Interested students were given an information sheet and a consent form. In the pre-assessment, subjects viewed fourteen flashed example faces of micro-expressions, consisting of either, disgust, sadness, happiness, contempt, fear, anger or surprise. Subjects were prompted to select one of the seven emotional labels.
On completion of the pre-assessment a score, expressed as percentage correct, was assigned and recorded. The next part of the CD ROM was a training session, where a narrator explained, in a slow-motion video clip, the four pairs of commonly confused emotions, e.
The narrator provided explicit examples of differences and similarities in the regions of the eyes, nose and mouth. The lips are pressed tightly on the right but they're open with tense lips, probably saying something quite unpleasant on the left". Following this was a practice session where subjects labelled 28 facial expressions, and, if incorrect, a still picture was paused for as long as necessary until the subject selected the correct emotional label.
Like in the training section, the review used alternative faces to display four pairs of commonly confused expressions. The post-assessment followed the same procedure as the pre-assessment and again a score was recorded. Finally, participants were invited to provide open comments on any aspect of the METT and it's relation to their training in clinical communication.
Results were investigated for normality. Appropriate statistical tests alpha level set to 0. The OSCE results of the students who volunteered to take part in the study were compared to the rest of the appropriate quartile cohort. When the difference between METT pre and post-assessment results were examined however a difference did emerge between the high and low quartile groups. Means and standard deviations of pre- and post-assessment scores are shown in Table 1.
The highest quartile students improved their ability to identify facial micro-expression after training whilst the lowest quartile students did not Figure 1. Average scores for pre-and post-assessments. Average scores on the pre- and post assessments of the METT for students in the lowest quartile and highest quartile groups. Error bars represent standard errors. Students in both groups saw the relevance of the training. The following quotes were made by participants from the highest and lowest quartile groups respectively:.
In an OSCE station this would come into use with patient-doctor consultation and history taking'. Students however, saw some limitations in it's application, for example this student in the lowest quartile group:.
Especially when in the OSCE or real life I would be getting information from tone of voice and other body language'. In the current study there was no difference between the abilities of students assessed as being either good or poor communicators in the METT baseline measure of perception of facial micro-expression pre-assessment.
This suggests that an inability to recognise facial expressions in patients was not the reason that these students were performing poorly in their communication skills assessments. There are various other potential reasons that communication with patients is ineffective including poor non-verbal communication behaviour from the health professional[ 18 , 19 ], or lack of appropriate verbal responses to cues from the health professional[ 20 , 21 ].
It may even be, as was suggested in the study by Archinard et al, that the facial expression information could be perceived by the health professional but not consciously acted upon[ 22 ]. From this small study it is impossible to determine which areas these students were poorly performing in. The highest quartile students showed a significant improvement in their ability to perceive facial micro-expressions after training whilst the lowest quartile students did not, therefore the METT could be used to improve performance.
Why there was a difference in improvement between the two groups in the current study is not clear, although it could be due to a variety of reasons including the low quartile group; requiring a longer period of training, having greater difficulty in perceiving the differences highlighted in the training, or being poorer at learning or less motivated to improve.
Anxiety, including social anxiety may also impact on attention and learning[ 23 , 24 ]. This study could not be used to determine which of these possible reasons is valid for these students. Understanding why the higher quartile group benefited most is important for the potential to understand which aspects of the training improved their performance but did not impact on the lower quartile group and why this was the case. This could inform targeted training for future medical students.
The students generally commented that they found training interesting and viewed it as useful. This study has several limitations. The METT involves static facial micro-expressions. This may not be directly comparable to the ability to perceive such expressions in real time interactions, indeed this point was raised by one of the students in the study see qualitative results. There are anatomical and physiological differences in brain response when an individual is viewing dynamic facial images compared to static images[ 25 ] and this may affect behavioural responses.
Future work should concentrate on perception of facial expressions in video footage or real interactions. Unfortunately the participation rate was low for this pilot study. More subjects would be required to confirm this effect and explore the link between assessed communication ability and improvement in perception of micro-expressions with training. This pilot study did however show the feasibility of utilising this CD ROM for undergraduate medical student training.
When considering facial expressions alone, Ekman[ 26 ] points out eight kinds to be aware of: from none to sub-visible, momentary, subtle, full, false, referential and mock. Our study was restricted to momentary facial micro-expressions, therefore the ability to perceive other types of expressions was not investigated. Training Programmes Further your knowledge and skills with our range of courses teaching foundation skills up to degree level qualifications.
Name: Please check your surname for any errors. Well, you can. As popularized by the hit TV show Lie to Me, Humintell offers online training to help individuals recognize micro and subtle expressions. Microexpressions and subtle expressions are the scientifically documented concealed signs of emotion, which people elicit in high stakes situations when they have something substantial to lose or gain.
Years of research has shown that emotion recognition training can enhance and strengthen your ability to detect when someone is lying, recognize how other people feel and help you see the impact your behavior has on others.
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