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Yedidia MJ, Gillespie CC, Kachur E, et al. Effect of Communications Training on Medical Student Performance. JAMA. 2003;290(9):1157–1165. doi:10.1001/jama.290.9.1157
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).
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
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
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