Comparing three experiential learning methods and their effect on medical students’ attitudes to learning communication skills

Figures & data

Table 1.  Earlier studies of medical students’ attitudes towards CSL.

Study	Theme	Participants	Method	Results
Rees & Garrud (2001)	Qualitative study to explore medical students’ views and experiences of CSL	First-year medical students (N = 5)	Focus groups	Three attitude-related themes: (1) positive attitudes towards CSL; (2) negative attitudes towards CSL; and (3) relationship between students’ attitudes and their education, age and communicative abilities
Rees et al. (2002b)	Qualitative study to explore medical students’ attitudes towards learning communication skills	First- to fifth-year medical students (N = 32)	Focus groups	– Two attitude-related themes were found: (1) positive and (2) negative attitudes towards CSL – Negative attitudes related to: communication skills as a social science; communication skills courses being taught in the preclinical part of the curriculum; and socialization into the same negative attitudes of older students and qualified doctors
Rees et al. (2002a)	Developing the CSAS to measure medical students’ attitudes towards CSL	First time: First- and second-year medical students (n = 490) Second time: first- and second-year medical students (n = 39)	– Factor analysis – The test–retest reliability	– The CSAS consists of 26 items – The scale has two subscales, each with 13 items – In subscale I, PAS, the items relate to positive attitudes to CSL – In subscale II, NAS, the items relate to negative attitudes to CSL
Rees & Sheard (2002)	Exploring the relationship between medical students’ attitudes and their demographic and education-related characteristics at the University of Nottingham and Leicester	First- and second-year medical students (N = 490)	CSAS	– Female students had more positive attitudes to CSL than male – Students’ whose parents were doctors had more negative attitudes than students whose parents were not doctors – Students who thought their communication skills needed improving had more positive attitudes – Leicester students had higher scores on the PAS and lower scores on the NAS than Nottingham students
Rees & Sheard (2003)	Evaluating medical students’ attitudes towards CSL before and after a communication skills course	First-year medical students’ (N = 216)	– CSAS – A personal details questionnaire	– Students rated their communication skills lower at the end of the course – Students’ PAS scores decreased at the end of the course – Gender, language and ethnicity exhibited two-way interactions with attitudes over time – Female students developed significantly less negative attitudes than males by the end of the course
Cleland et al. (2005)	Assess medical students’ attitudes towards CSL in the University of Aberdeen and validate the use of the CSAS in a different population	First- to third-year medical students (N = 467)	CSAS	– First-year students had higher PAS scores than second and third-year students – First-year students’ NAS scores were lower than scores for second-year students but not for third-year students – The PAS and NAS scores for second- and third-year students were not significantly different – Female students had more positive attitudes than males – The CSAS was an appropriate tool to measure attitudes of medical students in different population
Wright et al. (2006)	Exploring medical students’ attitudes towards CSL, knowledge of appropriate provider–patient communication and confidence of communicating with patients in USA	First- and fourth-year medical students (N = 118)	– CSAS – Perceived importance of medical communication – Perceived confidence about communicating with patients – Appropriate provider communication knowledge	– First- and fourth-year students did not differ in terms of attitudes or knowledge, but fourth-year students were significantly more confident about communicating with patients – Students’ PAS scores were significantly related to perceived importance of communication skills and confidence of communicating with patients – Female students had more positive attitudes than males
Shankar et al. (2006)	Exploring positive and negative attitudes among medical students at the Manipal College of Medical Sciences, Pokhara, Nepal	Third- and fourth-year medical students (N = 123)	CSAS	– Median PAS score was 51. Mean NAS score was 31.18 – No difference in PAS scores of female and male students – Communication skills training in this particular medical school should be modified and strengthened
Anvik et al. (2007)	Exploring medical students’ attitudes towards CSL in Norway and comparing the findings with earlier reports	Norwegian medical students (N = 1833)	– Translated version of the CSAS – A PCA	– CSAS measured three factors which were different from the formerly described two-factor model with PAS and NAS – The CSAS may be used in order to distinguish between affective and cognitive components of attitudes
Anvik et al. (2008)	Exploring cognitive and affective attitudes towards CSL among medical students in Norway	Norwegian medical students (N = 1833)	Translated version of the CSAS	– Norwegian medical students had positive attitudes to learning and using communication skills – Cognitive attitudes stayed high during medical school but affective attitudes declined – Female students had more positive attitudes than males
Harlak et al. (2008a)	Validating a Turkish translation of the CSAS	First- to fifth-year medical students (N = 197)	– Translated version of the CSAS – Factor analysis	Confirmed that the translated version of the CSAS is a valid and internally consistent instrument to measure medical students’ attitudes to CSL
Harlak et al. (2008b)	Exploring and comparing Turkish medical students’ attitudes to CSL and their empathy tendency before and after a communication course	Turkish first-year medical students (N = 59)	– Translated version of the CSAS – The Empathy Tendency Scale – Questions about age and gender	– Mean scores in the positive attitude group decreased significantly by the end of the course compared with the start – No significant change in the negative attitude group – Female students had more positive attitudes than males
Ahn et al. (2009)	Develop a Korean version of the CSAS, and explore pre-medical and medical students’ attitudes towards CSL	First survey: pre-medical and medical students (n = 325) Second survey: medical students and doctors-in-training (n = 257)	First survey: – Translated version of the CSAS – A PCA Second survey: – Open questions	Korean pre-medical and medical students’ attitudes consist of five factors: (1) facilitation of interpersonal skills, (2) doubts about the importance of CSL in medicine, (3) motivation, (4) negative attitudes to assessment, and (5) overconfidence. – Some modifications to the CSAS to improve its fit for measuring Korean students’ attitudes
Molinuevo & Torrubia (2011)	Validating a Catalan version of the CSAS	First- and second-year medical students and first-year nursing students (N = 569)	Translated version of the CSAS – A PCA	– Confirmed that the translated version of the CSAS is a valid and internally consistent instrument to measure medical and nursing students’ attitudes towards CSL – Female students had more positive attitudes than males
Bombeke et al. (2011)	Comparing medical students’ patient-centred attitudes and attitudes to communication skills in two cohorts before and after clinical clerkship	First group (n = 48) did not receive training and second group (n = 37) had received 5 years of training	Translated version of the CSAS and four other validated questionnaires	– Communication-trained students declined in patient-centred attitudes and attitudes to CSL compared to non-trained students – Female students had more positive attitudes than males

Table

Practice points

All three learning methods, TIE, SPs and RPs, had a positive impact on medical students attitudes to learning communication skills. Female students had more positive attitudes than male students. Longitudinal research on medical students’ attitudes to CSL is required.

Table 2.  Structure of the pilot course in speech communication.

Preparation	Training		Evaluation
All students – 1 h introduction – 2 h/seven small groups – Short lesson in doctor–patient communication – Students analysed doctor–patient interaction shown on DVD – Students formulated their learning goals	Group A (TIE) – 2 × 2 h – TIE workshop	All – Students spent 2 days in health centres – Students observed real doctor–patient consultations and wrote reports on their findings (self-study exercise)	All – 2 h/seven small groups – Students discussed the self-study exercises – Students’ learning experiences were discussed
	Group B (SP) – 2 × 2 h – SP interviews with amateur actors
	Group C (RP) – 2 × 2 h – RP with peers

Table 3.  Relationships between PAS scores at T1 and T2.

	Median PAS score at T1 (inter-quartile range)	Median PAS score at T2 (inter-quartile range)	Wilcoxon test statistic, p-value
Whole data	45 (40.5–49)	47 (42–51)	z = −3.932, p = 0.000***
Male (n = 42)	42 (37.75–47)	43 (40–48.5)	z = −2.877, p = 0.004**
Female (n = 83)	46 (42–50)	48 (43–52)	z = −2.795, p = 0.005**
Group A (n = 42)	45 (42–49.5)	49 (42.75–54)	z = −2.768, p = 0.006**
Group B (n = 44)	45 (42–48)	46 (43–50)	z = −2.221, p = 0.026*
Group C (n = 43)	43 (37.5–49)	45 (39–49)	z = −1.952, p = 0.051

Notes: ***Significant at the p < 0.001 level; ** significant at the p < 0.01 level; and *significant at the p < 0.05 level.

Table 4.  Relationships between NAS scores at T1 and T2.

	Median NAS score at T1 (inter-quartile range)	Median NAS score at T2 (inter-quartile range)	Wilcoxon test statistic, p-value
Whole data	31 (27–35)	28 (25–33)	z = −3.677, p = 0.000***
Male (n = 43)	32 (27–38)	31 (26.5–36)	z = −1.490, p = 0.136
Female (n = 83)	30 (27–33)	27 (24–32)	z = −3.495, p = 0.000***
Group A (n = 42)	29.5 (26–35)	26 (22–33)	z = −3.757, p < 0.0001***
Group B (n = 44)	29.5 (27–33.25)	28 (25–33)	z = −1.218, p = 0.223
Group C (n = 43)	32 (27.75–36.25)	30 (27–35)	z = −1.538, p = 0.124

Note: ***Significant at the p < 0.001 level.

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