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Effect of Communications Training on Medical Student Performance
Michael J. Yedidia, PhD;
Colleen C. Gillespie, PhD;
Elizabeth Kachur, PhD;
Mark D. Schwartz, MD;
Judith Ockene, PhD;
Amy E. Chepaitis, MBA;
Clint W. Snyder, PhD;
Aaron Lazare, MD;
Mack Lipkin, Jr, MD
JAMA. 2003;290:1157-1165.
Context 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.
Design and Setting 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.
Participants 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).
Intervention 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.
Main Outcome Measures 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.
Author Affiliations: Center for Health and Public Service Research, Robert F. Wagner Graduate School of Public Service (Drs Yedidia and Gillespie and Ms Chepaitis), and School of Medicine (Drs Schwartz and Lipkin), New York University, and Medical Education Development (Dr Kachur), New York City; University of Massachusetts Medical School, Worcester (Drs Ockene and Lazare); and Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Snyder).
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