title: Instrumental strategy: A stage in students' consultation skills training? Observations and reflections on students' communication in general practice consultations.
abstract: OBJECTIVE
  To explore and examine students' abilities to communicate with patients during a general practice course in the final year of the curriculum and to analyse and consider this experience in relation to earlier consultation training.
  
  
  METHODS
  General practice courses in the undergraduate curriculum.
  
  
  METHODS
  Qualitative data analysis was used. A special focus-group interview of experienced supervisors was performed and analysed (editing analysis). Credibility of data was tested at local seminars and conferences. Authors' experiences of observing student consultations over many years were also used.
  
  
  RESULTS
  A main theme, 'open invitation', emerged based on categories 'initially attentive' and 'listening attitude'. In contrast, the second main theme was 'instrumental strategy', based on the following categories: 'one-sided collection of medical facts' and 'relationship-building lost'. The students also had difficulties in devoting attention to patients' life experiences. An hourglass metaphor of students' and young physicians' progression of communication strategies is presented. The narrow part of the hourglass corresponds to an instrumental strategy at the end of undergraduate clinical education.
  
  
  CONCLUSIONS
  An instrumental strategy may be a stage in student's consultation learning progression that interferes with communication training. A question is raised: is training of a patient-centred approach throughout the clinical curriculum needed for optimal development of consultation skills? Further research is needed to test this hypothesis.
authors.affiliation: Department of Primary Health Care, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. mats.wahlqvist@allmed.gu.se
authors.forename: Mats
authors.initials: M
authors.lastname: Wahlqvist
authors.forename: Bengt
authors.initials: B
authors.lastname: Mattsson
authors.forename: Gösta
authors.initials: G
authors.lastname: Dahlgren
authors.forename: Monica
authors.initials: M
authors.lastname: Hartwig-Ericsson
authors.forename: Betty
authors.initials: B
authors.lastname: Henriques
authors.forename: Bengt
authors.initials: B
authors.lastname: Hamark
authors.forename: Ulrika
authors.initials: U
authors.lastname: Hösterey-Ugander
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003479:Curriculum; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D004645:Empathy; D005194:Family Practice / Q000193:education*; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D014743:Videotape Recording