Medical students learning communication skills in a second language. Empathy and expectations

Communication skills [CS] training for medical interviewing is increasingly being conducted in English at medical schools worldwide. In this study, we sought to identify whether Arabic-speaking medical students experienced difficulty with the different components of the CS training that were conducted in English. Individual third-year preclinical medical students [N = 45] were videotaped while interviewing simulated patients. Each student assessed his/her performance on a 13-item [5-point scale] assessment form, which was also completed by the tutor and other students in the group. Of the 13 components of their CS training, tutors awarded the lowest marks for students' abilities to express empathy, ask about patients' feelings, use transition statements, ask about functional impact, and elicit patients' expectations [P <0.001]. The expression of empathy and the ability to elicit patients' feelings and expectations are difficult to develop in medical students learning CS in a second language

[Impact of a communication skills audiovisual package on medical students' knowledge]

Over the last decade more emphasis is being put on teaching communication skills [CS]. Use of videos and role-play was suggested to improve CS. This article will present the impact of an audiovisual package on promoting the knowledge of medical students in CS. Seventy-five second year medical students - distributed into eight groups led by four facilitators - critiqued a video clip immediately before and after the introduction of a communication skills audiovisual package. The skills taught included opening the interview, questioning, facilitation, clarification, reflection, confrontation, summarizing, and preparation of the patient for the physical exam. The students, also, role-played the reviewed scenario. The students' pre- and post-intervention responses were analyzed using a standardized grading form. There was a significant improvement in students' knowledge [p < 0.000] after the introduction of the intervention in all the CS taught except closed ended questioning. This improvement was consistent among the four facilitators. Reviewing video scenarios and role-playing improved the knowledge in core communication skills among second-year medical students assessed by a video-based written examination

[Focus groups findings reveal barriers to teach communication skills to medical students]

In December 2002, 74 medical students in the second preclinical years at the American University of Beirut [AUB] attended a workshop on basic communication skills [CS]. The students watched video clips which demonstrated different communication skills and stages of the consultation, and role-played to try out ways they could improve the consultation. Their familiarity with the skills taught was assessed at the beginning of the workshop, immediately afterwards, and again six months later. There was a significant improvement noted immediately after the intervention but this apparent gain was lost at six months. Sixteen students, who attended the workshop, also attended two focus group discussions which were aimed to assess student recall of the communications skills workshop, and explore ways in which the students thought the knowledge gained could be maintained. In general students thought that lack of exposure to patients at the time when the CS course was held, and a lack of consistency in CS coupled with poor faculty CS role modeling hindered their ability to maintain and practice good CS. Teaching CS may be more effective if medical students are taught these skills when they are exposed to patients on a regular basis, and the training is maintained throughout the clinical years. However, more emphasis should be on reminding faculty members of their role as teachers and good communicating role models to students through workshops and seminars

Managing diabetes mellitus in a Lebanese primary care centre. working towards change

Objectives: demand for medical care in Lebanon is dominated by diseases, such as diabetes. Quality of documentation of care given to these patients in a primary care centre, prior to and after introducing a diabetes initiative [DI] is reported. Methods: Chart audit of diabetic patients attending an inner city health center in Beirut, during 1/6/94-30/8/96 was conducted. DI was introduced in 1/1/97, and audit repeated six months later. Results First and second audits identified 213 and 162 patients respectively. Audit I showed poor recording for almost all parameters; example: family history [3%], smoking status [11%], hypertension [9%], dyslipidaemia [4%], BMI [nil], blood pressure [46%], foot exam [16%], HbA1c [nil], serum cholesterol and triglyceride [27%] and urine analysis [12%]. Audit II revealed an improvement in the recording of most parameters, risk factors such as: smoking status, hypertension, hyperlipidaemia [98-99%], physical examination: BMI [39%], foot and peripheral circulation [91-92%] blood pressure [87%]. Over half the patients had undergone a complete metabolic workup. Conclusion: Over the short period of time there appear to have been an important improvement in the documentation of medical care for these diabetic patients. Effects of this change in terms of clinical outcomes is currently being assessed