Communication with patients as a problem in undergraduate medical education.

The work is based on the following concepts: communication with patients ceases being a matter of experience learning only (the trial and error method) and should become a part of systematic training; it should not be included only into continuous education of graduated physicians but must be gradually introduced into undergraduate education as well; it is not an optional activity which may but may not be performed by physicians, but it is a specific component of their clinical competence. Today attempts to instruct medical students in communication with patients and their relatives are being made at many medical schools all over the world. Reports on such instruction are, however, scattered in various journals or in internal publications published by universities, faculties and clinics. Thus they are not available very easily. If there exist some survey works, they are mostly conceived on the national level. The objective of the study presented here is to show a comparatively comprehensive survey dealing with the medical student instruction on the international level, analyze trends in development and identify problems that have not been solved so far. The work consists of five chapters. The first one gives a short survey of current concepts in communication with patients reaching beyond the traditional training in taking medical history. Among others, the following factors are included here: explanation of both diagnostical and therapeutical methods to the patient, informing the patient about results obtained from the examination, telling him or her general conclusions and recommendations, informing patients of social associations of the disease, developing in the patients those attitudes which support their cooperation with physicians and the patient's will to live, ability to treat serious and terminal patients properly, ability to treat patients' relatives and communicate with other members of a medical team. The second chapter shows current attempts to train the medical student-patient communication in Czechoslovakia, especially at Charles University. Third chapter describes how medical students in the former USSR were instructed, especially at medical schools in Moscow. This kind of information is still difficult to be had for people from abroad. The fourth chapter is the most important. Current attempts to train medical students in communication with patients in Europe, North and South America, Asia, Africa and Australia are described there. Reference frames in which the instruction takes place (medical, educational, psychological frames) are studied.(ABSTRACT TRUNCATED AT 400 WORDS)