Consultation skills of medical students before and after changes in curriculum

Abstract

The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed--a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval -20 to -6%, P < 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change.

A proposal for overcoming problems in teaching interviewing skills to medical students

“…However, we believe that these principles are particularly important for teaching interviewing skills. Indeed, several authors (Utting et al 2000;Maguire and Pitcealthy 2002;Smith et al 1998;Draper et al 2002;Lin et al 2001) have implemented teaching programs of patient interviewing that consist of an ongoing teacher-learner dialogue, which is the main tenet of the proposed approach. Some of these programs have used individual tutoring, thus establishing a personal relationship between the teacher and the learner (Birgegard et al 1996).…”

“…Fourth, several authors have questioned the appropriateness of the methods of assessment of students' interviewing skills. These methods consist of observation of trainees while interviewing standardized or real patients (Holmboe 2004), either during an entire patient's interview (Fallowfield et al 2003;Utting et al 2000;Enzer et al 2003) or during an objective structured clinical examination (OSCE) (Junger et al 2005). The assessment of the observed performance is based either on behavioral coding by detailed checklists (Roter 1977;Smith et al 2000) or global ratings that are guided by a relatively small number of evaluation items (Cohen et al 1991).…”

“…Still, some teaching programs have encountered difficulties (Utting et al 2000), and as late as the last decade, research has drawn attention to the deficiencies in interviewing skills among students, residents and practicing physicians in the US (Holmboe 2004;Mueller et al 2006), Canada (Langille et al 2001) and the UK (Fallowfield and Jenkins 2006). For example, recent surveys at academic medical centers have revealed that internal medicine faculty rated the adequacy of their own training (Mueller et al 2006) and that of their students (Langille et al 2001) in patient interviewing as poor; another study noted that patients frequently left their medical consultations with insufficient understanding about their management, and attributed this situation to the ''dismal communication skills training that most healthcare professionals receive'' (Fallowfield and Jenkins 2006).…”

Problem‐based learning: a dissemination success story?

“…Furthermore, the adoption of PBL provides an opportunity to achieve change in curriculum content, 22 reflecting the ideology of the educational change agents promoting the approach. This has led to a greater emphasis on topics such as community medicine, interaction skills, palliative care and other learning areas that were traditionally marginalised or neglected in the curriculum 23 .…”

Impact of three alternative consultation training formats on self-efficacy and consultation skills of medical students

“…Students should be trained to observe consultations to be able to provide relevant feedback to peers. Utting et al 2000). In the present study, we move beyond a focus on more consultation skills development.…”