Undergraduate Training for Communication in Medical Practice

Abstract

Communication is a major aspect of medical practice in such areas as the consultation, counselling, team work, management duties, health education and teaching. Many communication skills essential to the clinical consultation are different from those used in everyday life. They require an understanding of the doctor/patient relationship and of the self as well as of others. They also require a subserving repertoire of specific behavioural skills. The present paper sets out to emphasize this pervasive importance of communication skills in medical practice and to suggest some educational goals and objectives for those skills of particular relevance to the consultation. It describes one attempt to pursue these within the author's own school despite the piecemeal nature of such teaching. In Britain great emphasis is placed on the importance of clinical skills and this is reflected in the priority given to them in the final professional examination, and yet their communication aspects are rarely well defined within the curriculum or directly assessed. The author advocates the teaching and assessment of communication skills as a continuous process throughout undergraduate and postgraduate medical education for clinical practice.

The teaching of communication skills in United Kingdom medical schools

“…It was noticeable that among these there were seldom clear objectives integrating communication skills with skills in clinical logic or decision‐making such as those published by Crisp (1986), which include the statement ‘As a result of such knowledge and skills, additional to other medical knowledge and skills, to be able to take a full history within the clinical situation, incorporating relevant social and psychological information into a diagnosis and formulation …’. Only an occasional department had an objective of this nature, such as: ‘The student should be able to relate to patients in ways that will elicit all information needed for a valid diagnosis and for the formulation of appropriate treatment.’…”

Teaching interview skills to preclinical medical students

“…Interview skills are obviously important for all doctors and recently there has been an increasing interest in training medical students and junior doc tors in effective interviewing (Maguire et al, 1978;Engler et al, 1981;Thompson & Anderson, 1982;Maguire, Fairburn & Fletcher, 1986a;Maguire, Fairburn & Fletcher, 1986b;Crisp, 1986). Maguire et al (1978) demonstrated that without interview skills training, students tended to use closed ques tions, have difficulty in keeping patients to the point, in beginning and ending interviews and were reluc tant to cover psychological problems.…”

“…This formed an intro duction to an established programme of teaching communication skills throughout their undergradu ate training which has been described elsewhere (Crisp, 1986). Our teachers were registrars in psy chiatry who had previously undergone a training in interview skills (Drummond et al, 1988).…”

Communicating well in general practice

“…An initial good grounding is clearly important and, as might be expected, there are many recommendations in the literature that undergraduates should be taught communication skills (Table) throughout their courses. [35][36][37] Australian medical students report enjoying the use of video feedback in consultation skills training. 38 This is also employed in postgraduate education for Australian general pracnce.» Medical students taught with videotaping and feedback tutorial workshops had better communication skills than colleagues who did not.t-However, such differences were lost five years after graduatlon.'…”