Monitoring communication with patients: analyzing judgments of satisfaction (JOS).

Medical students struggle to put into practice communication skills learned in medical school. In order to improve our instructional designs, better insight into the cause of this lack of transfer is foundational. We therefore explored students' cognitions by soliciting self-evaluations of their history-taking skills, coined 'judgments of satisfaction (JOSs)'. Our cognitive-psychological approach was guided by Koriat's cue-utilization framework (J Exp Psychol Gen 126:349-370. doi: 10.1037/0096-3445.126.4.349 , 1997) which rests on the assumption that internal and external cues inform learners' metacognitive judgments, which, in turn, steer their actions. Judgments based on unsuitable cues will cause ineffective behavior. Consequently, students are unable to adequately master these skills or properly apply them in similar situations. For the analysis, we had 524 medical undergraduates select scenes they were satisfied or dissatisfied with from their video-recorded simulated-patient encounters and explain why. Twenty transcripts were sampled for directed content analysis. We found that approximately one-third of students' judgments focused on content (JOS-type-a); about half on the quality of the communication skills (JOS-type-b); and about ten percent targeted the appropriateness of the skills harnessed (JOS-type-c). This lack of reflection on appropriateness may explain why students experience problems adapting to new situations. It was primarily high-performance students who formed type-c judgments; poor performers tended to give type-a and type-b judgments. Future research would benefit from the use of our modified version of Koriat's framework in order to further explore how high and poor performing medical students differ in the way they form JOSs during communications skills training.