November 4, 1999
UW School of Medicine teaches doctor/patient communication at each level of physician training
Sometimes effective or ineffective communication styles can make the difference between a doctor who’s easy to talk to and another who gives the mistaken impression of being highhanded and dismissive.
Long recognizing that good doctor/patient communication is essential to good practice, the University of Washington (UW) School of Medicine has made it one of the cornerstone skills of the Introduction to Clinical Medicine course series for first- and second-year medical students. The series, which focuses on the fundamentals of doctor/patient interactions — professionalism, patient interviewing, and the medical history and exam — has been taught since 1969. The course is required for the Seattle-based medical students and for those taking their UW medical school first-year classes at Montana State University in Bozeman, University of Alaska-Anchorage, University of Idaho-Moscow, University of Wyoming in Laramie, and Washington State University.
“We start with the basics of beginning and ending a patient interview — introducing yourself to the patient, asking the patient’s name, how to bring an interview to a close and so on,” said Dr. Erika Goldstein, associate professor of medicine in the Division of General Medicine, “then we move on to cover thoroughly all aspects of interviewing a patient in all kinds of medical situations.” Goldstein co-chairs the course with Dr. Jane Huntington, acting assistant professor of family medicine.
Students practice with each other, with faculty members, and with simulated patients. These are people who either act in the role of a patient or who are actual patients trained in presenting their illness in a standardized way. At times the interviews are taped for the medical students to review afterward.
Goldstein explained that students are taught many techniques to give them flexibility to fit the situation at hand. The course also gives medical students practice in approaching difficult topics, such as suspected physical abuse or alcoholism. Overall, she said, the series teaches medical students how to listen and be sensitive to subtleties in order to understand better what is going on with their patients.
The UW School of Medicine is seeking new ways to reinforce these skills during the last two years of medical school, which is the clinical training period.
“Across the country there has been little attention paid to developing doctor/patient communication skills after students begin their clinical rotations,” said Dr. Larry Mauksch, a behavioral scientist and clinical associate professor of family medicine. “Research on the use of doctor/patient communication skills among practicing physicians shows that we need to emphasize more skill development throughout training, particularly during the third and fourth years of medical school when students’ clinical styles begin to form.”
The UW Department of Family Medicine, in collaboration with other departments, has begun a new effort to integrate doctor/patient communication and patient-centered care across the four years of medical school. This effort will be supported with the department’s federal training grant from the Health Resources and Services Administration of the U.S. Public Health Service. Dr. Tom Greer, associate professor and director of medical student education in the Department of Family Medicine, is the principal investigator on this grant.
Beginning this year, all medical students who take their required family medicine clerkship at UW Medical Center will receive additional training in doctor/patient communications. They will review a videotape demonstrating three sets of skills: working with the patient to set an agenda, eliciting the patient’s and family’s perspective on the illness, and reaching common ground on a treatment plan. The students will read some of the research literature on doctor/patient communications, and will tape clinical interactions to review with the clerkship coordinator. Mauksch will directly observe his students with patients and later give them feedback using a skill-tracking form.
In addition, Mauksch offers an elective clinical course for fourth-year medical students. This course, taught in actual patient-care settings, provides more intensive training in doctor/patient interviewing and primary-care counseling.
After graduating from medical school, new physicians in the UW residencies often continue to receive advanced education in doctor/patient communication as an integral part of their programs. A survey of UW residency graduates conducted in 1998 by Dr. Robert Crittenden, associate professor of family medicine, and Dr. Douglas Schaad, instructor in medical education, documented the importance UW-trained practicing physicians attached to learning how to communicate well.
The primary-care residencies of pediatrics, general internal medicine, and family medicine, as well as the obstetrics/gynecology residency, place a special emphasis on this topic, according to Dr. John Gienapp, director of graduate medical education program assessment and development. Several of the residency programs evaluate the communication abilities of their new residents. In many cases, he said, additional training then focuses on enhancing skills the residents already gained during medical school.
Clinical psychologist Dr. Dan O’Connell, a Northwest regional consultant for the Bayer Institute for Health-Care Communications and a faculty member of the Foundation for Medical Excellence, assists several UW residency programs on their curricula in this area. O’Donnell is a clinical instructor in psychiatry and behavioral sciences at the UW.
A number of research studies have documented the effectiveness of good communication skills in improving the provision of care.
“When patients feel they have participated fully in their treatment decisions, when they believe they have been heard and their questions answered,” Mauksch said, “their satisfaction with their care is higher, and the outcome of their care is better as well.”
