Teaching medical communication skills: a call for greater uniformity.

Background And Objectives: Evidence suggests that strategies used in teaching communication skills vary widely among, and within, medical education programs. Such variance also exists in the amount of emphasis placed on specific communication skills. This study examines the degree of variability among medical faculty in identifying opportunities for teaching communication skills.

Methods: Sixty-seven medical faculty (physicians and behavioral scientists) reviewed a videotaped interview of a clinician with a standardized patient. Using a transcript of the interview, participants identified moments in the tape they believed warranted an instructional intervention to reinforce or modify the clinician's communication skills. Items identified by the participants were compared to items identified by a panel of experts. Frequencies and ANOVAs were used to report on consistency and on consistency as a function of faculty experience and educational background.

Results: Faculty demonstrated marked differences in identifying teachable moments across all six communication categories: (1) rapport building, (2) agenda setting, (3) information management, (4) active listening for the patient's perspective, (5) responding to emotion, and(6) skills in reaching common ground. Of 67 respondents, 29.6% identified none of the opportunities to teach rapport building, while only 31% identified all opportunities; 32.8% identified none of the information management opportunities, 26.9% identified all; 77.6% failed to identify the agenda-setting opportunity, 22% did identify the opportunity; 25.4% identified none of the active listening opportunities, 9% identified all; 57.6% identified none of the responding to emotion opportunities, 18% identified all; 35.8% did not identify the opportunity for reaching common ground, 64% did identify the opportunity.

Conclusions: Our findings demonstrate that faculty who teach communications vary widely in the issues that they identify and about which they chose to teach. Recommendations are made for further research in this area.