Bolstering Medical Students' Communication Skills

Contact Lois Bowers, 216-368-4692 or [email protected]

Although good communication is vital to the doctor-patient relationship and, therefore, patient health, the formal teaching of communication skills traditionally has been relegated to the first two years of medical school, before students begin seeing a lot of patients, and has focused mainly on interviewing techniques.

Now, three medical schools are seeking to change that tradition through a grant from the New York-based Josiah Macy Jr. Foundation.

The medical schools at CWRU, New York University, and the University of Massachusetts have joined forces in the Initiative in Health Communication, a demonstration project that researchers hope will produce a teaching model that can be used by medical schools across the country.

The CWRU medical school will receive almost $1.4 million over four years toward this end.

"A wealth of research shows that formally teaching physicians communication skills alters practice, improves patient outcomes, improves patient satisfaction and improves physician job satisfaction," said Theodore V. Parran Jr., assistant professor of medicine and family medicine and one of the project's principal investigators at CWRU.

"The communication skills training that has taken place in medical schools in the past has occurred mainly in the first and second years, before students begin seeing a lot of patients," he added.

"When students are in the midst of the ultimate learning laboratory, the third year, when they are with patients all day, every day, the formal teaching about communication disappears. A lot of informal mentoring continues because of the expertise of the faculty, but it's not built into the learning objectives of the clerkships and the various other experiences students have."

The Macy Foundation has a long history of impelling curricular reform, explained Susan Wentz, assistant professor of family medicine and medicine and the other principal investigator at CWRU.

This particular project was born of a wish of the foundation's president, June E. Osborn, who wanted to expand the foundation's emphasis to include not only general curriculum and faculty development, but also professionalism in medicine.

The initiative allows those at CWRU to combine their expertise with the expertise at UMass, including Aaron Lazare, chancellor of UMass Worchester and dean of the UMass Medical School, and the expertise at NYU, including Mack Lipkin, professor of clinical medicine and director of the division of primary care in the NYU Department of Medicine.

Lipkin is one of the founders of the Task Force on the Medical Interview, which later became the American Academy on Physician and Patient, "clearly the leading group on physician-patient communication skills and how to teach them," said Parran.

Lipkin and Lazare are co-editors, along with Samuel M. Putnam, of the Medical Interview, "the most comprehensive textbook on the medical interview that's been published to date," Parran added, noting that the medical interview is "the vessel of the doctor-patient relationship."

The three schools are now determining the core communication skills that students and residents should learn in each year of medical school and examining their curricula to determine which skills are already taught and which ones need to be added. The specifics of student evaluation and faculty development are being decided as well.

Approximately 600 medical students are enrolled at CWRU. Implementation will begin with the 1999-2000 academic year.

"One of the most amazing things about the Macy project is that it reflects and supports long-standing educational initiatives that have been a part of this school over many years," Wentz said.

Osborn and Lazare graduated in 1961 from CWRU's School of Medicine, and Parran is a 1982 alumnus. Now they are contributing to that tradition as medical professionals.

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