LAUSR

What problems were addressed? In the medical education curriculum, communication is valued as both a competency and a desired skill at the undergraduate and graduate levels. This is not surprising as, if viewed strictly, the honing of skills in speaking and listening shapes the effectiveness of every patient encounter, consultation, family meeting, handover and interprofessional dynamic in any health care setting. Basic sciences knowledge and clinical reasoning aptitude are well documented and extensively analysed prior to matriculation. The medical school curriculum is then strategically designed to build on this scaffold and to gauge learner improvement in these areas using an array of standardised measures and rating schemes. Although medical training is also rife with strategy-focused approaches for speaking to patients that use evidence-based checklists and scripting, far less curriculum incorporates the structured appraisal of a student’s baseline predisposition, efficacy and talent in communication as an essential prerequisite to implementing skills training. Our aim was to shift the structure of our communication curriculum from a focus on ‘what a physician says’ to learner-focused ‘how you will communicate when you’re a physician’. What was tried? In the spring of 2016, we piloted an interpersonal communication and interviewing skills elective for undergraduate medical students anchored to experiential learning theory and social psychology principles. Rather than fixing the course to evidence-based strategies using scripts, session curriculum and instruction were designed to stimulate self-assessment and the discussion of tendencies, tribulations and interviewing objectives by individual learners. We explored the contributions of each learner’s upbringing and social experiences to his or her current interviewing tactics and evaluated decision-making strategies when selecting a communication approach. Early skills assessments permitted students and instructors to gain a thorough understanding of their own baseline prior to implementing lessons and practice. In all sessions, learners documented their preexisting knowledge of and beliefs about each course topic and were asked to make decisions about how newly introduced content and evidence compared or contrasted with their existing framework. Practical exercises included structured observation and experiments with new skills, self-assessment and reflection, instructor and peer feedback, and the setting of attainable communication goals for future interactions. Reflection stems included How do you respond?, What do you think?, and How do you decide? Final sessions included critical evaluations of individual assets and collective pitfalls, observations of others’ behaviour, and giving and requesting feedback in both clinical and personal settings. At the conclusion, student progress was assessed using a series of structured, themed interviews with community members that showcased their integrated skills. What lessons were learned? Remarkably, we learned that our cohort of students had not been exposed to this type of instruction or assessment at any level of prior training. We are currently analysing standardised preand post-assessments of skills and efficacy. However, learner feedback regarding the course structure and the relevance of curriculum to clinical care has been overwhelmingly positive, with preliminary data and student commentary indicating marked improvements in personal and professional encounters. As several students reported that the time and preparation commitment for practical exercises was difficult to manage, we adjusted the number and breadth of practice requirements for the subsequent pilot term. The course was approved for implementation in future years with support for interprofessional enrolment.