Teaching clinical communication: A mainstream activity or just a minority sport?

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Abstract

This plenary presentation from the EACH International Conference on Communication in Healthcare in Oslo 2008, takes an honest look at the present state of communication teaching and considers how to take the next steps to move communication into the very centre of medical education.

Although clinical communication teaching has become increasingly accepted as a formal component of the medical curriculum, there is still a problem to be faced. Communication still often appears in medical education to be a peripheral element rather than a mainstream activity truly perceived by schools and learners as central to all clinical interactions.

This presentation explores why clinical communication often appears to be a minority sport in medical education, considers how to overcome this via integration throughout the curriculum, looks at five specific examples of integration in action, presents a new UK consensus statement which helps integrate communication into the mainstream, and finally explores the progression to maturity in communication curricula.

Introduction

Over the last 10 years, clinical communication skills teaching has come of age. For those of us working in the field, it has been gratifying to see the increasing acceptance of the subject as a formal component of the medical curriculum. However, the title of this talk “Teaching clinical communication: a mainstream activity or just a minority sport?” suggests there is a problem to be faced. Is communication truly perceived by schools and learners as central to all clinical interactions or is it being taught as a token gesture? The prime focus of this presentation is to take an honest look at the present status of communication teaching and consider how to take the next steps to move communication into the very centre of medical education.

Many people have contributed to the thoughts in this paper and I would like to particularly thank my colleagues Suzanne Kurtz and Julie Draper. We have worked long and hard over many years putting these ideas together and I would like to acknowledge their joint contribution to the concepts I’m going to express.

I would also like to acknowledge a great strength of these International Conferences on Communication and Healthcare, the bringing together of the two worlds of research and teaching about communication. This presentation focuses on the world of communication teaching but teaching and research in communication are entirely inter-dependent. Teachers are reliant on researchers to know what and how to teach but without the translation of this research into effective teaching, patients will not benefit by future changes in clinicians’ skills. And it is this which concerns me—how to ensure that the final common pathway for all our work, the education of the next generation, is secured.

At these conferences, there is a wide representation of disciplines contributing to the teaching of communication skills. This diversity adds greatly to the richness of our teaching: backgrounds include psychology, sociology, social anthropology, nursing, professions allied to medicine, general practice, psychiatry and specialist medicine. Yet as we will see, sometimes the underrepresentation of certain of these groups in our teaching contributes to the problem of the marginalisation of our specialty that I am going to discuss.

Because of my own background, I am going to look at this issue from the perspective of undergraduate medical education but I very much hope that what I say will translate into other teaching environments including postgraduate education and other healthcare professionals.

In this talk I will cover the following five areas:

  • 1.

    Why does clinical communication often appear to be a minority sport in medical education?

  • 2.

    How to overcome this: integrate, do not separate.

  • 3.

    Five specific areas of integration.

  • 4.

    A new UK consensus statement to help integrate communication into the mainstream.

  • 5.

    The progression to maturity in communication curricula.

Section snippets

Basic premises

However, before I start, there are two premises which I need to mention briefly, both vitally important constructs on which all else is predicated.

Why does clinical communication often appear to be a minority sport in medical education?

Yet despite this, why does clinical communication teaching still often appear to be a peripheral element rather than a mainstream activity in medical education? I am privileged to visit many medical schools around the world and when I look at their communication curricula, I always ask myself the same set of questions to try to establish how communication is perceived within their institution.

  • Do real clinicians model this? Is the teaching in the communication curriculum mirrored or undermined

Conclusion

I sincerely believe that we are now on the verge of communication skills teaching becoming a mainstream activity in medical education. I applaud everybody who has put so much effort into championing the cause over the last 30 years and encourage all of us now to push the boundaries forward by integrating, collaborating and above all persevering.

Role of funding

I have received no financial support for the preparation of this article.

Conflict of interest

There are no conflicts of interest to disclose.

Acknowledgements

I would like to acknowledge the help of Marcy Rosenbaum, Associate Professor of Family Medicine, University of Iowa Carver College of Medicine, for her advice in fine tuning the original presentation of this article at the Oslo conference.

References (20)

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