The General Medical Council states that doctors have a duty to 'work in partnership with patients' [1
], combining effective clinical communication skills with an attitude towards patients which is respectful and supportive. The national core curriculum for communication skills in undergraduate medical education [2
] similarly notes that respect for patients is a fundamental attitude which must underpin the teaching of communication skills. This guidance is the result of accumulated evidence that the relationship between the patient and doctor is closely linked to improved patient outcomes, such as patient satisfaction [3
] and adherence to medical recommendations [4
], as well as patient understanding and recall, and symptom resolution [5
It has been established that certain important clinical communication skills do not develop spontaneously with exposure to clinical environments [6
]. A combination of didactic and experiential learning, however, can foster effective clinical communication skills in medical students [7
] and qualified clinicians [9
]. However, the relationship between communication skills and attitudes towards patients is not entirely clear [11
]. There is an increased focus on teaching interventions to foster professional and patient-centred attitudes at medical school [12
]. However, there is a need to determine whether this affects professional attitudes as well as behaviours (such as improved communication skills), particularly as patient-centred attitudes are known to decline with increased clinical experience [13
]. Furthermore, studies have found that clinicians' confidence in their clinical skills (including communication skills) is not necessarily congruent with observed skills [14
]. Therefore, 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?
There is a further question about whether communication skills teaching is most effective when delivered as 'stand-alone' teaching, where the focus is specifically on 'teaching communication skills', or as part of integrated teaching (e.g. in case-based teaching) which addresses a number of domains within a session [15
]. While stand-alone communication skills teaching is known to be effective in improving observable communication skills [6
], it risks creating a 'silo effect', which may cause the learner difficulty in generalising the knowledge and skills [16
]. The impact on communication behaviour of integrated teaching requires further exploration.
Measurement of students' observed communication skills has been achieved in previous research using behavioural rating of videoed consultations with standardised patients. Studies of medical students [17
] and doctors [21
] have concluded that differences in communication behaviours after an intervention can be identified using video recordings. Furthermore, this method is sufficiently sensitive to detect differences in communication 'process' skills, such as effective information gathering [19
] and non-verbal skills [23
] in medical student consultations.
The current study is part of a prospective investigation examining the effects of introducing early professional development teaching into a UK medical curriculum [24
]. This included communication skills teaching as part of a vertical module in the first two years of undergraduate medical training. However, rather than the focus being on behavioural skills training, communication skills teaching was placed in the context of integrated, case-based teaching, addressing a number of domains, including professional attitudes. This study examines the effect of professional development training on students' observed communication skills, and the relationship between observed communication, confidence in communicating with patients, patient-centred attitudes, and performance in later clinical examinations.
Aims of the study
(1) To determine whether the introduction of professional development teaching in the first two years of the medical course improved students' observed communication skills, by comparing students from two consecutive cohorts at a UK medical school.
(2) To establish whether students' patient-centred attitudes and confidence in communicating with patients were related to observed communication skills.
(3) To determine whether observed communication skills in early medical training (years 1 and 2) are related to performance in later clinical assessments (objective structured clinical examinations) (years 3 and 5).