Faculty and medical students' perceptions of teaching and learning about the doctor-patient relationship

Objective: To explore student and faculty perceptions of how students are learning doctor-patient relationship skills in their clinical medical education. Methods: Exploratory qualitative study involving data from interviews and focus groups with students and interviews with teaching faculty. Results: Respondents reported that pre-clinical relationship skills curricula were not well-coordinated with clinical curricula. Within the clinical curriculum, respondents perceived a disparity between general practice and hospital-based attachments. Teaching of relationship skills on the wards was highly variable, rarely explicit, and primarily dependent on role-modelling. In contrast, general practice runs included explicit teaching with feedback that reinforced skills taught in the pre-clinical curriculum. Respondents recommended increased focus on and assessment of students' interpersonal skills within clinical settings. Conclusion: Pre-clinical and clinical relationship skills curricula were not coordinated. The tension between service commitments and student teaching in hospital-based attachments contributed to an insufficient focus on communication and relationship skills acquisition and did not reinforce teaching in pre-clinical and ambulatory clinical settings. Practice implications: The teaching of doctor-patient relationship skills can be augmented by coordinating pre-clinical and clinical curricula and by requiring observation and structured feedback related to explicit criteria of student skills acquisition across all clinical learning experiences. (C) 2009 Elsevier Ireland Ltd. All rights reserved.