1,539 | −7.029 |
Positive values are increased in ReHo. Negative values are decreased in ReHo. ReHo=Regional homogeneity; MNI= Montreal Neurological Institute; IFG= inferior frontal gyrus; ACC= anterior cingulate cortex; MFG= medial frontal gyrus; MidFG= middle frontal gyrus; SFG= superior frontal gyrus; PCC= posterior cingulate cortex.P<0.05, Alphasim corrected. |
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