Table 1.

Nonverbal Factors in a Mute State and in Speech, and Their Examples

Category	Score=0	Score=1	Examples
Nonverbal factors in a mute state
Facial expression	Blank or mismatched	Adequately expressive
Eye contact	More likely when talking	Equal when talking and listening
Affirmative gestures	Infrequent	Adequately frequent	Head nodding, smiling, hand gestures in accordance with the context of conversation
Self-touching or unpurposive movements	Frequent	Few or none	Touching the face, twirling a pen, manipulating objects
Postural change	Yes	No	If a student shifted body lean or posture at the point of the communication challenge issued by the standardized patient.
Body lean	Backward to the chair, touching the back of the chair	Neutral or forward to the patient
Body position	Closed	Open	Closed: crossed arms, angled away from the patient
Nonverbal factors in speech
Speech rate and voice volume	Not accorded	Accorded	Patient-doctor accordance of speech rate and voice volume
Match of voice tone with verbal contents	Flat	Adequate	Match of voice tone and intonation with the verbal contents
Moments of unnecessary silence, pauses of conversation	Frequent	Few or none
Giggle	Frequent	Few or none