CONTEXT For doctors, curiosity is fundamental to understanding each patient's unique experience of illness, building respectful relationships with patients, deepening self-awareness, supporting clinical reasoning, avoiding premature closure and encouraging lifelong learning. Yet, curiosity has received limited attention in medical education and research, and studies from the fields of cognitive psychology and education suggest that common practices in medical education may inadvertently suppress curiosity.OBJECTIVES This study aimed to identify common barriers to and facilitators of curiosity and related habits of mind in the education of doctors. METHODSWe conducted a theory-driven conceptual exploration and qualitative review of the literature.RESULTS Curiosity is related to inquisitiveness, reflection and mindfulness. Instructional practices can suppress curiosity by confusing haste with efficiency, neglecting negative emotions, promoting overconfidence and using teaching approaches that encourage passive learning. Curiosity tends to flourish in educational environments that promote the student's responsibility for his or her own learning, multiple perspectives and mindful reflection on both the subject and the learning process. Specific educational strategies that can support curiosity in classroom and clinical settings include the mindful pacing of teaching, modelling effective management of emotions, confronting uncertainty and overconfidence, using inquiry-based learning, helping students see familiar situations as novel, simultaneously considering multiple perspectives, and maximising the value of small-group discussions. Instructor attributes that contribute to the development of student curiosity include patience, a habit of inquiry, emotional candour, intellectual humility, transparency and recognition of the benefits to be gained in learning from peers.CONCLUSIONS Curiosity, inquisitiveness and related habits of mind can be supported in medical education through specific, evidence-based instructional approaches. Medical educators should balance the teaching of facts, techniques and protocols with approaches that help students cultivate and sustain curiosity and wonder in the context-rich, often ambiguous world of clinical medicine.the cross-cutting edge

CONTEXT: Studies showing that physicians often interrupt the patient's opening statement assume that this compromises data collection. OBJECTIVE:To explore the association between such interruptions and physician accuracy in identifying patient concerns. DESIGN:This study replicates the Beckman-Frankel methodology and adds exit interviews to assess physician understanding. The authors audiotaped a convenience sample of 70 encounters and surveyed both parties following the visit.SETTING: A community-based ambulatory clinic. PARTICIPANTS:Internal medicine residents (77%) and attending physicians and their adult, English-speaking patients who were primarily low income and ethnic minority. OUTCOME MEASURE: The Index of Understanding measures patientphysician problem list concordance. It is the percentage of patient problems, obtained on exit, that the physician correctly identifies. RESULTS:In 26% of the visits, patients were allowed to complete their agenda without interruption; in 37% the physicians interrupted; and in 37% no inquiry about agenda was made in the first 5 minutes. Neither physician experience nor their assessment of time pressure or medical difficulty was associated with these rates. Exit interviews showed no significant difference in Index of Understanding between those involving completion of agenda (84.6%) and those involving patient interruption (82.4%) (P =.83). But when the physician did not solicit an agenda, the concordance was 59.2%, significantly lower than either the completion (P =.014) or the interruption group (P =.013). CONCLUSION:Interruption as defined by Beckman-Frankel does not curtail ability to identify patient concerns, but failure to ask for the patient's agenda associates with a 24% reduction in physician understanding.

Medical educators have promoted skillful communication as a means for doctors to develop positive relationships with their patients. In practice, communication tends to be defined primarily as what doctors say, with less attention to how, when, and to whom they say it. These latter elements of communication, which often carry the emotional content of the discourse, are usually referred to as interpersonal skills. Although recognized as important by some educators, interpersonal skills have received much less attention than task-oriented, verbal aspects. Moreover, the field lacks a common language and conceptualization for discussing them. This paper offers a framework for describing interpersonal skills and understanding their relationship to verbal communication and describes an interpersonal skill-set comprised of Understanding, Empathy, and Relational Versatility.