Teaching clinically experienced physicians communication skills. A review of evaluation studies

Context Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest , relatively limited curricular time is spent on the teaching of communicat ion skills. The limited attention to the teaching of these skills applies e ven more to the physicians' clinical years, when attention becomes highly f ocused on biomedical and technical competence. Continuing training after me dical school is necessary to refresh knowledge and skills, to prohibit decl ine of performance and to establish further improvements. Objective This review provides an overview of evaluation studies of communi cation skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation m ethodology and instruments, and training results. Methods CD-ROM searches were performed on MedLine and Psychlit, with a focu s on effect-studies dating from 1985. Results Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent beh avioural observations and patient outcomes. Most of the studies used inadeq uate research designs. Overall, positive training effects on the physicians ' communication behaviour are found on half or less of the observed behavio urs. Studies with the most adequate designs report the fewest positive trai ning effects. Conclusion Several reasons are discussed to explain the limited findings. F uture research may benefit from research methods which focus on factors tha t inhibit and facilitate the physicians' implementation of skills into actu al behaviours in daily practice.