Effect of communications training on medical student performance.
BACKGROUND
Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials.


OBJECTIVE
To determine whether communications training for medical students improves specific competencies known to affect outcomes of care.


METHODS
A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention.


METHODS
One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001).


METHODS
Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development.


METHODS
Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance.


RESULTS
Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude.


CONCLUSIONS
Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture.
Yedidia
Michael J
MJ
Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service, and School of Medicine, New York University, and Medical Education Development, New York City, NY 10003, USA. michael.yedidia@nyu.edu
Gillespie
Colleen C
CC
Kachur
Elizabeth
E
Schwartz
Mark D
MD
Ockene
Judith
J
Chepaitis
Amy E
AE
Snyder
Clint W
CW
Lazare
Aaron
A
Lipkin
Mack
M
D002983:Clinical Competence; D015331:Cohort Studies; D003142:Communication; D003479:Curriculum; D004501:Education, Medical; D006801:Humans; D017145:Models, Educational; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D014481:United States