Discussion
Our findings suggest that practical and interactive online healthcare communication education using counseling videos with blank lines is as effective as face-to-face communication education among healthcare college students. Since the spread of COVID-19, communication exercises utilizing group work with online conferencing systems have been conducted [25,26,27], but it is difficult to use such methods in a large-group lecture such as this study. Therefore, we believe online healthcare communication education with the video materials developed in this study provide a noteworthy example in the context of university education.
Another important implication is that the online lectures were as effective as face-to-face lectures in improving students’ comprehension and confidence in healthcare communication and clinical internships for healthcare college students. Thus, online communication skills training was found to be more effective in improving students’ self-efficacy than expected in previous studies [26, 27]. Nevertheless, the power for the difference between the effects of the two groups was low in this study, implying that a larger sample size may have produced a more significant difference. However, this difference was small compared to the improvement in each outcome caused by the lectures, and it was unlikely to be a practically meaningful difference, given that the main effect of time is well recognized in this study. Therefore, we can infer that there was no difference in effectiveness between the online and face-to-face groups.
The greatest strength of this study is its approach to interactivity [17] and practicality [18], which are challenges in online healthcare communication education. In addition, there are three possible reasons for the effectiveness of the online healthcare communication program used in this study. First, the e-learning pre-training homework emphasized the importance of active listening, empathy, and clear communication, providing students with strategies and techniques to improve their interactions with patients. The e-learning materials used in this study focused on micro-counseling skills, a basic model of counseling, and provided clear examples of good and bad practices [21]. In recent years and with the influence of the COVID-19 pandemic, e-learning education has rapidly developed and been accepted by students [28]. In healthcare communication lectures for healthcare college students, e-learning alone is expected to be sufficient to improve their perceived communication skills [29] and to be an effective pre-learning tool for role-play application in communication education for clinical psychology students [20]. Therefore, we believe that the pre-training using an e-learning approach contributed significantly to improving students’ confidence in healthcare communication.
Second, the healthcare provider–patient conversation video with blank lines was a practical exercise implemented in the lectures and may have contributed to improving healthcare college students’ confidence in communicating with patients. This video was developed by the authors of this paper in prior research and is expected to have effects similar to those of role-playing [19]. No previous studies have used similar video exercises for healthcare communication education, and thus the effectiveness of these exercises should be independently verified in the future.
Third, only online methodologies allow for students to share their opinions using a chat function, and this may have enhanced the understanding of communication skills of students who participated in the lectures. Students have been reported to have a preference for text interactions, which can be enabled by chat functions that allow students to ask questions during online lectures, and thus this can be used as a new educational strategy [30]. In particular, Japanese students are not very keen on speaking up and discussing in group lectures, and the chat may have made it easier for these students to express their opinions [31].
However, healthcare communication lectures did not improve students’ actual communication skills as much as they did improve their confidence in communication. Previous studies have suggested that active and practical strategies are essential for improving communication skills, even among healthcare professionals [32]. Moreover, it may be difficult for students to acquire communication skills through an educational program alone, seeing that even communication education that utilizes simulated-patient and role-play activities reportedly has a limited effect on healthcare students’ acquisition of communication skills [33]. Therefore, further consideration should be given to the content of online communication exercises. Additionally, comparative studies with different participants and settings are required to develop educational programs that consider factors such as learning style, age group, and area of expertise.
This study has five limitations. First, this study is merely a quasi-experiment and not a randomized controlled trial. However, it is interesting that the results show that online interactive healthcare communication education, which was conducted under necessity during the COVID-19 pandemic, was as effective as face-to-face education. Second, the possible differences between the two groups could not be adequately established a priori as hypotheses. If a very small effect size should have been detected, the sample size was insufficient and statistical power was low. Third, it compared data from a cross-sectional survey at three time points and did not compare data longitudinally at the three time points. However, the data were collected during educational lectures, and the samples at the three time points were generally homogeneous. Fourth, this was a single-center study, limiting the generalizability of the programs presented and the study findings. Finally, the outcomes were self-assessed and did not indicate objective changes in the comprehension and skills of students regarding healthcare communication.
Conclusions
This study showed that e-learning pre-training activities and the implementation of counseling videos with blank lines improved healthcare college students’ confidence in healthcare communication in online lectures as well as in face-to-face lectures. This study shows that e-learning, pre-learning activities and counseling videos with blank lines improve college students’ confidence in healthcare communication in online lectures as well as in face-to-face lectures. In so doing, this research configures an impressive first step toward the development of online education in the field of healthcare communication. In the future, the content of related online educational programs should be further refined to secure the development of healthcare professionals with good communication skills.
Practical implications
An important implication of our study is that the effectiveness of online communication exercises is not inferior to face-to-face, but rather has additional potential. Communication exercises in pre-graduate education should be used more widely online in the future.
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