Objective:

Formal physician-patient communication training at the University of Health Sciences (UHS) College of Osteopathic Medicine has previously been limited to first year students.   Currently, physical examination skills are taught during the first two years.  There was no course combining both communication and physical examination skills before 2002.

Integration of communication and examination skills will improve the clinical performance of medical students.  The culmination of the first and second years of training is the Clinical Skills Assessment, a multi-station OSCE designed to emulate clinical scenarios commonly encountered during clerkships.  Integrating communication and physical examination skills training will likely improve performance on clerkships and the national board examination. 

Methods:

A new course, Advanced Clinical Communication Skills, was created in 2002 to encompass core skills required during clerkships.   At UHS, this course presented multiple challenges and opportunities to develop solutions. 

Our large class size (approximately 250/class) problem was conquered by offering repeated learning opportunities in small groups (ie - spreading out the activity over time).  The challenge of having few full-time faculty devoted to the course was solved by using residents and part-time community faculty.  The ubiquitous problem of ensuring students are performing physical exam skills properly was alleviated by better training of Standardized Patients (SP's), as well as by videotaping the sessions for review by faculty.  The process of implementing the new curriculum within the existing curriculum was made easier by dividing the entire class into groups, and alternating with other activities, so that we would have 1/4 of the class at a time.  Grading numerous progress (SOAP) notes was done by objectifying feedback via a scoresheet, which makes it much quicker, as well as using faculty from other departments to help teach and grade documentation skills.

Results:

The Advanced Clinical Communication Skills course was successfully implemented and feedback from learners has been positive.  Ongoing assessment of this program’s success includes evaluation of preceptor feedback following clerkships, comparison to students who did not take the course, and UHS student success on the first performance evaluation component of national boards. More data will become available after the first cycle of the Performance Evaluation of the National Boards has ended.  

Conclusion:      
It is possible to create and implement an advanced communication skills course using SP's and integrating the physical examination with communication skills within an existing curriculum.  Despite a large class size, the program was successfully integrated, and has received positive feedback from both learners and teachers. It has been especially well received by students after they have begun clinical rotations, as it is immediately useful then.