Advancing Politeness and Assertive Communication Through Tone of Voice in Crisis Team Situations: Pre-Post Acoustic Analysis Study of Team and Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) Virtual Simulation for Interprofessional Education in Health Care Undergraduate Students

Abstract

Background:Effective interprofessional communication, including politeness, respect for coworkers, and self-control, is crucial in emergency care. These values are emphasized by both Thai and US cultures. Notably, nurses place greater significance on respect and self-control than physicians, underscoring the need for physicians to recognize and adopt these attributes, especially in interactions with nursing staff. To develop these competencies, interprofessional education (IPE) programs are essential, with simulation-based IPE, particularly virtual simulations, showing promise in enhancing teamwork and communication. However, research on the tone of voice in emergency communication is limited, especially in Thailand, where standardized IPE curricula are lacking.

Objective:This study aimed to assess the effectiveness of Team and Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) virtual simulation IPE, using a 3D computer-based or virtual reality (VR) approach, in enhancing interprofessional communication among health care students, focusing on politeness and assertiveness in the tone of voice.

Methods:An experimental design was used with 30 health care students from 5 disciplines, including medical, nursing, medical technology, radiological technology, and pharmacy students. Participants were recorded during pretraining and posttraining TeamSTEPPS sessions. Acoustic analysis focused on 3 cues: duration, intensity, and fundamental frequency (F0). Duration measured the length of utterances, whereas intensity (loudness) and F0 (pitch) were analyzed using parameters, such as maximum, minimum, mean, SD, and range. In total, 5663 utterances were analyzed, providing a dataset for identifying significant shifts in vocal delivery after training. Using the Wilcoxon signed-rank test, these 11 acoustic parameters were extracted and statistically analyzed to compare pre- and posttraining differences.

Results:Significant improvements in the tone of voice were observed. Medical and nursing students exhibited changes in pitch (SD and mean of F0; P<.001) and loudness (mean of intensity, P<.001), suggesting more attentive communication. The increased utterance duration in core team members suggests that they engaged in more elaborate information sharing and verification, critical for patient safety. Medical technology and radiological technology students showed reduced pitch (mean of F0; P<.05 in medical technology students and P<.01 in radiological students) and intensity (mean of intensity; P<.01 in medical technology students), reflecting calmer, more controlled communication. Pharmacy students showed minor changes.

Conclusions:TeamSTEPPS virtual simulation IPE, using a 3D computer-based or VR approach, effectively enhances interprofessional nonverbal communication by improving key acoustic features related to politeness and assertiveness within the Thai culture context. Medical and nursing students showed the most notable gains, whereas quieter more controlled communication styles emerged among the other groups. The results demonstrate the ways in which vocal modulations can reflect role-specific responsibilities and interpersonal sensitivity in clinical interactions. These findings highlight the significance of tailored virtual simulation IPE programs for improving teamwork and patient outcomes across health care disciplines.