An advanced communication skills course for fourth-year, post-clerkship students

A novel five-module advanced communication skills course entitled "Doctor-Patient Relationships" was planned and implemented in 2000-01 at the University of British Columbia (UBC). The course was part of the final four-month component of the new MD undergraduate program: Effective Skills for Medical Practice. The goals of the communication skills course were to (1) address problems experienced by the students so far; (2) address deficiencies in achieving the UBC exit competencies; (3) help the students pass the Medical Council of Canada examinations, in particular objectives related to the Considerations of the Legal, Ethical, and Organizational aspects of the practice of medicine (CLEO); and (4) help students prepare for their roles beyond undergraduate medicine (residency, independent practice).

The course was developed by an interdisciplinary team (family practice, pathology, pediatrics, psychiatry, surgery) with input from students. The broad strengths and weaknesses of their communication skills training were identified by seven third-year medical students who kept logs over the course of their clinical clerkships to document their learning of communication skills. Analysis of these logs plus feedback meetings with the students revealed attitudinal and skills issues that needed to be addressed in the new course. The goals and principles of the course were in part agreed upon by focus groups with students, attended by faculty observers, to ensure their relevance to students. The first module "Beyond the Mask: Surviving and Thriving in Residency Training" is designed to focus students' attention on the personal relevance of developing excellence in communication skills in preparation for residency training. It includes a video of residents talking about their experiences of communication problems to trigger reflection and discussion. In the remaining four modules the students are required to put communication skills together with their medical knowledge. Each module includes pre-readings, video demonstrations (in sessions 4 and 5), practice with standardized patients (total of 14 scenarios) and structured feedback from SPs, students, and tutor. The themes of the sessions are "Dealing with Emotionally Challenging Patient Situations (informing about bad news), "Compliance and Patient Information," "Informed Consent and Shared Decision Making," and "Difficult Physician-Patient Encounters." Each module lasts two hours. The course was implemented for 120 students, facilitated by 14 tutors (seven to eight students per group).

Student involvement in many different ways provided an important reality check and made us think about how to present the new course so that it was relevant and interesting to students. Attention to student input was a major contributor to the good evaluations given the course. Students rated the course highly: the relevance of the weekly themes was rated 4.21 on a five-point scale; the effectiveness of the SP interviews, 4.10; the effectiveness of the group discussion and feedback, 4.18; and overall course effectiveness in enhancing communication skills, 3.91. The tutors also rated the course highly, and the students rated the tutors highly. Minor changes will be made to the course next year based on the specific suggestions for improvement, which were identified.