Associations of Communication Skills, Self-Efficacy on Clinical Performance and Empathy in Trainee Doctors (전공의 의료커뮤니케이션 능력과 진료수행 자기효능감, 공감능력과의 상관관계)
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- Korean Journal of Psychosomatic Medicine
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- v.29 no.1
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- pp.49-57
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- 2021
Objectives : This study evaluated the medical communication skills of trainee doctors and analyzed the relationship between medical communication skills, self-efficacy on clinical performance (SECP) and empathy. Methods : A total of 106 trainee doctors from a university hospital participated. The questionnaire comprised self-evaluated medical communication skills, modified SECP and the Korean version of the Jefferson Scale of Empathy-Health Professionals version. The mean difference in medical communication skills scores according to gender, age, division (intern, internal medicine group or surgery group) and position (intern, first-/second- and third-/fourth-year residents) were analyzed. Pearson correlation coefficients were determined between medical communication skills, modified SECP and empathy. The effects of each variable on medical communication skills were verified using the structural equation model. Results : There were no statistically significant mean differences in self-evaluated medical communication skills according to gender, age, division or position. Medical communication skills had a significant positive correlation with modified SECP (r=0.782, p<0.001) and empathy (r=0.210, p=0.038). Empathy had a direct effect on modified SECP (β=0.30, p<0.01) and modified SECP had a direct effect on medical communication skills (β=0.80, p<0.001). Empathy indirectly influenced medical communication skills, mediating modified SECP (β=0.26, p<0.05). Conclusions : Medical communication skills are an important core curriculum of residency programs, as they have a direct correlation with SECP, which is needed for successful treatment. Moreover, the medical communication needs a new understanding that is out of empathy.
We investigated what factors motivate gamers to participate in a guild and why they continue to be engaged as members of the guild. We find that, based on the result of focus group interviews with MMORPG gamers, social support and self-esteem factors play important roles. Considering both prior research and the focus group interviews we have conducted, we define social support and character control as independent variables. Character identity, guild identity, and self-esteem are proposed as mediating variables while guild flow and game loyalty as dependent variables. Accordingly, we develop the research model and hypotheses, and verify them empirically. Based on our experiences of playing the WoW game, we proposed a research model and conducted focus-group interviews (FGIs). FGIs involve formulating a hypothesis and then collecting some relevant data. FGIs were conducted face-to-face with students of C University in Korea. We formulated structured interview schedules, and the questions were based on our research variables and personal experiences. The questions for the interviews encompassed the following areas: (a) the demographic characteristics of the focus group; (b) the number of years for which respondents had played online games; (c) the motive for starting a game; (d) the number of game-characters assumed by each gamer; (e) the type of game played; and (f) other issues such as the reasons for involvement in the play, the willingness to reuse the game in case new versions were released, etc. On average, it took two hours to interview each of three groups. A primary set of FGIs was conducted with three groups on the premise that there would be some differences caused by character race (Horde vs. Alliance) or by playable server (Normal vs. Combat). With respect to the manner of playing, we found that guild members shared information, felt a sense of belonging, and played computer games for quite a long time through the guild; however, they did not undergo these experiences when playing alone. Gamers who belonged to a specific guild helped other players without expecting compensation for that, freely shared information about the game, gave away items for free, and more generous with other members who made mistakes. The guild members were aware of the existence other members and experienced a sense of belonging through interactions with, and evaluations from, other players. It was clear that social support was shown within the guild and that it played an important role as a major research variable. Based on the results of the first FGIs, a second set of in-depth FGIs was carried out with a focus on the psychology of the individual within the guild and the social community of the guild. The second set of FGIs also focused on the guild's offline meetings. Gamers, over all, recognize the necessity of joining a community, not only off-line but also online world of the guild. They admit that the guild is important for them to easily and conveniently enjoy playing online computer games. The active behavior and positive attitudes of existing guild members can motivate new members of the guild to adapt themselves to the guild environment. They then adopt the same behaviors and attitudes of established guild members. In this manner, the new members of the guild strengthen the bonds with other gamers while feeling a sense of belonging, and developing social identity, thereby. It was discovered that the interaction among guild members and the social support encouraged new gamers to quickly develop a sense of social identity and increase their self-esteem. The guild seemed to play the role of socializing gamers. Sometimes, even in the real world, the guild members helped one another; therefore, the features of the guild also spilled over to the offline environment. We intend to use self-esteem, which was found through the second set of FGIs, as an important research variable. To collect data, an online survey was designed with a questionnaire to be completed by WoW gamers, who belong to a guild. The survey was registered on the best three domestic game-sites: 'WoW playforum,' 'WoW gamemeca,' and 'Wow invent.' The selected items to be measured in the questionnaire were decided based on prior research and data from FGIs. To verify the content of the questionnaire, we carried out a pilot test with the same participants to point out ambiguous questions as a way to ensure maximum accuracy of the survey result. A total of 244 responses were analyzed from the 250 completed questionnaires. The SEM analysis was used to test goodness-of-fit of the model. As a result, we found important results as follows: First, according to the statistics, social support had statistically significant impacts on character control, character identity, guild identity and self-esteem. Second, character control had significant effects on character identity, guild identity and self-esteem. Third, character identity shows its clear impact on self-esteem and game loyalty. Fourth, guild identity affected self-esteem, guild flow and game loyalty. Fifth, self-esteem had a positive influence on the guild flow. These days, the number of virtual community is rising along with its significance largely because of the nature of the online games. Accordingly, this study is designed to clarify the psychological relationship between gamers within the guild that has been generally established by gamers to play online games together. This study focuses on the relationships in which social support influences guild flow or game loyalty through character control, character identity, guild identity, and self-esteem, which are present within a guild in the MMORPG game environment. The study results are as follows. First, the effects of social support on character control, character identity, guild identity and self-esteem are proven to be statistically significant. It was found that character control improves character identity, guild identity and self-esteem. Among the seven variables, social support, which is derived from FGIs, plays an important role in this study. With the active support of other guild members, gamers can improve their ability to develop good characters and to control them. Second, character identity has a positive effect on self-esteem and game loyalty, while guild identity has a significant effect on self-esteem, guild flow and game loyalty. Self-esteem affects guild flow. It was found that the higher the character and guild identities become, the greater the self-esteem is established. Contrary to the findings of prior research, our study results indicate that the relationship between character identity and guild flow is not significant. Rather, it was found that character identity directly affects game players' loyalty. Even though the character identity had no direct effect on increasing guild flow, it has indirectly affected guild flow through self-esteem. The significant relationship between self-esteem and guild flow indicates that gamers achieve flow, i.e., a feeling of pleasure and excitement through social support. Several important implications of this study should be noted. First, both qualitative and quantitative methods were used to conduct this study. Through FGIs, it was observed that both social support and self-esteem are important variables. Second, because guilds had been rarely studied, this research is expected to play an important role in the online community. Third, according to the result, six hypotheses (H1, H5, H6, H7, H8, and H11) setup based on FGIs, were statistically significant; thus, we can suggest the corresponding relationships among the variables as a guideline for follow-up research. Our research is significant as it has following implications: first, the social support of the guild members is important when establishing character control, character identity, guildidentity and self-esteem. It is also a major variable that affects guild flow and game loyalty. Second, character control when improved by social support shows notable influence on the development of character identity, guild identity and self-esteem. Third, character identity and guild identity are major factors to help establish gamers' own self-esteem. Fourth, character identity affects guild flow through self-esteem and game loyalty. The gamers usually express themselves through characters; the higher character identity is, the more loyalty a gamer has. Fifth, guild identity, established within the guild, has clear effects on self-esteem, guild flow and game loyalty. Sixth, qualitative and quantitative methods are employed to conduct this study. Based on the results of focus group interviews and SEM analysis, we find that the social support by guild members and psychological factors are significant in strengthening the flow of guild and loyalty to the game. As such, game developers should provide some extra functions for guild community, through which gamers can play online games in collaboration with one another. Also, we suggest that positive self-esteem which is built up through social support can help gamers achieve higher level of flow and satisfaction, which will consequently contribute to minimizing the possibility for the players to develop negative attitude toward the guild they belong to.
I. Introduction : The purpose of this study is to test empirically hypothetical causality among constructs used in previous studies to build the model of relational market behavior on customers' participation and consumer-brand relationship after introducing theories of relationship marketing, loyalty program, consumer-brand relationship, customers' participation in service marketing as previous studies with regard to relational market behavior, which Bagozzi(1995) and Peterson(1995) commented on constructs and definition suggested by Sheth and Parvatiyar (1995). For this purpose, loyalty program by the service provider, customers' participation and consumer-brand relationship as preceding variables explain relational market behavior defined by Sheth and Parvatiyar(1995). This study proposes that loyalty program as a tool of relationship marketing will be effective in that consumers' participation in marketing relationship results in a narrow range of choice(Sheth and Parvatiyar, 1995) because consumers think that their participation motive result in benefits(Peterson, 1995). Also, it is proposed that the quality of consumer-brand relationship explain the performance of relationship as well as the intermediary effect because the loyalty program could be evaluated based on relationship with customers. We reviewed the variables with regard to performance of relationship based on relation maintain in marketing literature, and then tested our hypotheses related to several performance variables including loyalty and intention of relation maintain based on the previous studies and constructs(Bendapudi and Berry, 1997 ; Bettencourt, 1997 ; Palmatier, Dant, Grewal and Evans, 2006 ; You Jae Yi and Soo Jin Lee, 2006). II. Study Model : Analyses about hypothetical causality were proceeded. The marketing effect of loyalty program on relational market behavior was empirically tested in study regarding a service provider. The research model in according to the path hypotheses (loyalty program
Introduction The purpose of this research is to develop overall model which involves the effect of ongoing support services by franchisor on franchisee's relationship quality(trust, satisfaction, and commitment) and business performance(financial and non-financial performance), and to investigate the relationships among trust, satisfaction, commitment, financial and non-financial performance. This study also suggests franchise business or franchise system should be based on long-term orientation between franchisor and franchisee rather than short-term orientation, or transactional relationship, and proposes the most effective way of providing on-going support services by franchisor with franchisee thru symbiotic relationship among franchisor and franchisee Research Model and Hypothesis The research model as Figure 1 shows the variables on-going support services which affect the relationship quality between franchisor and franchisee such as trust, satisfaction, and commitment, and also analyze the effects of relationship quality on business performance including financial and non-financial performance We established 12 hypotheses to test as follows; Relationship between on-going support services and trust H1: On-going support services factors (product category & price, logistics service, promotion, information providing & problem solving capability, supervisor's support, and education & training support) have positive effect on franchisee's trust. Relationship between on-going support services and satisfaction H2: On-going support services factors (product category & price, logistics service, promotion, information providing & problem solving capability, supervisor's support, and education & training support) have positive effect on franchisee's satisfaction. Relationship between on-going support services and commitment H3: On-going support services factors (product category & price, logistics service, promotion, information providing & problem solving capability, supervisor's support, and education & training support) have positive effect on franchisee's commitment. Relationship among relationship quality: trust, satisfaction, and commitment H4: Franchisee's trust has positive effect on franchisee's satisfaction. H5: Franchisee's trust has positive effect on franchisee's commitment. H6: Franchisee's satisfaction has positive effect on franchisee's commitment. Relationship between relationship quality and business performance H7: Franchisee's trust has positive effect on franchisee's financial performance. H8: Franchisee's trust has positive effect on franchisee's non-financial performance. H9: Franchisee's satisfaction has positive effect on franchisee's financial performance. H10: Franchisee's satisfaction has positive effect on franchisee's non-financial performance. H11: Franchisee's commitment has positive effect on franchisee's financial performance. H12: Franchisee's commitment has positive effect on franchisee's non-financial performance. Method The on-going support services were defined as an organized system of continuous supporting services by franchisor for the purpose of satisfying the expectation of franchisee based on long-term orientation and classified into six constructs such as product category & price, logistics service, promotion, providing information & problem solving capability, supervisor's support, and education & training support. The six constructs were measured agreement using a 7-point Likert-type scale (1 = strongly disagree to 7 = strongly agree)as follows. The product category & price was measured by four items: menu variety, price of food material provided by franchisor, and support for developing new menu. The logistics service was measured by six items: distribution system of franchisor, return policy for provided food materials, timeliness, inventory control level of franchisor, accuracy of order, and flexibility of emergency order. The promotion was measured by five items: differentiated promotion activities, brand image of franchisor, promotion effect such as customer increase, long-term plan of promotion, and micro-marketing concept in promotion. The providing information & problem solving capability was measured by information providing of new products, information of competitors, information of cost reduction, and efforts for solving problems in franchisee's operations. The supervisor's support was measured by supervisor operations, frequency of visiting franchisee, support by data analysis, processing the suggestions by franchisee, diagnosis and solutions for the franchisee's operations, and support for increasing sales in franchisee. Finally, the of education & training support was measured by recipe training by specialist, service training for store people, systemized training program, and tax & human resources support services. Analysis and results The data were analyzed using Amos. Figure 2 and Table 1 present the result of the structural equation model. Implications The results of this research are as follows: Firstly, the factors of product category, information providing and problem solving capacity influence only franchisee's satisfaction and commitment. Secondly, logistic services and supervising factors influence only trust and satisfaction. Thirdly, continuing education and training factors influence only franchisee's trust and commitment. Fourthly, sales promotion factor influences all the relationship quality representing trust, satisfaction, and commitment. Fifthly, regarding relationship among relationship quality, trust positively influences satisfaction, however, does not directly influence commitment, but satisfaction positively affects commitment. Therefore, satisfaction plays a mediating role between trust and commitment. Sixthly, trust positively influence only financial performance, and satisfaction and commitment influence positively both financial and non-financial performance.
Today's consumers perceive consumption as a representation of themselves. It is not simply an act that fulfills a consumer's physical and practical needs. Even in terms of life quality, consumers increasingly want to achieve an emotional and sensible experience through consumption. Consumers now make decisions based on their need to express their position in relation to other people, pursue emotional satisfaction, and try to improve the quality of life. Culture-art products that meet such internal and external demands of consumers have made significant improvements in both quantity and quality, because of the social interest and policy support. The recognition of personal and social values of culture and arts has brought about interest in and need for culture-art products. Businesses have agilely embraced such change and actively implemented various marketing strategies utilizing culture and arts. For example, businesses began to sponsor artists who produce culture-art products while building facilities for cultural and art performances or exhibitions. Businesses have also provided performances and exhibitions free-of-charge or at affordable prices. As a result, the supply in the market has started to exceed its demand as is often the case in many of other markets. However, such imbalance has occurred not because of over-supply but because of a lack of demand. Given these circumstances, the government and culture and art related organizations, which had mainly concentrated on the supply side, started to recognize the importance of creating personal and social values in culture and arts. As a result, the government and various organizations are now creating various strategies that include policy measures to achieve their new found goal. Unfortunately however, such efforts are not meeting the expectations. Focusing on above-mentioned circumstances and problems, this study aims to find measures to create demand for culture-art products in the internal conditions of those who consume culture-art products. In other words, given that the demand for culture-art products has not increased despite all external conditions to encourage consumption, this study aims to find the reasons in consumers' value judgment on culture-art products. Though there were recent studies on culture-art products that applied consumer behavior on marketing theories, most of them focused on peripheral aspects such as people's motivation for or satisfaction from watching culture-art events. Hence, there is a need to understand what kind of value consumers perceive from culture-art products and how such value cognition leads to consumption in a comprehensive manner. This study acts as follow-up to a separate study entitled "Qualitative Study about Value Cognition and Benefits of Consumer on Culture-Art Products". The current study aims to extend practical implications that enhance the effectiveness of marketing strategies among the producing and policy agencies in the industry. The purpose of this study is to investigate dimensions of value cognition, benefits and attributes of culture-art products, and identify the effects of consumer value cognition on benefits and attributes. The questionnaire was developed based on the conceptual structure of qualitative research and previous researches. It was composed of value cognition, benefits, attributes of culture-art products and demographic variables. This survey was conducted on-line and off-line among a total of 662 persons ranging from their teens to their 50's who were living in Seoul, Gyeonggi-do, various metropolitan cities, and small and medium-sized cities. The data collected was analyzed by factor analysis and path analysis using SPSS WIN 18.0 and AMOS 16.0. This empirical study found that the dimensions of value cognition of culture-art products were categorized into personal goods, aesthetic goods and public property. This shows that the consumers perceive culture-art products as products that are worthy enough to pay the costs not just for personal benefits but also for their social values. Also the formation of value cognition for culture-art products requires special conditions unlike that for physical consumer goods and services, which simply require marketing stimuli. The dimensions of benefits pursued by consuming culture-art products were found to be composed of four types - pursuit of aesthetic benefits, pursuit of actual benefits, pursuit of emotional benefits, and pursuit of conspicuous character. This result implies that people consume culture-art products not just to pursue pleasure from emotional and intelligent satisfaction as well as social relations, but also to seek the needs and benefits embodied at a social level. The dimensions of attributes of culture-art products had seven different factors, - environmental, price, evaluation, people, artwork, composition, and personal relations - which is plentiful. This is because the attributes of culture-art products are very complicated compared to other consumer goods or services. Since culture-art products include not just cultural or artistic works but also all physical, human, environmental, and systemic elements of the products in a comprehensive manner, consumers perceive everything they experience in the process of consuming culture-art products as part of the products. The dimensions of value cognition was found to affect attributes of the products, mostly using pursued benefits as a mediating factors. This result is consistent with the result of qualitative research, and proves that applying the means-end chain theory in the reverse direction is reasonable. The result can be interpreted that consumers' value cognitions for culture-art products turns into actual benefits leading to consumers' decisions. Furthermore, this result reveals that when consumers choose culture-art products, they take into account the attributes of culture-art products depending on the benefits they pursue. These results confirm that despite their conceptual and abstract attributes, culture-art products have values that contribute to actual benefits for individual consumers and society. Hence, value cognition generates benefits to be pursued and this in turn affects the consumers' choices of attributes on products. Based on the conceptual structure of consumers' value cognitions on culture-art products and its dimensions, it is possible to find detailed methods to provide opportunities for education and training to form and reinforce positive value cognition on culture-art products. And through those methods, it will be possible to develop attributes of culture-art products according to the dimensions of pursued benefits, and allow conceptual products become the subject to valuable consumption in real life. These results provide theoretical understanding of consumer behavior in culture marketing and useful information to culture-art producers, companies that use culture and art, and government agencies that use culture-art as a mean to improve the public perception of quality of life. As a follow up on this study, there should be experimental studies that can develop criteria visualizing the demands of consumers who purchase culture-art products and identify their detailed attributes. Studies that compare characteristics of different areas within the culture-art product category and in-depth studies on a specific area or genre will also be needed. In order to develop marketing strategies for culture-art products, studies on the formation and reinforcement of positive value cognition on culture-art products and education for the development of consumer demand as well as on the development and differentiation of attributes of culture-art products depending on types of consumer groups should also follow.