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Response to “Behind the Mask: Emotion Recognition in Healthcare Students”

Dear Editor,

We read with great interest the recent article “Behind the Mask: Emotion Recognition in Healthcare Students” [1], which found an increased number of errors in emotion recognition of masked versus unmasked individuals by healthcare students. We would like to discuss how this aspect has affected our interactions with patients as current medical students and propose ways to develop relevant communication skills.

We agree that recognising certain emotions in masked individuals can be challenging. Importantly, not being able to identify and respond to emotional cues can make it difficult for us to be empathetic, a key component in building rapport [2]. Furthermore, as medical students, we are still learning how to respond to and manage emotions and concerns, particularly during difficult conversations, and therefore need to be able to identify these. Additionally, we use patients’ emotions as a valuable form of feedback on how our communication is perceived. The inability to identify emotions effectively in patients can therefore impede on our ability to develop effective communication skills, impacting our interactions with patients and ultimately our professional development.

We believe that this issue has important implications for clinical training, and therefore agree with the authors that more training on recognising emotions in masked patients would be useful, such as learning how to detect subtleties in upper facial changes. We feel that this should go hand-in-hand with training to detect other non-verbal expressions of emotion, such as posture, tone of voice and gestures, which were not investigated by the authors. Considering the complexities of emotions patients express, which often go beyond the investigated emotions of fear, sadness, happiness and anger; for example, confusion or embarrassment, we believe that more focus should be placed on teaching specific techniques to encourage patients to verbally express and elaborate on their emotions and to develop active listening skills.

Ultimately, being able to recognize and address emotional cues has been shown to improve patient care [3]. As such, it is crucial that medical students develop the necessary skill set to identify emotions in masked patients, which we believe can be achieved with more focused training in medical curricula. We believe that such skills will also be applicable to interactions with other patients, such as those with neurological disorders who are limited in expressing emotions, or those who wear face coverings for religious reasons.

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  1. 1.

    Bani M, Russo S, Ardenghi S, Rampoldi G, Wickline V, Nowicki S, Strepparava M. Behind the mask: emotion recognition in healthcare students. Med Sci Educ. 2021;31(4):1273–7.

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    Blanch-Hartigan D. An effective training to increase accurate recognition of patient emotion cues. Patient Educ Couns. 2012;89(2):274–80.

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    Norfolk T, Birdi K, Walsh D. The role of empathy in establishing rapport in the consultation: a new model. Med Educ. 2007;41(7):690–7.

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Correspondence to Sophie Simmonds.

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Simmonds, S., Haas-Heger, T., Pook, C.J. et al. Response to “Behind the Mask: Emotion Recognition in Healthcare Students”. Med.Sci.Educ. (2021).

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