title: Medical students trained in communication skills show a decline in patient-centred attitudes: an observational study comparing two cohorts during clinical clerkships.
abstract: OBJECTIVE
  Literature indicates a decline in patient-centredness in medical students, especially during clinical clerkships. We examined the impact of preclinical communication skills training (CST) on students' development of patient-centred attitudes and attitudes toward CST during clerkships.
  
  
  METHODS
  We prospectively compared two cohorts before and after clerkships: one cohort (n=48) had not received CST, whereas the other (n=37) had received a five-year CST. We assessed the impact using five validated questionnaires.
  
  
  RESULTS
  Communication trained students slightly but significantly declined in patient-centred attitudes (3/4 scales) and attitudes toward CST during clerkships, whereas the scores of the untrained students remained stable (5/5 scales). Both cohorts did not differ in attitudes before clerkships. In the trained cohort, males mostly showed a sharper decline than females. In the total group (n=85), females demonstrated higher attitude scores toward CST, and in 1/4 scales measuring patient-centred attitudes.
  
  
  CONCLUSIONS
  This cohort study suggests that CST might make students more vulnerable to decline in attitude scores during clerkships.
  
  
  CONCLUSIONS
  These remarkable findings, contrary to what educators would expect to result from their efforts, challenge medical education to address the new questions that are raised about the validity of the questionnaires, the impact of CST and the learning processes involved in the development of patient-centredness.
authors.affiliation: University of Antwerp, Department of Primary and Interdisciplinary Care, Wilrijk, Belgium. katrien.bombeke@ua.ac.be
authors.forename: Katrien
authors.initials: K
authors.lastname: Bombeke
authors.forename: Sofie
authors.initials: S
authors.lastname: Van Roosbroeck
authors.forename: Benedicte
authors.initials: B
authors.lastname: De Winter
authors.forename: Luc
authors.initials: L
authors.lastname: Debaene
authors.forename: Sandrina
authors.initials: S
authors.lastname: Schol
authors.forename: Guido
authors.initials: G
authors.lastname: Van Hal
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
mesh_terms: D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002982:Clinical Clerkship; D002983:Clinical Competence; D003142:Communication; D016001:Confidence Intervals; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D019555:Physician-Nurse Relations; D011446:Prospective Studies; D011594:Psychometrics; D018709:Statistics, Nonparametric; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult