ASPE Webinar Reflection – Providing Feedback on Paraverbal Behaviors

By Carrie Bohnert

Have you ever experienced a situation with a learner that makes you think, “Something about their performance is off, but I just can’t put my finger on it”?  Where the non-verbal behaviors that are typically measured seem “acceptable” in an encounter, but you have a lingering feeling that something prevented the patient from fully trusting and opening up to this learner?

This fall, Angela Blood, University of Chicago, offered a webinar on the use of principles of paraverbal communication in feedback.  I had heard of paraverbal communication but was unclear on the specific definition of the concept.  This webinar provided a light-bulb, “a-ha” moment for me.

Paraverbal communication identifies the sometimes subtle manner words are spoken rather than focusing on the actual words that are used. This includes powerful qualities of communication such as volume, pitch, rate of speed, tone and inflection.  Paraverbal factors of communication have, perhaps, been under-assessed in our profession as SP educators.  Angela’s webinar gave me the language to identify and describe that “off-ness” that I see in underperforming students.  Immediately, I was able to put to this new information to use.

Like many fellow SP Educators in the US, I am knee-deep in preparing medical students for the Step 2 CS National Board Exam and remediating students who have failed our end-of-third-year OSCE.  When working with a learner who, although sincere, was interpreted by the patient to be condescending, I now had the words to describe the paraverbal characteristics that caused a perception of disconnect by the SP.  I was able to tell one student in particular that the pitch of her voice and the way her cadence rose at the end of a sentence could cause the patient to think that the student was speaking down to her.   We practiced together and I was able to coach the student to say the same words using a lower pitch and avoiding a lifting cadence at the end of each sentence. Those small changes helped the student’s sincerity to come through and the patient was no longer distracted by the student’s pitch and tone.

This information also helped me to address a student with a perceived “bad attitude”: an issue that, I suspect, many of us fear to address because of the potential for defensiveness if handled without tangible evidence.  Of course I avoided the words “bad attitude” with the student, but as a result of my new understanding of paraverbal communication, I was able to talk very concretely about clipped speech, strong vocal emphasis on the beginning of some words, lower than usual pitch of their voice, and strained sound, all of which are behaviors that the student had the ability to change.

Perhaps the most important thing that happened as a result of this webinar is that I saw the need to modify my communication training program for SPs to address these observable paraverbal behaviors.  Before this webinar I lacked the big picture vision of some subtle elements of communication that I can now convey to students and SPs for a more satisfactory finished product for all.  I now have clear ideas about what content to cover in each stage of training.

Even more specifically, I look forward to offering some new ideas, thanks to Angela’s webinar, to my most experienced SPs who are hungry to develop new skills. I encourage all SP educators to explore information on paraverbal skills and think about how this knowledge can benefit the learners in your SP program!