Patient Education and Counseling 54 (2004) 119–121

Short Communication

Medical students’ views and experiences of methodsof teaching and learning communication skills

Charlotte Reesa,∗, Charlotte Sheardb, Amy McPhersonba Institute of Clinical Education, Peninsula Medical School, Tamar Science Park, ITTC Building, Davy Road, Plymouth PL6 8BX, UK

b Division of Psychiatry, University of Nottingham, Nottingham, UK

Received 22 February 2003; received in revised form 18 May 2003; accepted 9 June 2003

Abstract

This study aims to explore undergraduate medical students’ views and experiences of methods of teaching and learning communicationskills. Five focus groups were conducted with 32 students, with representatives from each of the 5 years of the medical degree, at theUniversity of Nottingham, UK. The audiotapes were transcribed in full and the transcripts were theme analysed independently by twoanalysts. Two themes relating to methods of teaching and learning communication skills emerged from the analysis. Students had mixedviews about instructional methods of teaching and learning communication skills such as lectures. Students seemed to prefer experientialmethods of learning communication skills such as role-playing with simulated patients and communicating with real patients in a clinicalcontext. These findings have a number of educational and research implications and these are discussed in this paper.© 2003 Elsevier Ireland Ltd. All rights reserved.

Keywords: Medical education; Communication skills teaching

1. Introduction

Aspegren [1] reviewed 83 medium- and high-qualitystudies evaluating the effectiveness of communicationskills training programmes. Twenty-five randomised stud-ies demonstrated that medical students could and do learndifferent communication skills by training. The review alsodemonstrated that instructional methods such as lectureswere ineffective in the teaching of communication skills incomparison with experiential methods like videotaped inter-views with simulated patients and feedback from the teacher.Although many studies have evaluated the effectiveness ofteaching and learning methods, there is a lack of researchthat explores in depth undergraduate medical students’views and experiences of such methods. This short commu-nication aims to address this gap in the research literature.

2. Methods

After receiving ethical approval, five focus group discus-sions were convened with 32 students, with representatives

∗ Corresponding author. Tel.:+44-1752-238009;fax: +44-1752-238001.E-mail address: charlotte.rees@pms.ac.uk (C. Rees).

from each of the 5 years of the medical degree, at the Univer-sity of Nottingham in the academic session 2000–2001. Allof the discussions were audiotaped and transcribed in fulland the transcripts were theme analysed independently bytwo analysts. This allowed the determination of inter-raterreliability, and any differences were negotiated. The levelof agreement between the two analysts for each of the fivefocus groups wereκ = 0.609 (year 1),κ = 1.000 (year2), κ = 0.400 (year 3),κ = 0.545 (year 4) andκ = 0.300(year 5). These levels of agreement were substantial (year1), perfect (year 2), fair (year 3), moderate (year 4) and fair(year 5), as indicated by Landis and Koch[2]. Full detailsof the design, sampling and recruitment procedures, mate-rials, focus group procedure and data analysis are reportedelsewhere[3].

3. Results

Participants’ ages ranged from 19 to 27 years (median=20, inter-quartile range= 19.25–22.0). The majority werewhite (n = 28, 87.5%), female (n = 22, 68.8%) andfrom socio-economic status I and II (n = 31, 96.9%).All spoke English as their first language. Seven (21.9%)participants were first-year students, 7 (21.9%) weresecond-year students, 10 (31.3%) third-year students, 5

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120 C. Rees et al. / Patient Education and Counseling 54 (2004) 119–121

Table 1Verbatim quotations supporting themes

Themes Verbatim quotations

Formal methods of teaching 1. I remember the very first hospital visit. . . we hadn’t had any CS lectures then. . . we were trying to talk to a blokeabout why he was there and it took about 10 minutes to find out what he was actually there for, because we didn’t askan open question to start off with. The first GP visit after the lecture was so much easier, because we knew what to do(first-year student).2. In a lecture, a lot of it that is covered does seem like common sense and it seems like a bit of a waste of time beingthere, because you think, ‘well, I’d know not to use complicated medical terms when I was talking to a child’(second-year student).3. It’s such an odd way to learn about how to communicate when someone’s talking at you (third-year student).4. Another advantage of having a seminar would be that people can talk about their individual experiences and whatthey have learned from them and share it with other people in the seminar group (second-year student).5. The video one was really good, because it was really good to see what you do. . . pick up all your annoying habitsthat you do and stuff, ’cause when you’ve seen them, you can try to do something about them (first-year student).6. It’s [role-playing] not patient contact, it’s practicing, and the best place to practice is not on patients (third-year student).7. X: If you’ve prepared it all [the interview] and you’ve got questions lined up in your head then it’s artificial.

Y: That is one of the main problems I felt with it [role-playing], that it’s been quite a poor substitute for actuallytalking to patients (second-year students).

Practice with real patients 8. I think it would be good to do more patient interviews. . . I think that would be really good (first-year student).9. I had an old guy and he was just sitting there and he was like, ‘hi’, and I didn’t know what to say at all. I mean’cause you’ve seen it so many times you think it’s going to be fairly easy, ’cause your GP does it all the time, youthink, ‘oh yeah, I could do that’ and then you get there and you’re like, ‘I can’t remember anything’ (first-year student).10. My GP doesn’t have the time, doesn’t have a spare room, and he made that very clear to me last year, he apologised,he said, ‘you cannot interview a patient on your own because there’s not the time to do it’ (second-year student).

(15.6%) fourth-year students and 3 (9.4%) were fifth-yearstudents.

Two themes relating to teaching and learning methodsemerged from the analysis of the focus group transcripts.

3.1. Students’ mixed views and experiences of formalteaching of communication skills

3.1.1. Instructional methodsStudents had mixed views about lectures as a method of

learning communication skills. Some students valued lec-tures on communication skills because they felt that lecturesstimulated their thinking about important communicationissues and helped them communicate with real patients(Table 1, quote 1). Other students criticised lecture methodsbecause the information given in lectures was viewed as‘non-academic’ (Table 1, quote 2) and that lectures involvedstudents’ passive acquisition of knowledge rather than theiractive learning of skills (Table 1, quote 3). Participantspraised seminars for giving students the opportunities tofacilitate their team working skills and share their experi-ences interviewing real patients with their peers (Table 1,quote 4).

3.1.2. Experiential methodsStudents had generally positive views about the use of

role-play as a method of practising and developing theircommunication skills. Some students thought that role-playwas an enjoyable way to learn and that role-play providedthem with opportunities to observe other students and com-pare their performances. Students also found that videotap-ing and then watching their role-plays was a useful learning

experience because it enabled them to identify their weak-nesses so that they could improve their communicationskills (Table 1, quote 5). Some participants felt that role-playhelped students practice more advanced communicationskills in ‘safe’ environments and that it was more appropri-ate for students to practice their communication skills withsimulated patients than with real patients (Table 1, quote6). However, other students criticised role-play for beingartificial and for not being spontaneous (Table 1, quote 7).

3.2. Students’ preferences for learning communicationskills by practising with real patients

Students valued opportunities to interview real patients,particularly pre-clinical students who spent most of theirtime in lectures and seminars (Table 1, quote 8). Somepre-clinical students explained how they had underestimatedhow difficult it would be to interview real patients beforetheir first interview (Table 1, quote 9). Other pre-clinicalstudents discussed the practical difficulties with communi-cating with real patients. Some students described how theyfelt uncomfortable being part of a large group of studentsinterviewing one patient on ward visits. Other pre-clinicalstudents explained that some of their GP tutors did not allowthem enough, if any, opportunities to interview real patients(Table 1, quote 10).

4. Discussion and conclusion

This study has begun to explore medical students’ viewsand experiences of methods of teaching and learning

C. Rees et al. / Patient Education and Counseling 54 (2004) 119–121 121

communication skills. Students have mixed views about in-structional methods of learning communication skills suchas lectures. Some students felt that lecture methods wereinappropriate because they involved the passive acquisitionof information rather than the active learning of skills. In hisreview of the literature, Aspegren[1] concluded that instruc-tional methods like lectures were ineffective in comparisonwith experiential methods such as students interviewingsimulated patients and receiving immediate feedback fromteachers. Students seemed to prefer experiential methodsof learning communication skills such as role-playing withsimulated patients and communicating with real patients ina clinical context. In particular, students found videotapedrole-plays useful for assessing their own communicationskills. Evans et al.[4] compared lectures (five lectures) andskills workshops (five lectures plus three 2-h videotapedrole-plays with discussion) as methods of learning com-munication skills and found that students undergoing theskills workshops demonstrated significant improvements ininterview skills compared with students in the lecture onlygroup. Whilst there were some improvements after masslectures, the most significant gains in history-taking wereobtained following the skills workshops[4]. However, somestudents in the current study criticised role-play interviewsfor being artificial, instead preferring practice with realpatients. Students valued opportunities to interview realpatients, particularly pre-clinical students who seemed toenjoy learning within an appropriate clinical context, as hasbeen advocated by other researchers[5].

4.1. Educational implications

There is evidence that medical educators should continueto use experiential methods of teaching communication

skills rather than instructional methods. This study sug-gests that students prefer communicating with real patientsto lectures and that videotaped role-plays appear to be anadequate replacement for encounters with real patients.Communication skills co-ordinators should reduce thenumber of lectures in their courses and increase students’opportunities for role-playing with simulated patients andfor communicating with real patients within a clinicalcontext.

Acknowledgements

This study was funded by a grant awarded to the firstauthor by the Teaching Enhancement Office at the Universityof Nottingham (Ref. 99TL/179). We would like to thank allof the students who participated in this study.

References

[1] Aspegren K. BEME guide No. 2: teaching and learning communicationskills in medicine: a review with quality grading of articles. Dundee:Association for Medical Education in Europe; 1999.

[2] Landis JR, Koch GG. The measurement of observer agreement forcategorical data. Biometrics 1977;33:159–74.

[3] Rees CE, Sheard CE, McPherson AC. A qualitative study to ex-plore undergraduate medical students’ attitudes towards communica-tion skills learning. Med Teacher 2002;24:289–93.

[4] Evans BJ, Stanley RO, Burrows GD, Sweet B. Lectures and skillsworkshops as teaching formats in a history-taking skills course formedical students. Med Educ 1989;23:364–70.

[5] Sanson-Fisher R, Cockburn J. Effective teaching of communicationskills for medical practice: selecting an appropriate clinical context.Med Educ 1997;31:52–7.