In order to share the issues involved in setting up a communication skills training programme in a medical school, the development of such a programme at the Skillslab of Maastricht Medical School, the Netherlands, is described and the problems encountered are addressed. A multidisciplinary working group developed teaching goals for communication skills, focused on observable behaviour to be displayed by students. These teaching goals were incorporated in a generic model for doctor-patient communication. A longitudinal training programme was created, throughout the four years of the preclinical curriculum. Students meet in small groups of 10, once every 2 weeks. In between group sessions they practise consultation skills in simulated patient contacts. Communication skills are assessed in the annual multiple station examination. In the development of this programme the following consecutive actions were taken: teaching material was produced, and an assessment tool was developed, as were instruments for programme evaluation. The programme evaluation allowed student feedback to teachers, the teachers' departments, and the administration of the medical school. Finally, teacher training was professionalized.

The higher scores obtained by the Maastricht students indicate a greater overall effectiveness of a longitudinal, integrated approach compared with concentrated courses. Absence of formal training in the clinical phase in Maastricht leads to stabilisation of communication skills, whereas the increase in the Leiden students' scores between years 4 and 6 offers evidence that formal communication skills training during the clinical phase does pay off. These findings suggest that the preferred approach to communication skills training would be an integrated, longitudinal programme, which continues during the clinical years.

The paper-and-pencil test of knowledge of communication skills has predictive value for the performance of these skills, but this value seems to be less pronounced than similar findings for clinical procedural skills. The stronger relationship between 'knowing how' and 'showing' in the Maastricht student group might be indicative of an effect of the training format.

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