verbal communication skills research paper

• Research article
• Open access
• Published: 03 July 2018

Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students

• Daniela Vogel 1 ,
• Marco Meyer 1 &
• Sigrid Harendza 1  

BMC Medical Education volume  18 , Article number:  157 ( 2018 ) Cite this article

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Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender.

During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses.

Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain ( p  < 0.05), while male students started the conversations significantly more often with an open question ( p  < 0.05) and interrupted the patients significantly later in two cases than female students ( p  < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain ( p  < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases ( p  < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases ( p  < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain ( p  < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy.

Conclusions

Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students’ awareness for the different aspects of communication and their interaction.

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Verbal as well as non-verbal communication and empathy play an important role in patient-physician encounters. Affiliative styles of communication were shown to be positively related to patients’ satisfaction with a physician while a negative association of patients’ satisfaction with a physician correlated with dominant/active communication styles [ 1 , 2 ]. An affiliative style of communication reduced patients’ anxiety and facilitated their openness whereas a dominant/active communication style displayed reprimanding or condescending features, which resulted in reduced patient disclosure and compliance [ 1 ]. A physician’s communication style seems to be very important for the first encounter with a new patient, because patients build their first impression of a physician by a strong focus on his or her communication style [ 1 ]. Furthermore, patients’ outcomes are congruently associated with their feelings about aspects of communication after the consultation with a physician [ 3 , 4 , 5 ]. In patient-physician communication, a patient-centred approach is crucial which includes five aspects: a biopsychosocial perspective, the ‘patient-as-person’, sharing power and responsibility, therapeutic alliance, and ‘doctor-as-person’ [ 6 ].

Communication in medical encounters comprises verbal and non-verbal aspects. If these forms of communication are inconsistent or contradictory, the non-verbal messages tend to override the verbal messages [ 7 ]. Mehrabian and Ferris even developed a formula for verbal and non-verbal effects of a message: total impact = .07 verbal + .38 vocal + .55 facial [ 8 ]. For patient-physician encounters, important non-verbal signs by a physician, which influence a patient’s disclosure of history details in a consultation are eye contact, posture, the tone of voice, head nods, gesture, and the postural position [ 9 , 10 , 11 , 12 ]. Relationships could be detected between some of these non-verbal signs, patients’ satisfaction [ 13 , 14 ], physicians’ workload [ 15 ], physicians’ malpractice claim history [ 10 ], patients’ recall of medical information, and compliance with keeping appointments and medical regimens [ 7 , 16 , 17 ]. Furthermore, the position of the patients facing forward to the physician in a 45-degree angle was the best regarding the frequency of eye contact [ 18 ]. Several studies reported a correlation between using records like computer or paper and the loss of eye contact while making notes. This lead to a reduced frequency of asking about psychosocial aspects in a patient’s medical history, a reduced response to emotional aspects provided by the patients, and to a reduced disclosure of history details by the patients [ 19 , 20 , 21 , 22 , 23 ].

Physicians who express empathy in patient encounters by acting in a warm, friendly and reassuring way seem to be more effective in reaching patients’ satisfaction and recovering [ 24 ]. Empathy is of great significance for better healthcare outcomes as part of a warm and friendly communication style [ 25 , 26 , 27 , 28 ]. Communication trainings are an effective teaching method to improve technical communication skills as well as empathy as a communication skill [ 29 , 30 ]. However, the focus of communication trainings for undergraduate medical students is often on particular aspects of communication, e.g. informed consent or breaking bad news [ 31 , 32 ]. Whether medical students are able to pay attention to all aspects of adequate and patient-centred communication in complex situations they will encounter in their future workplace is not known. Furthermore, gender has been reported to have an effect on patient-physician communication. Female physicians showed greater engagement in patient-centered communication and their consultation times were longer [ 33 , 34 ]. On the Jefferson Scale of Physician Empathy, female medical students scored significantly higher than male medical students [ 35 ]. The aim of our study was to analyze, whether and how well final year undergraduate medical students use skills of verbal and non-verbal communication during history taking and whether a correlation can be found with the empathy shown towards a standardized patient as observed by an external rater and with gender.

Until 2012, the undergraduate medical curriculum at the medical faculty of Hamburg consisted of two pre-clinical years, three clinical years, and a sixths practice year [ 36 ]. During the two pre-clinical years, history taking is taught in seminars with a focus on verbal communication skills and history taking techniques. In the three clinical years, which were organized in six thematic blocks, verbal and nonverbal history taking skills are practiced in bedside teaching courses on the hospital wards in the different medical disciplines. Seminars with standardized patients were scheduled in the thematic block “psycho-social medicine”, with a particular focus on empathetic communication including feedback by the actors.

In July 2011, 30 undergraduate medical students near graduation from the medical faculty of Hamburg University participated in a performance assessment resembling the first day of a beginning resident in hospital called UHTRUST (Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test), which had been developed in a cooperation between the universities of Utrecht and Hamburg [ 37 ]. This assessment consisted per student of five 10-min consultations for history taking with standardized patients, followed by 3 hours where participants could gather further information and also interacted with nurses and other staff, and ended with a report to the individual supervisor about the five patients (30 min). All 150 patient interviews were videotaped and the content of the patient cases is described in further details elsewhere [ 38 , 39 ]. In brief, the contents for the five different cases are: Case 1: coeliac disease (the mother of a 5-year-old girl describing the girls fatigue and abdominal pain), case 2: granulomatous polyangiitis (a 53-year-old missionary from Africa visiting his sister in Germany, complaining of hemoptysis and weakness), case 3: perforated sigmoid diverticulitis (a 58-year-old woman presenting with abdominal pain), case 4: myasthenia gravis (a 65-year-old female with difficulties to speak and to swallow who is accompanied by her husband), case 5: varicella zoster infection (a 36-year-old male under immunosuppressive therapy for rheumatoid arthritis and complaining of fever). The medical scenarios were developed by medical experts from the universities of Utrecht and Hamburg based on certain facets of competences as described earlier [ 37 ].

For the observation of the videos, three different instruments were used. Empathy was rated with the German version of the so-called CARE (Consultation and Relational Empathy) questionnaire [ 40 ]. The questionnaire was developed originally for assessment of physicians’ empathy by patients and contains 10 items, which have to be rated on a 5-point Likert scale (1: “I totally disagree” to 5: “I totally agree”). We used it in our study for external rating of empathy with only eight items because two items refer to therapy, which is not applicable in our setting of mere history taking. For verbal communication, six aspects have been adapted from the literature and were combined in a newly designed observation form: “uses suitable language” [ 41 ], “keeps the conversation running” [ 42 ], and “summarizes what has been said” [ 42 ], which were rated on a 3-point Likert scale (0: “does not apply”, 1: “applies partly”, 2: “applies fully”). For these aspects, a maximum score of 6 could be reached per patient case. Two further aspects, “opens the conversation with an open question” and “closes the conversation with an open question” were adapted from Sennekamp et al. [ 43 ] and answered dichotomously. Furthermore, the number of W-questions (what, when, why etc.) was counted per patient interview. For nonverbal communication, five aspects were combined in a new observation form: adequate body posture, appropriate facial expressions, eye contact, and appropriate tone of voice [ 18 , 42 , 43 ] were rated on a 3-point Likert scale (0: “not shown”, 1: “partially shown”, 2: “completely shown”). If all components were complete shown, a maximum value of 8 points per scenario could be reached. Additionally, the time between the end of the first question of the participant to the first interruption during the patient’s answer was measured.

All rating forms were piloted. Two raters rated 15 patient interviews (in each case five interviews of three patients) independently. The limit of acceptable difference was defined in the following way: two points for the non-verbal form and one point for the verbal form. Difference in agreements were 1.5 for the non-verbal and 1.2 for the verbal form. Hence, no further revision was necessary. The CARE questionnaire was piloted with ten patient interviews (five interviews of two patients) by two independent raters (MM, a physician, and DV, an educationalist). A maximum difference of eight points for the total score was defined as acceptable. After repeated discussion of the rating aspects, an acceptable agreement was reached. The videos were watched once for each questionnaire, i.e. three times in total. One-way ANOVA as well as t-tests and bivariate correlations were used for statistical analyses.

Of the 30 participating final year students, 22 were female and eight were male. This resulted in 150 patient interviews altogether with 110 patient histories taken by female students and 40 histories taken by male students. Fifty percent of the students were between 24 and 25 years old, 46.7% were between 26 and 30 years old, and one student was 36 years old. All students were in the final year of their undergraduate medical curriculum lasting 6 years in total.

All students showed the highest verbal competence in case 4 (woman with difficulties to speak and swallow, accompanied by her husband) (Table  1 ). Female students were rated significant higher for their verbal communication over all cases ( p  < 0.05) and particularly in case 3 (woman with abdominal pain) than male students ( p  < 0.05). All students asked the highest number of W-questions in case 3 (Table  2 ). This number was significantly different versus case 2 ( p  < 0.05) and case 4 ( p  < 0.01). Significant gender differences could not be found.

Students interrupted the patient in case 3, compared to all other cases, significantly earlier, already after 7.5 ± 6.4 s, while they interrupted the patient in case 2 latest after 32.7 ± 22.0 s (Table  3 ). Male students interrupted the patients over all cases significantly later than female students ( p  < 0.05), particularly in case 1 ( p  < 0.01), case 2 ( p  < 0.05), and case 5 ( p  < 0.05). About 65% of the students started the interview with an open question, 87.5% of the male and 56.4% of the female students, which shows a significant gender difference of p  < 0.05. This difference is also found for the first, fourth and fifth case ( p  < 0.01; p  < 0.01; p  < 0.05). The interview of case 5 was started significantly more frequently with an open question than the interview of the second case ( p  < 0.05). Only one third of the students closed the interview with an open question (32.7% of the female students versus 30.0% of the male students). The interview of case 1 was closed significantly more frequently with an open question (46.7%) than the interview of case 4 (23.3%, p  < 0.05). With respect to non-verbal communication (Table  4 ), female students displayed significantly more signs of non-verbal communication over all cases ( p  < 0.01), particularly in case 3 ( p  < 0.05) and 4 ( p  < 0.01) than male students did.

With respect to empathy, no differences were found for all participants between the five cases (Table  5 ). For case 3, female students were rated by an external rater to be more empathetic than male students ( p  < 0.05). Overall verbal communication correlated significantly with non-verbal communication ( p  < 0.01; r  = .524) but not with empathy. Empathy correlated significantly with non-verbal communication ( p  < 0.01; r  = .371).

The objective of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy. We found a significant correlation between verbal and non-verbal communication in our study. This could be interpreted as a sign for congruent communication, which is important for the interpersonal relationship [ 44 ]. This study also showed that inconsistent messages were associated with greater interpersonal distances, which might hamper the patient-physician relationship. The significant correlation of empathy with non-verbal communication but not with verbal communication supports the finding that physician involvement was associated with higher patient ratings of empathy and satisfaction [ 45 ]. Gaze and body orientation, two aspects of non-verbal communication, which were part of our observation scale, have been demonstrated to be important links to the perception of clinical empathy [ 46 ]. Furthermore, our findings support the idea, that non-verbal behaviour might be more important than verbal messages in the communication of empathy [ 47 ] and serves as the primary vehicle for expressing emotions [ 45 ].

Participants reached the highest scores for verbal and non-verbal communication skills with case 4, the female patient with difficulties to speak and swallow whom her husband accompanied. The fact that the patient’s speech was slurred and that a relative accompanied her might have drawn the students’ attention to particularly careful communication. From patients with aphasia it is known, that family members want physicians to try to communicate with the patient [ 48 ]. Whether students behaved in this manner instinctively or whether they were encouraged to behave in this way by training cannot be distinguished. With respect to gender differences, female students reached significantly higher scores than male students for verbal and non-verbal communication skills over all cases and in case 3, the woman with abdominal pain, and they received significantly higher scores for empathy in case 3. For communicating error disclosures, it is known that female physicians smiled more and were more attentive than male physicians were [ 49 ]. This might also be the case in our patient scenario with a female patient who was brought to the consulting room in a wheelchair because of severe abdominal pain. Another study reports empirical evidence for more signs of non-verbal and verbal ways of communication in female physicians including smiling, disclosing information about themselves, and encouraging and facilitating others to talk more freely [ 50 ]. The higher ratings for empathy are in line with another study, which showed that female students were more patient-centred than male students [ 51 ]. Furthermore, students in this study were more attuned to the concerns of patients of their own gender [ 51 ], which also might be the case with the patient in case 3.

The patient in case 3 was interrupted most frequently after the shortest interval from the start of the conversation and the highest number of W-questions was asked. Furthermore, in case 3 students have been shown to have asked significantly more questions about medical details than in any other case [ 38 ]. Case 3 covers the symptom abdominal pain, which is taught repeatedly in our 6-year undergraduate medical curriculum [ 36 ] and W-questions are important to distinguish differential diagnoses [ 52 ]. Our results might demonstrate, that students have studied the workup of patients with abdominal pain well. However, female students were found to interrupt patients significantly earlier than male students over all cases. With respect to interrupting a conversation, the important finding in the literature is that the quality of the interruption needs to be distinguished as there is a cooperative and an intrusive way of interrupting [ 53 ]. In physician-patient interviews, female patients exhibited cooperative interruptions more frequently than male patients [ 54 ]. Whether this might be the case for the female students in our study and account for the higher frequency of interruptions by female students requires further investigation. In general, female as well as male students in our study interrupted patients less frequently – except for that patient in case 3 – than primary care physicians who interrupted their patients on average after 12 s [ 44 ].

The medical students in our study show a decline of empathy during their undergraduate medical education [ 55 ]. Unfortunately, this is in line with observations of other groups in undergraduate [ 56 ] and postgraduate [ 57 ] medical students. As potential reasons for the decline of empathy, the hidden curriculum [ 57 ] as well as a lack of role models, high learning-volume, time pressure, hierarchy, cynicism, bureaucracy, and an atrophy of idealism during students’ socialization are given [ 56 ]. Positive role models and communication skills trainings with continuous student supervision with reflections and constructive feedback, which has been shown to have a positive influence on students’ performance, might help to prevent the decrease of empathy [ 55 ].

Strengths and weaknesses of this study

A strength of our study is the special format of a validated competency based assessment [ 37 ] with video material of 150 student-patient encounters. One weakness of this project is that only the CARE questionnaire is a validated instrument while the observation forms for signs of verbal and non-verbal communication were designed using aspects from the literature. Another weakness of our study is the large difference in numbers between male and female participants even though it resembles roughly the actual percentage of 60% female medical students in our cohorts. Another strength of this project is the external rating of the patient interviews with the CARE questionnaire, which is independent of the personal perception of empathy by the simulated patients. An additional weakness is the fact that the participant-patient encounters were only filmed with one camera, which does not allow for a very differentiated analysis of the facial mimic of participant and patient. Furthermore, the camera was visible and could have influenced the participants and the standardized patients in their reactions. However, a strength is that a similar format of videotaping is used in our communication course, which allows differentiated video feedback to the participants.

In conclusion, undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects and empathy in a competency-based assessment. While their verbal communication correlated significantly with their non-verbal communication but not with their empathy, their empathy correlated significantly with their non-verbal communication. Female students interrupted the simulated patients earlier than male students but showed in several cases significantly more signs of non-verbal communication. Since verbal and non-verbal aspects of communication are known to have an important impact on the physician-patient-encounter, the differences in communicatory aspects measured in our study suggest explicit teaching of verbal and non-verbal aspects of communication in communication classes during undergraduate training. Assessing different aspects of communication under simulated circumstances could be an important means for giving feedback to the students.

Abbreviations

Consultation and Relational Empathy Questionnaire

Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test

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We would like to thank all students who participated in this study.

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Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246, Hamburg, Germany

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DV and SH designed the study. MM coordinated the study and the data acquisition. DV and MM performed the statistical analyses and interpreted the results with SH. DV and SH drafted the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sigrid Harendza .

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The study was performed in accordance with the Declaration of Helsinki and Ethics Committee of the Chamber of Physicians approval (PV3649). Participation was voluntary, anonymized and with written consent.

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Vogel, D., Meyer, M. & Harendza, S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med Educ 18 , 157 (2018). https://doi.org/10.1186/s12909-018-1260-9

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Received : 03 January 2018

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Published : 03 July 2018

DOI : https://doi.org/10.1186/s12909-018-1260-9

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Verbal communication: an Introduction

Related Papers

Barry Smith

New Paradigm in Business and Education

Shadma I Rahmatullah

Language as a conceptual aspect acts as a medium between the individuals and the community. This chapter is directed at the linguistic aspect in the process of communication assisted by some qualitative research reviews and the researchers' conventional perspectives on the role of language in the context of communication. With the prevailing assumption that the linguistic framework is the one significant aspect of the verbal communication process apart from the cultural and ethnic background of people, that too reflects in the communicative practices. Human communication is full of complexities due to misinterpretation and misunderstanding between the communicators. The contemplation over the role of language in communication is acknowledging the amount of information, supported by the coherent articulation of speech. The adaptation of language relies upon the circumstances and finds its variation in contexts of distinct situations. The use of words, the intonation of speech, the facial expression, the body language of an individual, and the social-cultural environment, altogether help form productive communication.

Intercultural Pragmatics

Keith Allan

This essay begins by identifying what communication is and what linguistics is in order to establish the relationship between them. The characterization of linguistics leads to discussion of the nature of language and of the relationship between a theory of language, i. e., linguistic theory, and the object language it models. This, in turn, leads to a review of speculations on the origins of human language with a view to identifying the motivation for its creation and its primary function. After considering a host of data, it becomes clear that, contrary to some approaches, the primary function of human language is to function as a vehicle of communication. Thus, linguistics studies what for humans is their primary vehicle of communication.

Linguistic Intuitions

Steven Gross

Linguistic intuitions are a central source of evidence across a variety of linguistic domains. They have also long been a source of controversy. This chapter aims to illuminate the etiology and evidential status of at least some linguistic intuitions by relating them to error signals of the sort posited by accounts of online monitoring of speech production and comprehension. The suggestion is framed as a novel reply to Michael Devitt’s claim that linguistic intuitions are theory-laden “central systems” responses rather than endorsed outputs of a modularized language faculty (the “Voice of Competence”). Along the way, it is argued that linguistic intuitions may not constitute a natural kind with a common etiology and that, for a range of cases, the process by which the intuitions used in linguistics are generated amounts to little more than comprehension.

Patrick Hanks

Adisa Imamovic

Australian Journal of Linguistics (Vol.29, pp.1-10)

Michael Haugh

Deirdre Wilson

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Speech Acts as a Variety of Verbal Communication

Real-time price discovery via verbal communication: method and application to fedspeak, patients’ and physicians’ experiences with remote consultations in primary care, during the covid-19 pandemic: a multi-method rapid review of the literature..

BackgroundDuring the COVID-19 pandemic, many countries implemented remote consultations in primary care to protect patients and staff from infection.AimThe aim of this review was to synthesise the literature exploring patients’ and physicians’ experiences with remote consultations in primary care, during the pandemic, with the further aim of informing their future delivery.Design & settingRapid literature review.MethodWe searched PubMed and PsychInfo for studies that explored patients’ and physicians’ experiences with remote consultations in primary care. To determine the eligibility of studies, we reviewed their titles and abstracts, prior to the full paper. We then extracted qualitative and quantitative data from those that were eligible, and synthesised the data using thematic and descriptive synthesis.ResultsA total of twenty-four studies were eligible for inclusion in the review. Most were performed in the United States of America (n=7, 29%) or Europe (n=7, 29%). Patient and physician experiences were categorised into perceived ‘advantages’ and ‘issues’. Key advantages experienced by patients and physicians included: ‘Reduced risk of COVID-19’ and ‘Increased convenience’, while key issues included: ‘a lack of confidence in / access to required technology’ and a ‘loss of non-verbal communication’, which exacerbated clinical decision making.ConclusionThis review identified a number of advantages and issues experienced by patients and physicians using remote consultations in primary care. The results suggest that, while remote consultations are more convenient, and protect patients and staff against COVID-19, they result in the loss of valuable non-verbal communication, and are not accessible to all.

Phonological Characteristics Shared By Questioner And Responder: A Comparison Between Individuals With And Without Autism Spectrum Disorder

How typically developed (TD) persons modulate their speech rhythm while talking to individuals with autism spectrum disorder (ASD) remains unclear. We aimed to elucidate the characteristics of phonological hierarchy in the verbal communication between ASD individuals and TD persons. TD and ASD respondents were asked by a TD questioner to share their recent experiences on 12 topics. We included 87 samples of ASD-directed speech (from TD questioner to ASD respondent), 72 of TD-directed speech (from TD questioner to TD respondent), 74 of ASD speech (from ASD respondent to TD questioner), and 55 of TD speech (from TD respondent to TD questioner). We analysed the amplitude modulation structures of speech waveforms using probabilistic amplitude demodulation based on Bayesian inference and found similarities between ASD speech and ASD-directed speech and between TD speech and TD-directed speech. Prosody and the interactions between prosodic, syllabic, and phonetic rhythms were significantly weaker in ASD-directed and ASD speech than those in TD-directed and TD speech, respectively. ASD speech showed weaker dynamic processing from higher to lower phonological bands (e.g. from prosody to syllable) than TD speech. The results indicate that TD individuals may spontaneously adapt their phonological characteristics to those of ASD speech.

RELATIONSHIP BETWEEN VERBAL AND NON-VERBAL COMMUNICATION OF NURSES WITH COMMUNICATION BARRIERS TO FAMILIES OF PRE-SURGERY PATIENTS IN THE INTENSIVE CARE ROOM AT THE ACEH GENERAL HOSPITAL IN 2020

Background: The nurse's verbal and non-verbal communication greatly affects the readiness of the patient and the patient's family to undergo surgery. Unclear communication causes misperceptions and the emergence of communication barriers in the nurse-client interaction process. The limited time and information provided are the causes of communication barriers in the client care process. This of course greatly affects patient care, especially in conditions that require intensive care. Methods: This study aims to determine the relationship between verbal and non-verbal communication between nurses and perceptions of communication barriers in families of pre-surgery patients in the intensive care unit, with a correlation design using a Cross Sectional study approach. The number of samples was 95 families of preoperative patients in the intensive care unit using purposive sampling technique. Results: 51.6% of nurses' verbal communication was good, and 50.5% of nurses' nonverbal communication was good, and there were no communication barriers between nurses and patients' families (54.7%). There was a significant relationship between nurses' verbal communication with perceptions of family communication barriers in pre-surgery patients in the intensive room (P=0.001) and there was a correlation between nurses' nonverbal communication with perceptions of family communication barriers in pre- surgery patients in the intensive room (P=0.002). Recommendation: Nurses are expected to continue to communicate effectively verbal and non-verbal with patients and families to prevent barriers in communication

Non-verbal communication online

Verbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two danish hospices.

AbstractDenmark is considered one of the World’s most secular societies, and spiritual matters are rarely verbalized in public. Patients report that their spiritual needs are not cared for sufficiently. For studying spiritual care and communication, twelve patients admitted to two Danish hospices were interviewed. Verbal and non-verbal communication between patients and healthcare professionals were identified and analysed. Methodically, the Interpretative Phenomenological Analysis was used, and the findings were discussed through the lenses of existential psychology as well as philosophy and theory of caring sciences. Three themes were identified: 1. When death becomes present, 2. Direction of the initiative, and 3. Bodily presence and non-verbal communication. The encounter between patient and healthcare professional is greatly influenced by sensing, decoding, and interpretation. A perceived connection between the patient and the healthcare professional is of great importance as to how the patient experiences the relationship with the healthcare professional.The patient’s perception and the patient’s bodily experience of the healthcare professional are crucial to whether the patient opens up to the healthcare professional about thoughts and needs of a spiritual nature and initiates a conversation hereabout. In this way we found three dynamically connected movements toward spiritual care: 1. From secular to spiritual aspects of care 2. From bodily, sensory to verbal aspects of spiritual care and 3. From biomedical to spiritual communication and care. Thus, the non-verbal dimension becomes a prerequisite for the verbal dimension of spiritual communication to develop and unfold. The behaviour of the healthcare professionals, characterised by the way they move physically and the way they touch the patient, was found to be just as important as verbal conversation when it comes to spiritual care. The healthcare professional can create a connection to the patient through bodily and relational presence. Furthermore, the healthcare professionals should let their sensing and impressions guide them when meeting the patient in dialog about matters of a spiritual nature. Their perception of the patient and non-verbal communication are a prerequisite for being able to meet patient’s spiritual needs with care and verbal communication.

Verbal and Non-verbal Communication

Being present: is it the most important communication skill.

The COVID-19 pandemic has made people rely on the presence of the internet to run their business. Businesses, schools, retail, religious gatherings, and other components are all required to use an internet platform in some way. People can meet face-to-face and the feature of the contact is reinforced by both verbal and non-verbal communication prior to the viral eruption, making conversation much easier. The goal of this study is to emphasize the importance of being present during the COVID-19 Pandemic as well as the future projection of presence post-pandemic. Being present, as before the pandemic, comes effortlessly without conscious reflection because the interaction takes place offline without any restrictions. The result from this research that being present is the most crucial communication skill; it is the foundation of communication and can aid in more effective engagement on all levels (perception, comprehension, reasoning, memory, and production).

Communications Patterns in The Traditional Market “Pasar Sari Mulia” Kapuas City

Abstrak: Penelitian ini membahas tentang investigasi pola komunikasi di pasar tradisional “Pasar Sari Mulia” di Kota Kapuas. Masalah utama dalam penelitian ini adalah pola komunikasi yang digunakan di pasar tradisional. Selain itu, penelitian ini juga menemukan tentang bagaimana komunikasi nonverbal pembeli dan penjual di pasar tradisional. Dengan menggunakan pendekatan kualitatif dan data dianalisis tentang pengaruh budaya suatu bahasa dan bagaimana bahasa itu sendiri akan membentuk suatu budaya dalam suatu domain. Data diperoleh dari observasi dan menggunakan studi kepustakaan. Hasil penelitian menunjukkan bahwa bahasa Banjar merupakan bahasa yang umum digunakan di pasar tradisional. Alih kode dan kalimat persuasif biasa digunakan dalam melakukan transaksi. Pembeli dan penjual menggunakan pola komunikasi yang unik dan komunikasi non-verbal terutama dalam menarik, proses tawar-menawar dan ekspresi penutupan perdagangan. Namun bagi penjual, komunikasi yang digunakan cenderung membujuk pembeli untuk segera membeli barangnya. Abstract: This research deals with the investigation of communication patterns in the traditional market “Pasar Sari Mulia” in Kapuas City. The major issues in this research were the communication patterns which were used in the traditional market. Besides, this research also found about how are non-verbal communication of buyer and seller in the traditional market. Using qualitative approach and the data were analyzed about culture influences a language and how language itself will make a culture in a domain. The data were gotten from observation and used library research. The results showed that the Banjarese language was a common language which was used in the traditional market. Code switching and persuasive sentence were commonly used in doing transaction. The buyers and sellers used unique communication patterns and non-verbal communication especially in attracting, bargaining process and closing expression of trading. However, for the sellers, the communication used tends to persuade buyers to immediately buy their goods.

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Verbal Communication

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• Copyright year: 2016
• Audience: Institutes, libraries, undergraduate and postgraduate students as well as scholars and everyone interested in the whole area of communication studies as well as people interested in nonverbal communication and behaviour such as lingustists, psychologists, communication scientists and journalists.
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• Keywords: Verbal Communication ; Pragmatics ; Discourse Analysis
• Published: March 7, 2016
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Developing Effective Communication Skills

A practicing oncologist likely uses just about every medium to communicate. They talk on the phone, send e-mail messages, converse one-on-one, participate in meetings, and give verbal and written orders. And they communicate with many audiences—patients and their families, referring physicians, and office staff.

But are you communicating effectively? How do you handle differing or challenging perspectives? Are you hesitant to disagree with others, especially those in authority? Do you find meetings are a waste of time? What impression does your communication style make on the members of your group?

Be an Active Listener

The starting place for effective communication is effective listening. “Active listening is listening with all of one's senses,” says physician communication expert Kenneth H. Cohn, MD, MBA, FACS. “It's listening with one's eyes as well as one's years. Only 8% of communication is related to content—the rest pertains to body language and tone of voice.” A practicing surgeon as well as a consultant, Cohn is the author of Better Communication for Better Care and Collaborate for Success!

Kenneth H. Cohn, MD, MBA, FACS

Cohn suggests creating a setting in which “listening can be accommodating.” For example, don't have a conversation when one person is standing and one person is sitting—make sure your eyes are at the same level. Eliminate physical barriers, such as a desk, between you and the other party. Acknowledge the speaker with your own body language: lean forward slightly and maintain eye contact. Avoid crossing your arms, which conveys a guarded stance and may suggest arrogance, dislike, or disagreement.

When someone is speaking, put a premium on “being present.” Take a deep breath (or drink some water to keep from speaking) and create a mental and emotional connection between you and the speaker. “This is not a time for multitasking, but to devote all the time to that one person,” Cohn advises. “If you are thinking about the next thing you have to do or, worse, the next thing you plan to say, you aren't actively listening.”

Suspending judgment is also part of active listening, according to Cohn. Encourage the speaker to fully express herself or himself—free of interruption, criticism, or direction. Show your interest by inviting the speaker to say more with expressions such as “Can you tell me more about it?” or “I'd like to hear about that.”

Finally, reflect back to the speaker your understanding of what has been said, and invite elaboration and clarification. Responding is an integral part of active listening and is especially important in situations involving conflict.

In active listening, through both words and nonverbal behavior, you convey these messages to the speaker:

• I understand your problem
• I know how you feel about it
• I am interested in what you are saying
• I am not judging you

Communication Is a Process

Effective communication requires paying attention to an entire process, not just the content of the message. When you are the messenger in this process, you should consider potential barriers at several stages that can keep your intended audience from receiving your message.

Be aware of how your own attitudes, emotions, knowledge, and credibility with the receiver might impede or alter whether and how your message is received. Be aware of your own body language when speaking. Consider the attitudes and knowledge of your intended audience as well. Diversity in age, sex, and ethnicity or race adds to the communication challenges, as do different training backgrounds.

Individuals from different cultures may assign very different meanings to facial expressions, use of space, and, especially, gestures. For example, in some Asian cultures women learn that it is disrespectful to look people in the eye and so they tend to have downcast eyes during a conversation. But in the United States, this body language could be misinterpreted as a lack of interest or a lack of attention.

Choose the right medium for the message you want to communicate. E-mail or phone call? Personal visit? Group discussion at a meeting? Notes in the margin or a typed review? Sometimes more than one medium is appropriate, such as when you give the patient written material to reinforce what you have said, or when you follow-up a telephone conversation with an e-mail beginning, “As we discussed.…”

For one-on-one communication, the setting and timing can be critical to communicating effectively. Is a chat in the corridor OK, or should this be a closed-door discussion? In your office or over lunch? Consider the mindset and milieu of the communication receiver. Defer giving complex information on someone's first day back from vacation or if you are aware of situations that may be anxiety-producing for that individual. Similarly, when calling someone on the phone, ask initially if this is a convenient time to talk. Offer to set a specific time to call back later.

Finally, organize content of the message you want to communicate. Make sure the information you are trying to convey is not too complex or lengthy for either the medium you are using or the audience. Use language appropriate for the audience. With patients, avoid medical jargon.

Be Attuned to Body Language—Your Own and Others

Many nonverbal cues such as laughing, gasping, shoulder shrugging, and scowling have meanings that are well understood in our culture. But the meaning of some of these other more subtle behaviors may not be as well known. 1

Hand movements. Our hands are our most expressive body parts, conveying even more than our faces. In a conversation, moving your hand behind your head usually reflects negative thoughts, feelings, and moods. It may be a sign of uncertainty, conflict, disagreement, frustration, anger, or dislike. Leaning back and clasping both hands behind the neck is often a sign of dominance.

Blank face. Though theoretically expressionless, a blank face sends a strong do not disturb message and is a subtle sign to others to keep a distance. Moreover, many faces have naturally down turned lips and creases of frown lines, making an otherwise blank face appear angry or disapproving.

Smiling. Although a smile may show happiness, it is subject to conscious control. In the United States and other societies, for example, we are taught to smile whether or not we actually feel happy, such as in giving a courteous greeting.

Tilting the head back. Lifting the chin and looking down the nose are used throughout the world as nonverbal signs of superiority, arrogance, and disdain.

Parting the lips. Suddenly parting one's lips signals mild surprise, uncertainty, or unvoiced disagreement.

Lip compression. Pressing the lips together into a thin line may signal the onset of anger, dislike, grief, sadness, or uncertainty.

Build a Team Culture

In oncology, as in most medical practices, much of the work is done by teams. Communication within a team calls for clarifying goals, structuring responsibilities, and giving and receiving credible feedback.

“Physicians in general are at a disadvantage because we haven't been trained in team communication,” says Cohn. He points out that when he was in business school, as much as 30% to 50% of a grade came from team projects. “But how much of my grade in medical school was from team projects? Zero.”

The lack of systematic education about how teams work is the biggest hurdle for physicians in building a team culture, according to Cohn. “We've learned team behaviors from our clinical mentors, who also had no formal team training. The styles we learn most in residency training are ‘command and control’ and the ‘pace setting approach,’ in which the leader doesn't specify what the expectations are, but just expects people to follow his or her example.”

Cohn says that both of those styles limit team cohesion. “Recognizing one's lack of training is the first step [in overcoming the hurdle], then understanding that one can learn these skills. Listening, showing sincere empathy, and being willing to experiment with new leadership styles, such as coaching and developing a shared vision for the future are key.”

Stated goals and team values. An effective team is one in which everyone works toward a common goal. This goal should be clearly articulated. In patient care, of course, the goal is the best patient outcomes. But a team approach is also highly effective in reaching other goals in a physician practice, such as decreasing patient waiting times, recruiting patients for a clinical trial, or developing a community education program. Every member of the team must be committed to the team's goal and objectives.

Effective teams have explicit and appropriate norms, such as when meetings will be held and keeping information confidential. Keep in mind that it takes time for teams to mature and develop a climate of trust and mutual respect. Groups do not progress from forming to performing without going through a storming phase in which team members negotiate assumptions and expectations for behavior. 2

Clear individual expectations. All the team members must be clear about what is expected of them individually and accept their responsibility for achieving the goal. They should also understand the roles of others. Some expectations may relate to their regular job duties; others may be one-time assignments specific to the team goal. Leadership of the team may rotate on the basis of expertise.

Members must have resources available to accomplish their tasks, including time, education and equipment needed to reach the goal. Openly discuss what is required to get the job done and find solutions together as a team.

Empowerment. Everyone on the team should be empowered to work toward the goal in his or her own job, in addition to contributing ideas for the team as a whole. Physicians' instinct and training have geared them to solve problems and give orders—so they often try to have all the answers. But in an effective team, each team member feels ownership in the outcome and has a sense of shared accountability. Cohn notes, “You get a tremendous amount of energy and buy-in when you ask ‘What do you think?’”

Team members must trust each other with important tasks. This requires accepting others for who they are, being creative, and taking prudent risks. Invite team members to indicate areas in which they would like to take initiative. Empower them by giving them the freedom to exercise their own discretion.

Feedback. Providing feedback on performance is a basic tenet of motivation. For some goals, daily or weekly results are wanted, while for others, such as a report of the number of medical records converted to a new system or the average patient waiting times, a monthly report might be appropriate. Decide together as a team what outcomes should be reported and how often.

Positive reinforcement. Team members should encourage one another. Take the lead and set an example by encouraging others when they are down and praising them when they do well. Thank individuals for their contributions, both one on one and with the team as a whole. Celebrate milestones as a way to sustain team communication and cohesion.

Effective E-mail

E-mail has numerous features that make it a wonderful tool for communicating with a team: it is immediate; it is automatically time-stamped; and filing and organizing are easy. (E-mail with patients is a more complex topic and is not addressed herein.)

The e-mail subject line is an especially useful feature that is typically underused. Make it your best friend. Use it like a newspaper headline, to draw the reader in and convey your main point or alert the reader to a deadline. In the examples given below, the person receiving an e-mail headed “HCC” is likely to scroll past it—planning to read it on the weekend. The more helpful subject line alerts the reader to be prepared to discuss the topic at an upcoming meeting:

•      Vague Subject Line: HCC
•      More Helpful Subject Line: HCC Plan to discuss the SHARP trial this Friday—Your comments due December 5 on attached new policies

As with all written communication, the most important aspect to consider is the audience. Consider the knowledge and biases of the person/people you are e-mailing. Where will the reader be when he or she receives your message? How important is your message to the reader?

The purpose of writing is to engage the reader. You want the reader to do something, to know something, or to feel something. Write it in a way that helps the reader. Put the most important information—the purpose of the email—in the first paragraph.

Except among friends who know you well, stay away from sarcasm in e-mail messages. The receiver does not have the benefit of your tone of voice and body language to help interpret your communication. When delivering comments that are even slightly critical, it's better to communicate in person or in a phone call than to do so in an e-mail. Something you wrote with good intentions and an open mind or even with humor can be interpreted as nitpicky, negative, and destructive, and can be forwarded to others.

Because we use e-mail for its speed, it's easy to get in the habit of dashing off a message and hitting the “send” button. We count on the automatic spell-check (and you should have it turned on as your default option) to catch your errors. But spelling typos are the least of the problems in communicating effectively.

Take the time to read through your message. Is it clear? Is it organized? Is it concise? See if there is anything that could be misinterpreted or raises unanswered questions. The very speed with which we dash off e-mail messages makes e-mail the place in which we are most likely to communicate poorly.

Finally, don't forget to supply appropriate contact information, including phone numbers or alternative e-mail addresses, for responses or questions.

Conflict is inevitable in times of rapid change. Effective communication helps one avoid conflict and minimize its adverse consequences when it does occur. The next issue of Strategies for Career Success will cover conflict management.

What Not to Do When Listening:

• Allow distractions
• Use clichéd phrases such as “I know exactly how you feel,” “It's not that bad,” or “You'll feel better tomorrow”
• Get pulled into responding emotionally
• Change the subject or move in a new direction
• Rehearse in your head what you plan to say next
• Give advice

Make Meetings Work for Your Team

A good meeting is one in which team goals are introduced or reinforced and solutions are generated. The first rule—meet in person only if it's the best format to accomplish what you want. You don't need a meeting just to report information. Here are tips for facilitating an effective meeting:

Don't meet just because it's scheduled. If there are no issues to discuss, don't hold the meeting just because it's Tuesday and that's when you always meet.

Use an agenda. Circulate a timed agenda beforehand and append useful background information. Participants should know what to expect. If it's a short meeting or quickly called, put the agenda on a flipchart or board before people arrive.

Structure input. Promote the team culture by making different individuals responsible for specific agenda items. Follow-up on previous task assignments as the first agenda item to hold group members accountable for the team's success.

Limit the meeting time. Use the timed agenda to stay on track. If the discussion goes off on a tangent, bring the group back to the objective of the topic at hand. If it becomes clear that a topic needs more time, delineate the issues and the involved parties and schedule a separate meeting.

Facilitate discussion. Be sure everyone's ideas are heard and that no one dominates the discussion. If two people seem to talk only to each other and not to the group as a whole, invite others to comment. If only two individuals need to pursue a topic, suggest that they continue to work on that topic outside the meeting.

Set ground rules up front. Keep meetings constructive, not a gripe session. Do not issue reprimands, and make it clear that the meeting is to be positive and intended for updates, analysis, problem solving, and decision making. Create an environment in which disagreement and offering alternative perspectives are acceptable. When individuals do offer opposing opinions, facilitate open discussion that focuses on issues and not personalities.

Circulate a meeting summary before the next meeting. Formal minutes are appropriate for some meetings. But in the very least, a brief summary of actions should be prepared. Include decisions reached and assignments made, with deadlines for follow-up at the next meeting.

Kenneth H. Cohn: Better Communication for Better Care: Mastering Physician-Administrator Collaboration. Chicago, IL, Health Administration Press, 2005, www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2038

Kenneth H. Cohn: Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Chicago, IL, Health Administration Press, 2006, www.ache.org/hap.cfm

Suzette Haden Elgin: Genderspeak: Men, Women, and the Gentle Art of Verbal Self-Defense. Hoboken, NJ, Wiley, 1993

Jon R. Katzenbach, Douglas K. Smith: The Wisdom of Teams: Creating the High Performance Organization. New York, NY, Harper Business, 1994

Sharon Lippincott: Meetings: Do's, Don'ts, and Donuts. Pittsburgh, PA, Lighthouse Point Press, 1994

Kenneth W. Thomas: Intrinsic Motivation at Work: Building Energy and Commitment. San Francisco, CA, Berrett-Koehler Publishers, 2000

More Strategies for Career Success!

Deciding About Practice Options—J Oncol Pract 2:187-190, 2006

The Interview: Make it Work for You—J Oncol Pract 2:252-254, 2006

Employment Contracts: What to Look for—J Oncol Pract 2:308-311, 2006

Principles and Tactics of Negotiation—J Oncol Pract 3:102-105, 2007

Professional Advisors: They're Worth It—J Oncol Pract 3:162-166, 2007

Building and Maintaining a Referral Base—J Oncol Pract 3:227-230, 2007

Malpractice Insurance: What You Need to Know—J Oncol Pract 3:274-277, 2007

Joining a Practice As a Shareholder—J Oncol Pract 3:41-44, 2007.

Verbal Linguistic Intelligence and Communication Skills of College of Education Students of Bulacan State University: Inputs to Improved Academic Engagement

16 Pages Posted: 26 Sep 2019

Jovita Villanueva

Bulacan state university, marlon b. santos.

Date Written: September 17, 2019

The study looked into the relationship of verbal linguistics intelligence to the communication skills of students. The study included students of the college of education from various majors and courses. The findings of the study will served as guide to teachers and administrators on what activities may be undertaken by the university to help improve the academic engagements of college students who are having difficulties in communications.

Keywords: verbal-linguistics intelligence, communication skills, academic engagement

JEL Classification: I23

Suggested Citation: Suggested Citation

Jovita Villanueva (Contact Author)

Philippines

Marlon Santos

Bulacan state university ( email ).

Guinhawa Guinahwa Malolos, Bulacan 3000 Philippines

HOME PAGE: http://www. bulsu.edu.ph

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This article is investigating verbal communication research in teaching the English language, its importance, and necessity in daily human life. The article shows how the teacher should help students to improve and develop their verbal communication skills. For this point, there are given some useful and effective techniques with methods in teaching the English language, which we have to use for developing students’ verbal communication skills and speech etiquette. The chosen topic is relevant to the fact that verbal communication and speech etiquette have a key place in a person’s successful life; therefore many researchers and article readers are interested in this topic. Speech etiquette is a component in the linguistic cultural picture of the world, as well as possessions and understanding of speech etiquette depends on the people behavior. Speech etiquette plays a special role in the foreign language study.

English Language , Verbal Communication , Skills , Language Teaching , Speech Etiquette , Learning , Ethics

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1. Introduction

The relationship between language and its meaning is not straight forward (Søren- sen et al., 2019) , one reason for this is the complicated limitlessness of modern language semantics, including English (Wali et al., 2017) . Language is productive in the sense that there is an infinite number of words and phrases. There is no limit to a language’s vocabulary, as new words are introducing daily. Words are not the only things we need to communicate, although they are closely related to verbal and nonverbal (Parikh et al., 2014) symbols in terms of how we make the meaning of language. Every symbol represents some meaning related to a certain activity (Zhirenov et al., 2016) . Symbols can be used for communication verbally, for example, when spelling the word “winter”, in writing it is necessary to put the letters W-I-N-T-E-R together. Communication development is an effective teaching method in improving students technical communication skills as well as empathy (Vogel et al., 2018) .

Verbal communication helps express various needs, and in asking questions, that provide us with specific information. Verbal communication is also used in describing things, events, occasions, people, and ideas, by helping people to inform, persuade, and to take into consideration. In other words, verbal expressions help us to communicate with others in explaining our observations, thoughts, feelings, and needs.

Good communication skills are a self-confidence source, enabling a person to exert more control in their life by obtaining knowledge, research effectively, conceptualize, organize, and present ideas and arguments (Emanuel, 2011) . Verbal communication skills are a necessary tool for prospering in any subject; even learning these skills will take time, better practices can help students to learn quickly and apply knowledge in work. In addition, with improved communication skills, students will have the confidence and knowledge to not only get a good job but to perform well in interviews (Reith-Hall & Montgomery, 2019) . Communication skills are considered as an ability used to give and receive different kinds of information, similarly, in the development of personality throughout human being existence. During this period, communication becomes essential for personal growth, through which communicating people will find themselves, develop self-confidence, and define the relationship with the surrounding environment. The failure in building good communication skills will happen when people do not want to understand other’s opinions, thoughts, ideas, and feelings.

Particularly, there given methods to help students in improving their verbal communication skills and speech etiquette, by the following elements: how to choose words and vocabulary for this or that conversation topic, using key phrases through different dialogues; by watching movies students will be able to understand the language, eye contact, accents; and how to paraphrase and summarize the spoken language, and respond to different types of questions. This article has an actual place in linguistics because important role of verbal communication and speech etiquette in language learning and teaching process. The topic closely connected with methodology, owing to essential methods in teaching verbal com- munication skills and speech etiquette.

2. Communication Skills Importance

For teachers, it is highly important to have enough skills to communicate effectively, because they considered as one of the necessary determinants in teaching and learning success. In addition to transferring knowledge, the word “educate” is supposed to train learners verbal skills to develop themselves, the impact of higher education, the economy and the broader society transformed along time in various ways (Kromydas, 2017) .

In carrying out the learning process, teachers should combine their verbal and nonverbal communication skills; the ability of teachers in applying these types of communication can help improve both, teachers and students impressions in the process of teaching and learning. The teacher is the one who always explains and presents learning material to the class, for this purpose, the teacher should exhibit enough speaking with writing skills. The teacher is required to understand students’ verbal communication and be able to help students improve their verbal communication abilities. Verbal communication skills, either they are oral or written; involve vocabulary, mastering skills in choosing the right words to give meaning to the audience. Verbal abilities also concern with skills to organize the words logically.

More importantly, communication is the manifestation of accurate and open attitudes in information change between learners and students. Communication is closely related to culture (Piller, 2007) . Nevertheless, the culture itself can be a challenge in building interaction that potentially causes misunderstanding. Language problems can be associated with problems of hearing ability and pronunciation, speed, tone, and tune.

3. Developing Students Communication Skills

Participants in this study are teacher and students conducting education process. Students’ and teacher’s good and adequate communication shows their ethical level in the process of learning and teaching the language. Ethics is one of the most important things, which people need daily everywhere. Here we want to emphasize the regulation of ethical communication in foreign language teaching. Ethics is a branch of philosophy and it has been studied for thousands of years by many researchers.

In communication studies, curricula and ethics are often considered as a central place in service-learning courses, community-engaged activity, and communication activism where students come face-to-face with the harsh realities experienced by society. For some students, it may be the first time they witness and interact with people suffering from lack of basic resources, and sufficient educational opportunities, or subject to environmental hazards, to name just a few persistent inequities. These experiences lend themselves to a rich consideration of communication ethics situated at the individual, organizational, and systemic levels to understand how one voice intersects with others to affirm the dignity of all people as well as promoting learning and competence in everyday communication, as well as social changes through a broad and systemic transformation; ethical communication is necessary for social media, also impacting governmental regulation on ethics (Bowen, 2020) .

Competent and skilled communicators are ethical communicators who take responsibility for a message’s creation, impact, and effects in a diverse range of contexts, including mass media, interpersonal, intercultural, professional, and public areas. Stimulating the moral imagination is a key factor that helps students to recognize issues of communication ethics. They learn to weigh their self-interests relative to the self-interest of others, so their communication skills may construct the ethical dimension in the world they live in. In this regard, through the analysis of terminology the term speech etiquette is described in this article. Here we tried to give exact meaning and role of speech etiquette in foreign language learning and teaching.

Speech etiquette is included in the linguistic cultural picture of the world. Possession, understanding and choice of formulas of speech etiquette depends on the people behavior. The choice of speech etiquette formulas is playing a special role in the foreign language study. Without speech etiquette, it is impossible neither to enter the communication, nor to maintain communication, or to complete it. Speech etiquette is a set of requirements to the form, content, order, character and situational relevance of statements adopted in this culture. Speech etiquette, in particular, includes words and expressions used by people to say goodbye, requests, and apologies, accepted in various situations, forms of treatment, intonation features that characterize polite speech, etc. The study of speech etiquette occupies a special position at the junction of linguistics, theory and history of culture, ethnography, country studies, psychology and other humanities (Kereksha, 2019) . On the other hand, speech etiquette can be considered from the point of view of language norm. Thus, the idea of correct, cultural, normalized speech includes certain ideas about the norm in the field of speech etiquette (Ushakov, 2008) .

4. Ways to Obtain Good Communication Skills

There are some characteristics of effective verbal communicators which are very necessary, including active listening, adaptability, adapting one’s communication styles to support the situation, clarity, confidence and assertiveness, constructive feedback to giving and receiving it, emotional intelligence for identifying and managing teacher emotions, as well as students emotions, empathy, interpersonal skills as social skills which are especially useful in building strong arguments, interpretation of language, open-mindedness, patience, simplifying the complex, and storytelling.

The way to obtain a good proficiency in verbal communication is mention attributes concerning both the teacher and learners. Essentially, there are a lot of techniques and tools that teacher can use to improve students’ verbal communication skills ( Figure 1 ).

The useful thing here is to apply technology such as videos and audios, which are playing the most important role nowadays. Additionally, they will be in interesting and effective sense for students and learners.

Figure 1 . Techniques and tools for improving students’ verbal communication skills.

4.1. Watching Films That Model Conversation Skills

The conversation is one of the most basic and essential communication skills. It enables people to share thoughts, opinions, ideas, and receive information. Although it may appear simple on the surface, effective conversations include a give-and-take exchange that consists of elements such as language, eye contact, summarizing, paraphrasing, and responding.

Students can learn the fundamental elements of the conversation by watching films or videos about interactions taking place. The teacher can pause the video and ask questions such as, “What message is the listener sending by crossing his arms? What else can you tell by observing the language expressions in the conversation?”

4.2. Reinforce Active Listening

Communication is not just about speaking, but also about listening. The teacher can help their students to develop listening skills by reading a selection of text, and then having the class discussion and reflect the content by students explanations. Active listening also means listening to understand rather than a reply. Reinforce building good listening skills by encouraging students to practice asking clarifying questions to fully understand the speakers message.

4.3. Offer Group Presentations and Assignments

Team-building exercises can also help students sharpen both oral and written com- munication skills. Not only does it offer students the chance to work in small groups, thereby reducing some of the pressure, but it also allows them to debate their opinions, take turns, and work together towards a common goal.

4.4. Ask Open-Ended Questions

On the occasion where students require more than a one or two-word response, open-ended questions are vital for inspiring discussion and demonstrating that there are multiple ways to perceive and answer a question. A teacher might set a timer for students informal conversations and challenges to use open-ended questions. For example, teacher can show children the difference in how much more information they can obtain by asking, “What did you like best about the song?” rather than simply “Did you like the song?”

4.5. Use Tasks and Activities That Foster Critical Thinking

Another task-based method for improving student communication skills is through critical thinking exercises. These can be done verbally or through written assignments that give students the chance to answer questions creatively using their own words and expressions.

4.6. Offer Reflective Learning Opportunities

Recording students reading selected text or videotaping group presentations is an excellent method for assessing their communication strengths and weaknesses. Students can reflect on their oral performance in small groups. Then, ask each student to analyze the others so that they can get used to receiving constructive criticism. Besides these techniques and methods, there are other activities for improving students verbal communication skills, such as role-playing, which showed effective results from previous experiences.

5. Conclusion

Effective verbal communication skills include more abilities than just speech. Verbal communication encompasses both how to deliver messages and how to receive. Communication is a necessary skill, which is important to every student, teacher, and person, even to workers, who can convey information clearly and effectively to be highly valued by employers. Employees who can interpret messages and act appropriately on the information they receive have a better chance in their job excellence. Without speech etiquette, it is impossible to join and maintain the communication, or to complete it. Speech etiquette considered as a set of requirements to the certain form, content, order, character and situational relevance of statements adopted in this culture.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

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