Is a  change in vocal loudness a first step towards becoming a medical doctor?

Christiane Kiese-Himmel; Wolfgang Himmel; Martin Scherer

doi:10.4414/smw.2012.13534

Original article

Vol. 142 No. 0910 (2012)

Is a change in vocal loudness a first step towards becoming a medical doctor?

Christiane Kiese-Himmel
Wolfgang Himmel
Martin Scherer

DOI: https://doi.org/10.4414/smw.2012.13534
Cite this as:: Swiss Med Wkly. 2012;142:w13534
Published: 26.02.2012

Summary

QUESTIONS UNDER STUDY: Some evidence suggests that a loud voice is a core characteristic of medical professionals. It is unknown whether medical students talk louder than their non-medical peers and, if so, whether they commence their studies with a loud voice, representing a characteristic of admission, or whether sound pressure level changes during education, reflecting model learning.

METHODS: We performed a cross-sectional observation study with 206 students (57% female), stratified in 4 groups (medical and non-medical students as freshmen and fifth-year students). Habitual loudness was defined as a student's sound pressure level, measured with a standardised sound level meter on basis of 2 vocal tasks. The hypothesis was tested in a 2-way analysis of variance, with year of study (first vs. fifth year) and field by study (medicine vs. non-medicine) as main factors.

RESULTS: The sound pressure level of freshmen in medicine was, on average, 64.4 dB (SD 3.0), that of fifth-year medical students was 66.3 dB (3.7). The respective scores of non-medical students were 65.3 (SD 2.7) for freshmen and 64.0 (3.4) for fifth-year students, resulting in a significant interaction between field of study and years of study (F = 12.7; p = 0.0005).

CONCLUSIONS: The findings of this preliminary study present some evidence that medical students, in contrast to their non-medical peers, learn to raise vocal loudness during their education in medical school. Habitual loudness of medical students, as a way to gain professional dominance and a possible risk for hoarseness in later life, deserves more attention.

References

Scherer KR. On the symbolic functions of vocal affect expression. J Lang Soc Psychol. 1988;7(2):79–100.
Scherer KR. Expression of emotion in voice and music. J Voice. 1995;9(3):235–48.
Street RL Jr, Gordon H, Haidet P. Physicians' communication and perceptions of patients: It is how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65(3):586–98.
Teutsch C. Patient-doctor communication. Med Clin North Am. 2007;87(5):1115–45.
Haskard KB, Wiliams SL, DiMatteo R, Heritage J, Rosenthal R. The provider's voice: patient satisfaction and the content-filtered speech of nurses and physicians in primary medical care. J Nonverbal Behav. 2008;32(1):1–20.
Mast MS, Hall JA, Köckner C, Choi E. Physician gender affects how physician nonverbal behaviour is related to patient satisfaction. Med Care. 2008;46(12):1212–8.
Ong LML, De Haes JCJM, Hoos AM, Lammes, FB. Doctor-patient communication: A review of the literature. Soc Sci Med. 1995;40(7):903–18.
Schmid Mast, M. On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns. 2007;67(3):315–8.
Serber, M. Teaching the nonverbal components of assertive training. J Behav Ther Exp Psychiat. 1972;3(3):179–83.
Case J. Clinical management of voice disorders. 4th ed. Austin, TX: Pro-Ed; 2002.
Zraick RI. Marshall W. Smith-Olinde L. Montague JC. The effect of task on determination of habitual loudness. J Voice. 2004;18(2):176–82.
Hollien H, Gelfer MP, Carlson T. Listening preferences for voice types as a function of age. J Commun Disord. 1991;24(2):157–71.
Eisler RM, Miller PM, Hersen M. Components of assertive behavior. J Clin Psychol. 1973;29(3):295–9.
Rose YJ, Tryon WW. Judgements of assertive behaviour as a function of speech loudness, latency, content, gestures, inflection, and sex. Behav Modif. 1979;3(1):112–23.
Harrigan JA, Gramata JF, Lucic KS, Margolis C. It's how you say it: physicians' vocal behavior. Soc Sci Med. 1989;28(1):87–92.
Schmid Mast M, Hall, JA, Cronauer, CK, Cousin G. Perceived dominance in physicians: Are female physicians under scrutiny? Patient Educ Couns. 2011;83(2):174–9.
Cronauer CK, Schmid Mast, M. Gender-specific aspects of the physician-patient interaction. Rehabilitation (Stuttg). 2010;49(5):308–14.
Svec JG, Granqvist S. Guidelines for selecting microphones for human voice production research. Am J Speech Lang Pathol. 2010;19(4):356–68.
LingWAVES, Voice Diagnostic Center. [http://www.wevosys.com/products/lingwaves/lingwaves_voice_diagnostic_center.html] (last accessed 2011/06/01).
Walker GA. Common statistical methods for clinical research. 2nd ed. Cary, NC: SAS Institute, 2002.
Pérez Álvarez JC, Hacki T. Norm-Stimmparameter beim Standardlesetext [Norms for the voice parameters when reading a standard text]. In Aktuelle phoniatrisch-pädaudiologische Aspekte 1999/2000, vol. 7 [Current phoniatric-pedaudiologcal aspects]. Ed. Gross M. Heidelberg: Median; 2000;78–81.
Hafferty FW. The hidden curriculum, ethics, teaching and the structure of medical education. Acad Med. 1994;69(11):861–71.
Hafferty FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998;73(4):403–7.
White CB, Kumagai AK, Ross PT, Fantone JC. A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors. Acad Med. 2009;84(5):597–603.
Peng Y, Zebrowitz LA, Lee HK. The impact of cultural background and cross-cultural experience on impressions of American and Korean male speakers. J Cross Cult Psychol.1993;24(2):203–20.
Del Piccolo L, Mazzi M, Saltini A, Zimmermann C. Inter and intra individual variations in physicians' verbal behaviour during primary care consultations. Soc Sci Med. 2002;55(10):1871–85.
McCoy LA. The power of your vocal image. J Can Dent Assoc. 1996;62(3):231–4.
Bauer S, Tomicic A, Martinez C, Reinoso A, Schäfer A, Peukert A, Frangkouli A. The significance of the voice and voice tone during psychotherapy seen from the patient perspective (in German). Psychoanal Körper. 2010;9(2):27–50.
Brosnan C. Pierre Bourdieu and the theory of medical education. Thinking 'relationally' about medical students and medical curricula. In: Handbook of the Sociology of Medical Education. Eds. Brosnan C, Turner BS. NY: Routledge; 2009;51–68.
Buddeberg-Fischer B, Stamm M. The medical profession and young physicians' lifestyles in flux: challenges for specialty training and health care delivery systems. Swiss Med Wkly. 2010;140:w13134.

How to Cite

1.

Kiese-Himmel C, Himmel W, Scherer M. Is a change in vocal loudness a first step towards becoming a medical doctor?. Swiss Med Wkly [Internet]. 2012 Feb. 26 [cited 2024 Apr. 16];142(0910):w13534. Available from: https://smw.ch/index.php/smw/article/view/1438

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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[1] Scherer KR. On the symbolic functions of vocal affect expression. J Lang Soc Psychol. 1988;7(2):79–100.

[2] Scherer KR. Expression of emotion in voice and music. J Voice. 1995;9(3):235–48.

[3] Street RL Jr, Gordon H, Haidet P. Physicians' communication and perceptions of patients: It is how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65(3):586–98.

[4] Teutsch C. Patient-doctor communication. Med Clin North Am. 2007;87(5):1115–45.

[5] Haskard KB, Wiliams SL, DiMatteo R, Heritage J, Rosenthal R. The provider's voice: patient satisfaction and the content-filtered speech of nurses and physicians in primary medical care. J Nonverbal Behav. 2008;32(1):1–20.

[6] Mast MS, Hall JA, Köckner C, Choi E. Physician gender affects how physician nonverbal behaviour is related to patient satisfaction. Med Care. 2008;46(12):1212–8.

[7] Ong LML, De Haes JCJM, Hoos AM, Lammes, FB. Doctor-patient communication: A review of the literature. Soc Sci Med. 1995;40(7):903–18.

[8] Schmid Mast, M. On the importance of nonverbal communication in the physician-patient interaction. Patient Educ Couns. 2007;67(3):315–8.

[9] Serber, M. Teaching the nonverbal components of assertive training. J Behav Ther Exp Psychiat. 1972;3(3):179–83.

[10] Case J. Clinical management of voice disorders. 4th ed. Austin, TX: Pro-Ed; 2002.

[11] Zraick RI. Marshall W. Smith-Olinde L. Montague JC. The effect of task on determination of habitual loudness. J Voice. 2004;18(2):176–82.

[12] Hollien H, Gelfer MP, Carlson T. Listening preferences for voice types as a function of age. J Commun Disord. 1991;24(2):157–71.

[13] Eisler RM, Miller PM, Hersen M. Components of assertive behavior. J Clin Psychol. 1973;29(3):295–9.

[14] Rose YJ, Tryon WW. Judgements of assertive behaviour as a function of speech loudness, latency, content, gestures, inflection, and sex. Behav Modif. 1979;3(1):112–23.

[15] Harrigan JA, Gramata JF, Lucic KS, Margolis C. It's how you say it: physicians' vocal behavior. Soc Sci Med. 1989;28(1):87–92.

[16] Schmid Mast M, Hall, JA, Cronauer, CK, Cousin G. Perceived dominance in physicians: Are female physicians under scrutiny? Patient Educ Couns. 2011;83(2):174–9.

[17] Cronauer CK, Schmid Mast, M. Gender-specific aspects of the physician-patient interaction. Rehabilitation (Stuttg). 2010;49(5):308–14.

[18] Svec JG, Granqvist S. Guidelines for selecting microphones for human voice production research. Am J Speech Lang Pathol. 2010;19(4):356–68.

[19] LingWAVES, Voice Diagnostic Center. [http://www.wevosys.com/products/lingwaves/lingwaves_voice_diagnostic_center.html] (last accessed 2011/06/01).

[20] Walker GA. Common statistical methods for clinical research. 2nd ed. Cary, NC: SAS Institute, 2002.

[21] Pérez Álvarez JC, Hacki T. Norm-Stimmparameter beim Standardlesetext [Norms for the voice parameters when reading a standard text]. In Aktuelle phoniatrisch-pädaudiologische Aspekte 1999/2000, vol. 7 [Current phoniatric-pedaudiologcal aspects]. Ed. Gross M. Heidelberg: Median; 2000;78–81.

[22] Hafferty FW. The hidden curriculum, ethics, teaching and the structure of medical education. Acad Med. 1994;69(11):861–71.

[23] Hafferty FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998;73(4):403–7.

[24] White CB, Kumagai AK, Ross PT, Fantone JC. A qualitative exploration of how the conflict between the formal and informal curriculum influences student values and behaviors. Acad Med. 2009;84(5):597–603.

[25] Peng Y, Zebrowitz LA, Lee HK. The impact of cultural background and cross-cultural experience on impressions of American and Korean male speakers. J Cross Cult Psychol.1993;24(2):203–20.

[26] Del Piccolo L, Mazzi M, Saltini A, Zimmermann C. Inter and intra individual variations in physicians' verbal behaviour during primary care consultations. Soc Sci Med. 2002;55(10):1871–85.

[27] McCoy LA. The power of your vocal image. J Can Dent Assoc. 1996;62(3):231–4.

[28] Bauer S, Tomicic A, Martinez C, Reinoso A, Schäfer A, Peukert A, Frangkouli A. The significance of the voice and voice tone during psychotherapy seen from the patient perspective (in German). Psychoanal Körper. 2010;9(2):27–50.

[29] Brosnan C. Pierre Bourdieu and the theory of medical education. Thinking 'relationally' about medical students and medical curricula. In: Handbook of the Sociology of Medical Education. Eds. Brosnan C, Turner BS. NY: Routledge; 2009;51–68.

[30] Buddeberg-Fischer B, Stamm M. The medical profession and young physicians' lifestyles in flux: challenges for specialty training and health care delivery systems. Swiss Med Wkly. 2010;140:w13134.