Medical students' attitudes towards doctor-patient communication have for long been a concern among medical teachers, curriculum planners and policy makers [1
] and have been addressed in many studies.
] constructed the Attitudes Towards Medical Communication Scale with 41 items and used it in a cross-sectional study on 203 students in their first, second and fourth year respectively. This study, which was published in 2001, showed that female students had more positive attitudes than male students, and that first and second year students had more positive attitudes than fourth year students.
In 2001 de Valck [4
] presented a questionnaire measuring students' attitudes towards full disclosure versus non-disclosure in breaking bad news. Following one cohort of students for three years (53 students responded in all three years) they found that students became more in favour of non-disclosure as they progressed through medical school.
In 2002 Rees, Sheard and Davies [5
] published the Communication Skills Attitudes Scale (CSAS), which measures students' attitudes towards learning communication skills during medical school. This scale has until spring 2006 been used and validated in three different studies in the UK involving from 216 to 490 students [6
] and one involving 123 students in Nepal [9
]. Although mostly cross-sectional, these studies report that female students have more positive attitudes than male, and that students early in medical school have more positive attitudes than students later in medical school. In addition, having recently attended communication skills teaching tends to predict less positive attitudes towards learning such skills.
In 2004 Liddell and Davidson [10
] published the use of a questionnaire measuring medical students' attitudes towards five groups of consultation skills, one of which was communication skills. They performed a cross-sectional study of three consecutive classes of 357 final year students before and after attachments in general practice and a Consulting Skills Program. After the program, attitudes towards communication skills were more positive.
Attitudes involve evaluations by which we attach good or bad qualities to a topic or an organisation or a person. Attitudes drive behaviour. If we can change a person's attitude we may change his or her behaviour [11
]. Attitudes have three main components: affective (the way we feel), cognitive (the way we think) and behavioural (the way we act) towards a particular entity [11
]. Affective attitudes reflect emotional reactions and may change after repeated exposure to situations involving the goal for the attitude. Cognitive components of attitudes are believed to be more fundamental and constant over time and more closely connected to basic values [12
]. Cognitive attitudes are difficult to influence but may change when new knowledge is presented; provided the knowledge is convincing and the presenter is credible [13
]. Behavioural attitudes are manifestations of underlying cognitive and affective attitudes. There is evidence that changing behaviour by training new ways of acting in professional situations may influence the more fundamental aspects of attitudes without targeting them directly [14
]. There is need for assessment tools enabling teachers and curriculum planners to monitor changes in specific components of attitudes among students during medical school. The use of such tools may also facilitate comparisons between different medical schools. Such comparisons are important because differences in attitudes may to some extent be linked to differences in teaching methods and/or curriculum designs, thereby helping medical educators in finding new ways of improving and refining teaching in medical schools [15
The aims of our study are to explore the attitudes among all Norwegian medical students towards learning communication skills, and to compare our findings with reports from other countries.