Table 2.

Competency-based assessment of COMFORT COVID-19 communication modules with examples of data.

Learning objective	Competency criteria for coding open-response to scenario using app	Results	Examples from student responses
COVID-19 communication: video/phone calls (n = 117)
Recognize communication principles of health literacy and cultural humility in patient care	No competency  Wrong section of app or answer is not applicable and no explanation	32 (28%)	“I would make sure that I have a translator and make sure to stop frequently and let her ask questions as we go.”
	Competency  Correct section of the app with general, brief explanation	26 (22.8%)	“You can first ask, "do you feel comfortable with a telehealth visit?" to gauge how the mother feels. Additionally, you can ask, "have you used telehealth before?" so that you know if the patient is familiar with it.”
	Advanced competency  Correct section of the app and vivid and highly contextualized explanation	65 (57%)	“I would ask if they had heard of telehealth before and explain if not as well as further assessing their technological literacy. If this is a brand new concept to Steafon's mother it might be anxiety-inducing in a situation which is already very stressful. Addressing her concerns right away will help to put her more at ease. I would then ask if Steafon's mother had ever had a telehealth visit before and if so, would ask her how comfortable she was with the visit. If she was uncomfortable, perhaps I can find out the reason and alter my approach to address her concerns. If she hadn't had a telehealth visit before, I would want to assess her technology comfort levels.”
Use plain language in a telehealth interaction to discuss symptoms and side effects	No competency  Plain language for medication or symptom but not both	29 (25.6%)	“The cause of dyspnea is the newly found virus goes to the lungs and destroys lung tissues where the oxygen and carbon dioxide exchange and with no place to exchange oxygen into the blood, the person will have hard time to breathe.”
	Competency  Plain language for medication and symptom	43 (38%)	“When a person has difficulty breathing, we can give a medication that will take away swelling and make it easier to breath.”
	Advanced competency  Plain language for medication and symptom provided in context	34 (30%)	“Steafon is having difficulty breathing, we will give him a medication called dexamethasone, a medicine that takes away the swelling. This will allow Steafon to breath better.”
COVID-19 communication: personal protective equipment (n = 150)
Recognize communication principles of ‘being with’ patient	No competency  Wrong section of app or answer is not applicable and no explanation	54 (36%)	“I would sit down and listen. Perhaps suggest that he facetime his partner.”
	Competency  Correct section of the app with general, brief explanation	32 (21%)	“Manuel can communicate support by touching Alvin's shoulder, sitting at the bedside, and changing his tone of speech to be more supportive.”
	Advanced competency  Correct section of the app and vivid and highly contextualized explanation	51 (34%)	“Comfort the patient by talking at a slower pace so Alvin can see that Manuel cares and that Manuel is not in a rush to leave to take care of his other patients. It shows that Manual is taking his time with Alvin. Pausing would also help accomplish that.”
Use nonverbal communication techniques when PPE is a barrier	No competency  General list of nonverbal behaviors with no explanation	37 (24.6%)	“Two non-verbal behaviors can include direct eye contact and having an open body stance.”
	Competency  Two or more behaviors identified with general explanation	66 (44%)	“Kinesics, such as leaning in when listening to the patient, indicates that Manuel is engaged in what Alvin is saying. Haptics, such as holding Alvin's hand, facilitates connection between Alvin and Manuel and provides Alvin comfort.”
	Advanced competency  Two or more behaviors identified and vivid and highly contextualized explanation	36 (24%)	“Vocalics can be used. Expressing yourself in a coherent manner with the right tone and speed will improve Manuel's ability to communicate with Alvin. Changing how you use your voice will be beneficial since the voice is the main thing Manuel has to interact with the patient. Artifacts can be used. Having something comforting available and in the room will help Alvin feel more at peace. Only allowing him to have an unwelcoming and sterile hospital environment would be scary. Creating a space of comfort with artifacts will help Manuel set up a space in which Alvin can feel comfortable.”