Background
Communication skills are among the most fundamental and critical aspects to the practice of medicine. The Institute of Medicine has outlined in several of its reports that communication skills or lack thereof are among the most causes of poor or unsafe patient care. The AAMC has repeatedly highlighted good communication as a linchpin of its Medical School Outcomes Project and UPSOM also strongly agrees that communication should play a fundamental role throughout the curriculum. With these factors in mind, this content area was identified as one of the key learning domains in the Learning Objectives for the UPSOM Medical Student Curriculum.
Goals
Graduates of UPSOM will be exhibit skills of interpersonal communication in depth and extent comparable to that sought in their scientific and clinical knowledge base. They will be able to obtain complete histories from patients of diverse cultures, ethnicities and backgrounds in a nonjudgmental, empathetic manner that encourages willing participation of the patient in a free exchange of information to optimize medical decision making and care.
Implementation
Medical Interviewing
Students are explicitly introduced to the basics of interviewing patients during their introductory Medical Interviewing course in the first year. Further development of these skills occurs during second year in the Advanced Medical Interviewing Course.
Advanced Physical Examination
Students are further encouraged to apply their communication skills as they must interview and perform [a] physical examinations on inpatients through the second half of first year and all of second year. Additionally, students are challenged to communicate with patients they are seeing during their clinical experiences course also during first and second year. As part of their clinical experiences, all students [are required to] participate in a community service learning experience and project that is fundamental to working with underserved populations and communicating health information at the appropriate health literacy level. Assessments of a student’s communication skills are multiple and include not only faculty evaluations during these rotations but also formal evaluation of a complete history and physical examination (the Clinical Skills Assessment or CCA) during second year as well as the Advanced Physical Examination OSCE.
Patient, Physician and Society
In addition to courses that focus specifically on these important skills, the entire Patient, Physician and Society block focuses on issues of communication about patient-level decision-making and how to communicate with patients and other health professionals about broader health care and health policy issues.
Evidence and Discovery
The three courses in this block, Evidence-Based Medicine - Fundamentals, Evidence-Based Medicine - Applied, and Investigation & Discovery focus on the skills of communicating scientific evidence and how that translates directly to patient care.
Impact
Communication skills are further solidified and advanced during all clinical rotations. Students are evaluated during both third and fourth year rotations specifically on their communication skills, not only with patients but also with fellow team members and other health professionals. Students undergo frequent assessments with OSCE’s in almost every rotation as well as a summative Clinical Competency Assessment at the end of third year that focuses heavily on communication skills.
Opportunities
Above and beyond what are considered core courses in communication skills, however, are the various Areas of Concentration that have a heavy focus on communication skills such as the Geriatric Medicine, Disability Medicine, Global Health, Underserved Populations, and Women's Health AOCs. Students commonly choose to take electives in fields such as Medical Spanish, Advanced Pediatric Interviewing, Introduction to Disaster Management, and Community Based Research that help them develop specialized types of communications skills not offered elsewhere.
Students may also choose specifically to take courses such as Prep-for-the-Step, a half day elective during their end of third year spring clinical focus week that focuses on enhancing focused history and physical skills in the outpatient encounter. Consequently, through a broad array of required and elective opportunities, UPSOM solidifies its mission to ensure that graduating students have a very solid foundation in communication skills.