The Use of Linguistic Communication Strategies (Hedges and Intensifiers) in Simulated Pharmacy Education Shared Decision-Making

Hedges and intensifiers are linguistic strategies that are used to indicate respect for an individual's face needs, particularly their desire to feel autonomous or part of a social group. This study aimed to investigate the use of such linguistic strategies by pharmacy students and their impact on communication grades in an Objective Structured Clinical Examination (OSCE) focusing on shared decision making and uptake of pharmacists' recommendations by patients and prescribers. An analytical observational retrospective cohort of OSCE videos across poor, average and good grades was conducted. Underpinned by politeness theory and using summative content analysis and statistical analysis, use of hedges and intensifiers were identified, mapped and compared across communication grades. Overall, students used more hedges than intensifiers when interacting with physicians (1253 versus 565) and patients' carers (2026 versus 369). The most common hedges were modal auxiliary verbs (27.5%); whilst the most common intensifiers were high strength adverbs (47%). Students who were marked as good communicators were seen to use less hedges when speaking with carers than physicians (Median 42 versus 29) versus students who were marked with poor communication skills (Median 42 versus 38). Overall, pharmacy students tend to hedge when making recommendations. Students who were marked highly by examiners showed differences in the number of hedges between the two interlocutors, whereas students who were marked as poor communicators used similar language when talking to the patient or the physicians. Study findings provide insight on links between grading and linguistic strategies used and could inform innovative applied linguistic-based communication training programs for students and examiners, which could lead to preparing graduates to utilize linguistic strategies to communicate pharmacist-led recommendations in the workplace.