In a section of the BMJ under the header How To Do It, Ian Christopher McManus, Charles A. Vincent, S. Thom, and Jane Kidd offer practical advice from their experiences teaching communications to students at St. Mary’s Hospital Medical School.
I’m certainly not running a medical school, but there are still some interesting, practical ideas to be gleaned from the authors’ experiences.
The paper was published in 1993, and some of the ideas have found widespread acceptance, such as the use of actors in clinical simulations. Other ideas, like practical communications skills being part of final examinations, aren’t as widely used.
Central to the authors’ pedagogy and paper is the idea that
complaints about doctors by the public usually do not deal with clinical competence but with problems of communication.1 McManus et al. place this at the core of their training. In so many words, I knew that this was a common complaint of patients. What I wasn’t aware of is that
Without specific training, medical students’ communication skills seem to decline during medical training.2, 3
Communication needs to be emphasized and re-emphasized across the career of healthcare practitioners. Based on the data provider communication skills, McManus et al. start teaching communications as early as possible:
The introduction to communication skills takes place during the first days of the clinical course, thereby emphasising the central role of communication in good medical practice. Students are helped to recognise that good communication is important to clinicians in all specialties by the participation of behavioural scientists and practising clinicians from many departments—anaesthetics, continuing care, clinical pharmacology, endocrinology, general surgery, medicine, nephrology, obstetrics and gynaecology, oncology, paediatrics, public health, and respiratory medicine. Although in the early years we emphasised why communication skills were important, students now seem to accept that communication is important and our emphasis has shifted to how to communicate.
I know from my own experience that some groups are sold on the idea that better communication translates to an improved medical practice. Others aren’t. The first phase of any communications training is gauging how hard the instructor is going to have to work convincing their students that this training is worth it. Colleagues of mine in medical schools are often frustrated that students and administrators alike don’t see much value in communications training. This usually fades in the years after the program is introduced, although there will always be an individual student who wonders why they have to practice actually talking to people.
Another central focus of the paper by McManus et al. is that
that communication can be taught, or, more accurately, as they go on to elaborate, it can be learned:
It is important that all teachers understand that the purpose of the teaching is to help students develop their own skils. People, whether staff or actors, who feel that they have a specific “message” to impart are often not successful communication skills teachers.
This is part of why I approach communication from a structural point of view. Understanding how a story is told, and why it’s effective doesn’t make you more like anyone else, it makes you more like you. Everyone already uses some kernel of narrative to communicate. Learning how to nurture that instinct not only makes our communication more useful, it lets us be ourselves. Like McManus et al. say, if you can put a story into motion, you can develop your own skills.
I also appreciate how the practical skills the authors discuss are introduced gradually, and in ways at are as non-threatening as possible. As the authors put it,
going first is stressful. This is something I try to implement not only in my own teaching, but in my own approach. I sometimes get overwhelmed at the amount of critical theory that’s available. Every time I find myself roaming the postmodern landscape of Saussurean semiotics, I have to bring myself back to a few simple ideas: What is a story? What are the parts to a story? How does it begin? How does it end? How does it impact understanding? How does it motivate behavior?
One of the last elements that McManus et al. mention is that they know their teaching has had an impact. Further double-blind studies and peer-reviewed papers are good and necessary, but they know their work is successful because of the increased demand:
students have specifically suggested further topics. As the authors humbly put it,
such interest suggests that teaching has influenced attitudes towards communication in medical practice.
That’s the gold standard for anyone trying to connect providers and patients more. If patients and everyone who interacts with them come back saying, “This is useful, let’s do more of it!” we’ve done our job.
The article reviewed: McManus, I. C., C. A. Vincent, S. Thom, and J. Kidd. “Teaching Communication Skills to Clinical Students.” BMJ (Clinical Research Ed.) 306, no. 6888 (1993): 1322–27. https://doi.org/10.1136/bmj.306.6888.1322.
1 Richards, Tessa. “Chasms in Communication.” BMJ (Clinical Research Ed.) 301, no. 6766 (1990): 1407–8. ↑
2 Preven, David W., Elizabeth Krajic Kachur, Robin B. Kupfer, and Jane A. Waters. “Interviewing Skills of First-Year Medical Students.” Journal of Medical Education. 61, no. 10 (October 1986): 842–44. ↑
3 Sanson-Fisher, R., and P. Maguire. “Should Skills in Communicating with Patients Be Taught in Medical Schools?” Lancet 316, no. 8193 (September 6, 1980): 523–26. https://doi.org/10.1016/S0140-6736(80)91844-9. ↑
Featured Image: detail of Pietro Longhi’s The Apothecary, ca. 1752, in the Gallerie dell’Accademia, Venice, Italy; the work is in the public domain