Explicit curriculum vs implicit skills: Assessment of medical interns communication skills from a patient perspective

Abstract

Objectives Medical schools liberally design communication skills curricula to meet medical education accreditation standards. These curricula –though evidence-based– require evaluation. This study evaluates the effectiveness of the clinical communication skills curriculum at Alexandria Faculty of Medicine and benchmarks the Egyptian patient’s perception of physicians’ communication skills. Methods Using the Communication Assessment Tool (CAT) through an innovative paired design, we compared graduates (interns) of the new “5+2” program, who were exposed to the curriculum, with the unexposed “6+1” program. We paired 100 “5+2” vs. 100 “6+1” interns to interview the same patient. Patients (N = 100) assessed both members of the pair consecutively, using the CAT. We analyzed CAT scores to evaluate the curriculum and the percentage of “excellent” ratings to report patients’ perception. Results The curriculum significantly improved 2 out of 14 CAT items’ scores: “Showed care and concern” (p = 0.026) and “Spent the right amount of time with me” (p = 0.017), with no significant effect on total scores (p = 0.093). Patients perceived interns as most excellent at treating them with respect (58%) and least excellent at involving them in decisions (18.5%), with an average “excellent” rating of 44%. Conclusion: The “5+2” clinical communication skills curriculum improved ability to show care and spend adequate time with patients, yet not the overall skills. Egyptian patients feel dismissed from engagement in healthcare. Practice implications: We recommend: 1) Evaluating other aspects of the new medical education “5+2” program; 2) Further training of course facilitators; and 3) Integrating the unique Egyptian perspective and patients’ engagement within our clinical communication skills curricula.