{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:02:52Z","timestamp":1789380172332,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin. Pract.","Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: Subtle facial and interactional cues may prompt clinicians to explore possible anxiety, confusion or hesitation, but they do not establish a patient\u2019s internal state. The Micro-Expression Decoder (MED) links cue recognition with tentative interpretation, direct checking and communication adaptation. Methods: This preliminary, uncontrolled, single-group pre\u2013post convergent mixed-methods evaluation involved 60 final-year medical students from three London medical schools. Ten groups of six completed a 270 min simulation-based programme comprising conceptual teaching, video observation, standardised-patient encounters, feedback and reflection. Study-specific self-ratings and a parallel-form recognition task were completed before teaching and immediately after the instructional and simulation components, before the final debrief. Standardised-patient ratings were obtained during the first and final simulated encounters. There was no control group or follow-up. Results: Recognition confidence increased from 2.7 to 4.3 (mean change 1.6, 95% CI 1.39\u20131.81; dz = 1.98), interpretation confidence from 3.0 to 4.5 (dz = 2.01), standardised-patient-rated attentiveness from 3.2 to 4.6 (dz = 2.02), and satisfaction from 3.5 to 4.8 (dz = 1.94). Anxiety recognition increased from 25\/60 (41.7%) to 55\/60 (91.7%), and confusion recognition from 29\/60 (48.3%) to 52\/60 (86.7%). Qualitative accounts described earlier noticing, clarification and checking, alongside difficulty distinguishing cues, distraction, cultural variation and over-interpretation. Nineteen students increased confidence without categorical improvement in anxiety or confusion recognition. Conclusions: MED was associated with immediate improvement across study-specific outcomes in simulation. The uncontrolled design, immediate assessment, investigator-developed measures, expectancy effects and ceiling in post-training satisfaction preclude conclusions about causality, retention, real-patient benefit, empathy or clinical competence.<\/jats:p>","DOI":"10.3390\/clinpract16090170","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T08:10:23Z","timestamp":1789373423000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The\u00a0Micro-Expression Decoder: A Preliminary Mixed-Methods Evaluation of Training in Subtle Facial and Non-Verbal Cue Recognition in Final-Year Medical Students"],"prefix":"10.3390","volume":"16","author":[{"given":"Hashira","family":"Syed","sequence":"first","affiliation":[{"name":"School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Sini","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Conte","sequence":"additional","affiliation":[{"name":"Faculty of Life Sciences & Medicine, King\u2019s College London, London SE1 1UL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8772-4938","authenticated-orcid":false,"given":"Austen","family":"El-Osta","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2357-9858","authenticated-orcid":false,"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6914-7401","authenticated-orcid":false,"given":"Waseem","family":"Jerjes","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","first-page":"119","article-title":"Interpersonal communication in healthcare","volume":"11","author":"Chichirez","year":"2018","journal-title":"J. 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