A literature search for articles concerning communication skills teaching and learning in medicine was done.The search yielded 180 pertinent articles, which were quality graded into the three categories of high, medium and low quality, using established criteria. Only those of high and medium quality were used for the review, which thus is based on 31 randomized studies, 38 open effect studies and 14 descriptive studies. Communication skills can be taught in courses, are learnt, but are easily forgotten if not maintained by practice.The most effective point in time to learn these at medical school is probably during the clinical clerkships, but there is no study that has specifically addressed this question.After a short period of training, doctors can be effective as teachers.The teaching method should be experiential as it has been shown conclusively that instructional methods do not give the desired results.The contents of communication skills courses should primarily be problem defining.All students should have communication skills training since those with the lowest pre-course scores gain the most from such courses. Men are slower learners of communication skills than women, which should be taken into account by course organizers. As there is only one really long-term follow up into the residency phase of communication skills training at medical school, those who have done randomized studies in the field should if possible carry out further follow-up studies.

Study objective-To determine whether mortality from breast cancer could be reduced by repeated mammographic screening.Design-Birth year cohorts of city population separately randomised into study and control groups.Setting-Screening clinic outside main hospital. Patients-Women aged over 45; 21088 invited for screening and 21 195 in control group.Interventions-Women in the study group were invited to attend for mammographic screening at intervals of 18-24 months. Five rounds of screening were completed. Breast cancer was treated according to stage at diagnosis.End point-Mortality from breast cancer. Measurements and main results-All women were followed up and classed at end point as alive without breast cancer, alive with breast cancer, dead from breast cancer, or dead from other causes. Cause of death was taken from national mortality registry and for patients with breast cancer was validated independently. Mean follow up was 8-8 years. Altogether 588 cases of breast cancer were diagnosed in the study group and 447 in the control group; 99 v 94 women died of all causes and 63 v 66 women died of breast cancer (no significant difference; relative risk 0-96 (95% confidence interval 0*68 to 1.35)). In the study group 29% more women aged <55 died of breast cancer (28 v 22; relative risk 1.29 (0.74 to 2.25)). More women in the study group died from breast cancer in the first seven years; after that the trend reversed, especially in women aged -55 at entry. Overall, women in the study group aged -55 had a 20% reduction in mortality from breast cancer (35 v 44; relative risk 0 79 (0.51 to 1.24)).Other findings-In the study group 100 (17%) cancers appeared in intervals between screenings and 107 (18%) in non-attenders; 51 of these women died from breast cancer. Cancers classed as stages II-IV comprised 33% (190/579) of cancers in the study group and 52% (231/443) in the control group.Conclusions -Invitation to mammographic screening may lead to reduced mortalify from breast cancer, at least in women aged 55 or over.

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General complications, wound complications and hospital stay after surgery for operable mammary carcinoma were studied prospectively in 385 patients treated by either modified radical mastectomy (324 operations) or segmental resection with axillary dissection (71 operations). The overall infection rate was 3.6 per cent. Postoperative seromas were noted in 34.8 per cent of the wounds. Other complications were few. The average hospital stay was 7.2 days. Seventeen per cent of the total number of days in hospital for these patients were due to factors other than the mammary cancer.

Students in the last semester of medical school and experienced junior doctors with no or little training in communication skills were observed while interviewing or informing simulated patients. There was a remarkable similarity in behaviour between the two categories. Communication skills characteristic of common social conversation were learnt spontaneously, while important professional basic communication skills were not learnt despite 10 or more years of clinical work. These discrepancies and subsequent gaps should be the focus of future training courses at both pre- and postgraduate level.