Abstract
BackgroundThis study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations.MethodsEighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported.ResultsStudents who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination.ConclusionsStudents receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.
Highlights
This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students’ observed communication skills with simulated patients
The impact of professional development teaching on observed communication skills A repeated measures ANOVA was performed with total Interview Rating Scale score as the dependent variable, a within-subject factor of time and a between-subject factor of cohort
There was a significant effect of time (F1,81 = 30.9, p < 0.001), with students improving in observed communication skills over time, but not of cohort (F1,81 = 2.1, p = 0.15) or of the interaction between time and cohort (F1,81 = 1.6, p = 0.20)
Summary
This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students’ observed communication skills with simulated patients. A combination of didactic and experiential learning, can foster effective clinical communication skills in medical students [7,8] and qualified clinicians [9,10]. There is a need to determine whether this affects professional attitudes as well as behaviours (such as improved communication skills), as patient-centred attitudes are known to decline with increased clinical experience [13]. It is important to determine whether any interventions have both immediate and long-lasting effects: if improvements in communication skills and patient-centred attitudes are achieved early in medical training, are these maintained over the entire course?
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