Language background,English language proficiency and medical communication skills of medical students

Associations between language background, English language proficiency and medical communication skills were investigated in a group of 149 third year undergraduate medical students studying at an Australian university. Written and aural English proficiency were assessed with the Screening Test for Adolescent Language (STAL). Medical communication skills and the fluency of spoken language were scored during an Observed Structured Clinical Interview (OSCI), rated by a standardized patient and a clinician. An association was found between language background, performance on the STAL and spoken language proficiency. Satisfactory performance in medical communication skills was not associated with language background or overall performance on the STAL. In this study it was the global rating of unsatisfactory spoken language fluency that was associated with poorer performance in medical communication skills under examination conditions.     

Factors influencing the communication skills of first-year clinical medical students

The aim of this study was to examine the factors influencing medical students' communication skills. The sample comprised all first-year clinical students. Thirty-two received teaching in communication skills during the year; the remaining 56 did not. Students' career preferences, attitudes towards communication skills and confidence in their ability to communicate with patients were assessed by questionnaire at the beginning and end of the year. At the end of the year each student was videotaped interviewing a simulated patient. Students' communication skills were assessed on the basis of this interview by raters using a standardized rating scale, and by patient questionnaires. While there was some evidence that brief communication skills training improved skills, sex of student was a more significant predictor of level of skill. Students who perceived communication skills as less relevant to medicine and those who were more confident about their own communication skills were more likely to prefer a career in hospital medicine. Students' judgements of their ability to communicate effectively were poor. In the main there was no relationship between confidence and level of skill: where they were related, the association was negative. The benefits from communication skills training might be enhanced by involving hospital doctors in the teaching, and providing students with detailed video feedback on their skills at the outset.     

Assessing the development of communication skills in undergraduate medical students

CONTEXT: The teaching of clinical communication skills' teaching has become an important part of medical school curricula. Many undergraduate medical courses include communication skills training at various points in their curriculum. Very few reports have been published on the development of communication skills over the duration of a medical undergraduate training. AIMS: To determine the change in communication skills between early and mid-stages of the students' 5-year curriculum, and to investigate the predictive and theoretical significance of knowledge and understanding of communication skills in relation to observed performance. PARTICIPANTS: Students entering as the first cohort to the new medical curriculum at Liverpool Medical School (n=207). Nine students withdrew leaving 198 students who completed two summative assessments in June 1997 (level 1) and November 1998 (level 2). STATISTICAL ANALYSIS: Repeated measures multivariate ANOVAS were applied to the main study data to detect any change in performance between levels 1 and 2. RESULTS AND CONCLUSIONS: An improvement in communication skills was found in medical students over 17 months of their undergraduate teaching: that is from the level 1 to the level 2 assessment. Knowledge and understanding of communication skills at initial assessment did not show the predicted association with performance at level 2.     

The reliability of assessment criteria for undergraduate medical students' communication skills portfolios: the Nottingham experience

INTRODUCTION: Some educators have argued that portfolios should not be assessed summatively because there is little evidence supporting the reliability of their assessment. This study aims to determine the reliability of assessment criteria used for a portfolio at the University of Nottingham. METHODS: Two independent analysts assessed a random sample of portfolios (n = 100, 49.5%) using criterion-referenced assessment. Students' performances were examined against subjective items in five areas: 1) portfolio structure, 2) level of critical reflection, 3) level of skills development, 4) use of documentary evidence, and 5) use of relevant literature. These subjective judgements were later converted into quantitative scales ranging from 0 to 3 so that interrater reliability could be established. The level of agreement between the two analysts for the total percentage score was established using an intraclass correlation coefficient and for the individual items using weighted kappa coefficients. RESULTS: The level of agreement between the two raters for the total percentage score was 0.771 (95% CI = 0.678, 0.840), as measured by an intraclass correlation coefficient. The levels of agreement between the two raters for the individual items of the assessment criteria ranged from kappa=0.359 (item 3) to kappa=0.693 (item 4). DISCUSSION: This study provides some support for the summative assessment of portfolios. The findings suggest that discussion and negotiation between independent assessors can enhance the reliability of assessment criteria. Therefore, medical educators are encouraged to use such procedures in the summative assessment of portfolios.     

Aiding the development of communication skills in medical students

Difficulties with doctor-patient communication continue to be recognized as a major barrier to effective patient care. A fundamental requirement for effective communication has been identified to be an understanding of the patient as an individual, yet most medical students are educationally and socially isolated from their patients and have difficulty in understanding their problems. In an attempt to encourage an understanding of the communication difficulties which follow such ignorance, a simple project was designed for, and conducted by, two groups of medical students during their initial period of clinical contact. Students first estimated the expected level of basic biological knowledge and the likely life-styles of their patients and then compared their estimates with data collected from patients. Students' initial estimates of both knowledge and life-style were poor, but improved significantly after data collection and discussion of results. In addition to improving their knowledge, students also recognized the benefit that such understanding could bring to the quality of communication. From these results, it is suggested that similar class exercises could be valuably introduced with minimum effort into the undergraduate curriculum, as the first of a series of steps in the acquisition of effective communication skills.     

护理专业医学生医患沟通技能及其心理影响因素研究

目的 了解职业技术类院校护理及助产专业医学生的心理对其医患沟通技能的影响作用,为职业技术类院校的医学生医患沟通技能提升提供指导。 方法 利用成熟的医学生医患沟通态度、技能以及心理学相关量表设计调查问卷,采用全部抽样的方式,对忻州职业技术学院护理专业学生进行调研,并最终获得264份有效问卷用于逐步进入法的多元线性回归分析。 结果 分析结果表明,医学生学习医患沟通技能的积极态度（r=0.39,P<0.001）、情绪疏泄能力（r=0.29,P<0.001）、观点采择意识（r=0.20,P<0.001）对其医患沟通技能水平的作用具有统计学意义。 结论 职业技术类院校在培养医学生的医患沟通技能时,应重点关注学生的积极学习态度、情绪疏泄能力和观点采择意识。     

The lessons of deafness: deafness awareness and communication skills training with medical students

This paper describes a 1-day course on deafness awareness and communication skills with fourth-year medical undergraduates and summarizes their evaluation of the course. Deaf people commonly experience major communication difficulties with doctors. This course gives students an awareness of deafness (and of the insights deaf people can give to an understanding of communication)--the lessons of deafness--and challenges some critical assumptions in medical practice. Students are given personal experience of deafness and of the consequent powerlessness and loss of self-confidence, while also learning new communication skills which they then apply in a role-play consultation with a deaf patient. Systematic evaluation has been built into the programme and student opinion has been unanimously enthusiastic.     

Undergraduate medical students' views about a reflective portfolio assessment of their communication skills learning

INTRODUCTION: To date, no studies have examined preclinical medical students' views about portfolios. Since portfolios are becoming increasingly valued in medical education, this study explores second-year medical students' views about a reflective portfolio assessment of their communication skills. METHODS: 178 second-year medical students at the University of Nottingham completed the 18-item reflective portfolio questionnaire (RPQ) (alpha = 0.716) and a personal details questionnaire three days before submitting their portfolio assessment for communication skills. Data were analysed using univariate and multivariate statistics on SPSS Version 10.0. RESULTS: Total scores on the RPQ ranged from 40 to 75 (mean 58.28, SD 7.08). Significant relationships existed between RPQ total scores and students' ratings of their reflection skills (rs = 0.322, P < 0.001), RPQ total scores and students' confidence building another portfolio (T = 4.381, d.f. = 176, P < 0.001), and RPQ total scores and students' marks for their reflective portfolio assessment (rs = 0.167, P = 0.029). Students with more positive views about reflective portfolios were more likely to rate their reflection skills as good, receive better marks for their portfolio assessment, and be more confident building another portfolio. DISCUSSION: This study begins to highlight preclinical medical students' views about reflective portfolios. However, further research is required using qualitative studies to explore students' views in depth. Medical educators should be encouraged to consider introducing portfolios as a method of formative and summative assessment earlier in the medical curriculum.     

A comparison of the interviewing skills of first-and final-year medical students

This study compared the communication skills of randomly chosen first- and final-year medical students. The intention was to follow up previous research, conducted over 10 years ago, into the effects of the medical curriculum on communication skills. It was hypothesized that there would be little improvement in such skills over the period of training, with the possibility that the final-year students might be less caring, empathic and supportive, more directive, and less concerned with psychosocial information. All students interviewed a simulated patient in the role of a mother of a child with cerebral palsy, where the main problems were psychological and social. The interviews were recorded on videotape and analysed by an independent observer for the presence or absence of a set of communication behaviours considered important in facilitating an effective relationship and in the exploration and understanding of the problem. The results failed to support the hypotheses. The final-year students were superior to their juniors on several measures, indicating improvements in relating to the patient in a caring, empathic, facilitative and listening manner. They also elicited more information relevant to the problem. The indications were that these final-year students were more skilled than in earlier studies, suggesting that the general change in attitudes to communications skills and the limited, but increased input into the curriculum may be having effect, even though there remains a need for considerably more training.     

Interviewing skills: self-evaluation by medical students

In an independent learning project, 52 third-year medical students carried out a structured self-assessment of two videotaped psycho-social interviews they had conducted with volunteer clients 1 year earlier, as part of a previous course. The interviews had been conducted in small tutorials with feedback from their clients, fellow students and tutors, facilitated by videotape playback. During the sequence of 16 tutorials each student had carried out an early and a late interview and had observed and participated in the discussion of the interviews of 14 peers. Students were asked to tally the frequencies of various interview behaviours, to evaluate the quality of their behaviours, and to establish priorities for future learning. The videotapes were also reliably rated by an independent observer. Students' overall self-assessments correlated 0.46 with those of the independent observer. This correlation was higher than is typically reported in studies of the validity of self-assessment. In absolute terms, the students' mean rating of interviewing performance was 3.2 (adequate plus) which was significantly lower than the observer's mean of 3.6 (adequate to good). Results are discussed in terms of Gordon's (1992) two recommendations for improving the validity of self-assessments and two further suggestions, for paired comparisons and low-threat learning environments, are added.     

Communication skills training for medical students: an integrated approach

Skills of communication are not easily taught to medical students. Three main clinical departments (general practice, medicine and mental health) of the Medical Faculty of the Queen's University, Belfast, introduced an integrated course in January 1988 to teach the basic principles. The course is held at the beginning of clinical training and is an integral part of the introductory clinical course. It was introduced in response to the Report of a Working Party of the Education Committee of the General Medical Council (1987) which advocated the need for improved training in history-taking and communication. It is a 12-week course and every Monday and Friday afternoon from 1400 to 1700 hours 12 students are seconded from ward work, four to the Department of Medicine, four to the Department of General Practice and four to the Department of Mental Health. Hand-outs about information to be obtained and interview style are standardized and the principles to be followed are clearly defined in an aide-mémoire. Staff from the Departments of General Practice and Mental Health experienced in teaching communication by videotape feedback and analysis of consultations prepared 12 tutors for their role and responsibilities. Procedures to be followed were carefully explained to all students beforehand. General practice and psychiatry traditionally have established teaching programmes in communication but the inclusion of the Department of Medicine has made a significant impact. Students have come to realize that the taking of a good history demands as much skill as the physical examination of the patient and is an important aspect of any clinical assessment.     

The development of a scale to measure medical students' attitudes towards communication skills learning: the Communication Skills Attitude Scale (CSAS)

INTRODUCTION: There is little research identifying medical students' attitudes towards communication skills learning. This pilot study outlines the development of a new scale to measure attitudes towards communication skills learning. METHODS: First- and second-year medical students (n = 490) completed the 26-item Communication Skills Attitude Scale (CSAS) and 39 students completed the CSAS on a second occasion. Factor analysis was conducted to determine the factors underpinning the scale. The internal consistency of the subscales was determined using alpha coefficients. The test-retest reliability of the individual scale items were determined using weighted kappa coefficients and the test-retest reliability of the subscales were established using intraclass correlation coefficients. RESULTS: Maximum likelihood extraction with direct oblimin rotation resulted in a 2-factor scale with 13 items on each subscale. Factor I represented positive attitudes towards communication skills learning and factor II represented negative attitudes. Subscale I had an internal consistency of alpha=0.873 and an intraclass correlation of 0.646 (P < 0.001). Subscale II had an internal consistency of alpha=0.805 and an intraclass correlation of 0.771 (P < 0.001). The majority of items on the positive (n=9, 69.2%) and the negative attitude subscales (n=8, 61.5%) possessed moderate test-retest reliability. DISCUSSION: The development of a new and reliable scale to identify medical students' attitudes towards communication skills learning will enable researchers to explore the relationships between medical students' attitudes and their demographic and education-related characteristics. Further work is needed to validate this scale among a broader population of medical students.     

Breaking bad news: medical undergraduate communication skills teaching and learning

Summary. Teaching on the theme of 'breaking bad news' was selected for special development as part of an introductory course on communication skills for preclinical medical students in 1987. Eight parents of handicapped children and three patients terminally ill with neoplastic diseases cooperated in a series of semi-structured group discussions in which students were encouraged to interact with patients and children. The patients/parents readily assumed the role of teachers and where it was possible, they participated in similar sessions the following year.
Analysis of questionnaires indicated that the plan had proved acceptable to patients, relatives and students. Follow-up of student opinion one year later indicated that students felt they had derived benefit from these opportunities to learn first-hand from patients and parents of handicapped children.     

The teaching of communication skills in United Kingdom medical schools

A survey was carried out of the teaching of communication skills in medical schools in the United Kingdom during the academic year 1989/90. Comparison with previous surveys shows a considerable development over the last 10 years. Departments of psychiatry and general practice continue to play a major part in such teaching. There was wide variation in educational objectives and in the curricular time available. Concern is expressed about the methods of assessment and the degree of integration between departments. Future plans and the perceived barriers are reported and the implications discussed.     

现代医学教育中医学生人文素质教育的几点思考

现代高等医学教育不仅要求医学生要掌握医学专业知识，具备良好的职业道德和高度的责任心，而且要具备各方面的素质，特别是要具备较好的人文素质，因此，加强医学生的人文素质教育，使他们成为高素质的医学人才，是医学发展的必然和需要。     

Can medical schools rely on clerkships to train students in basic clinical skills?

OBJECTIVE: Many medical schools have drawn up lists of basic clinical skills that students are required to have mastered at the end of medical training. To determine whether undergraduate students actually perform these basic clinical skills during clerkships and whether different approaches to skills training led to different results, we surveyed 365 final-year medical students in 1996 and 1997. METHOD: A questionnaire containing items on 265 skills in eight body systems was administered to students from two conventional medical schools (Ghent and Antwerp, Belgium), and one Dutch medical school, Maastricht, which offers a problem-based curriculum and systematic skills training. RESULTS: Although quite a few skills were not performed by Maastricht students, the results of this school compared favourably to those of the Ghent and Antwerp medical schools. Significant differences between Ghent and Antwerp were found for surgery, paediatrics and gynaecology/obstetrics. In the non-obligatory clerkships in dermatology, otorhinolaryngology and ophthalmology a great percentage of skills were not performed. CONCLUSIONS: The main conclusion is that all three medical schools cannot rely on clerkship experiences alone to provide adequate basic skills training. A problem-based learning environment and training in a skills laboratory appear to result in students performing more skills during clerkships. Assessment of clinical skills, obligatory clerkships in specialties and general practice, and continuous monitoring of the quality of clerkships may also be strong determinants of the present findings.     

Teaching communication skills to pre-clinical medical students: a general practice based approach

This paper describes a method of teaching communication skills to pre-clinical medical students in the setting of general practice. By focusing on the nature of the patient's problem this teaching tries to place interviewing and diagnostic procedures in their proper context in the doctor-patient relationship.     

Background and sexual experience of israeli medical students

It is now general professional consensus that to develop a good human sexuality curriculum it is mandatory to first study the future target population. Such a study was done on a national basis at the four medical schools in Israel, concentrating on the senior students. The data on background, sexual experience, knowledge, and attitudes were analyzed and compared to findings of similar studies in other countries. This article reviews the results on background and sexual experience, also trying to analyze logical hypotheses of possible links between variables. Most Israeli senior medical students are unmarried Jewish Ashkenasi males, with a rather small proportion of females, Sephardic-originated Jews, Moslems, and Christians. Their sex education during childhood originated mostly from peers and literature, but was almost completely lacking at school. Masturbation started early, being more frequent for males. The majority of both sexes had dated, had gone steady, and had had sexual intercourse frequently with at least two partners. Only 5.4% of males had never experienced coitus. Intercourse with prostitutes was infrequent. The students' background has direct influence on their early sexual knowledge and experience. This in turn influences self-ratings on sexual matters. This is further correlated with sexual behavior.This research was supported by grants from the Bruner Foundation, New York, and from the Israeli Family Planning Association. Part of this material was presented at the Second International Congress of Sexology, Montreal, October 28–31, 1976.