There is ample evidence that clinical communication skills deteriorate in medical students without specific training, but are improved by training. However, little is known about how well-equipped students are to communicate with patients on entering medical school, and there is limited evidence about whether all students improve with tuition in communication skills. This thesis describes a longitudinal study into these issues at the University of Otago�s Medical School. It was hypothesised that the majority of participants would demonstrate significant improvement in communication skills over their first two phases of specific tuition in communication. However, a small minority of participants were expected to fail to develop adequate skills in communication over this time, and the researcher wished to investigate whether any of the variables measured at baseline (demographic characteristics, personal qualities, academic abilities, and demonstrated interaction and interview observation skills) would predict those participants who developed superior communication skills, or who failed to demonstrate sufficient improvement by the end of eighteen months of medical education.
Participants were 232 new entrants to the Otago Medical School programme, who were evaluated at three time points over the first eighteen months of their medical training. After completing a range of baseline measures (including a pre-training videotaped interview with a simulated patient role-played by an actor), participants completed two phases of communication skills training and, at the end of each phase, undertook a further videotaped interview. Interviews were marked by trained raters, using a novel assessment tool, the Brown-Peace Interview Marking Schedule, developed specifically for this purpose. Actors and participants themselves also evaluated each interview.
Results showed that there was considerable variation in participants� abilities to perform the pre-training interview, indicating that the communication skills required in a clinical setting were not present in the majority of participants before training. Analysis of participant performance over time indicated that, while certain skills improved with training (e.g., receptive listening skills, non-verbal expression, and degree of structure in the interview) others did not improve significantly (e.g., responsiveness to the patient�s needs). As a group, participants benefited from the training, but a small sub-group of participants exhibited significant deficits in communication, even after two phases of communication skills training. It was easier to predict those participants who would develop superior communication skills than those who would continue to experience difficulties with simulated interviews. However, a small number of qualities (such as lack of familiarity with the English language, and high levels of personal qualities such as aloofness) were useful predictors of poor performance in the videotaped interviews.
Further research could clarify whether the same personal qualities influence student performance in later interviews, once students have had more experiential training and opportunities to practise interviewing in a range of settings. In terms of the practical implications of the research findings, a number of issues are highlighted, such as the range of skills required of those who teach and evaluate communication skills. Recommendations are made regarding the timing, content and implementation of communication skills training for medical students.
| Identifer | oai:union.ndltd.org:ADTP/266452 |
| Date | January 2005 |
| Creators | Brown, Nicola, n/a |
| Publisher | University of Otago. Dunedin School of Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://policy01.otago.ac.nz/policies/FMPro?-db=policies.fm&-format=viewpolicy.html&-lay=viewpolicy&-sortfield=Title&Type=Academic&-recid=33025&-find), Copyright Nicola Brown |
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