Curricular disconnects in learning communication skills: what and how students learn about communication during clinical clerkships.

OBJECTIVE: In many medical schools, formal training in clinical communication skills (CCS) mainly occurs during pre-clinical training prior to clinical rotations. The current research examined student perceptions of both what and how they learn about CCS during clinical rotations.
METHODS: During 2008 and 2009, 4th year medical students were invited to participate in interviews focused on learning of CCS during clinical rotations. Interview transcripts were analyzed to identify salient themes in their discussions of CCS in clinical learning experiences.
RESULTS: 107 senior students participated and reported learning CCS during clinical rotations mainly by: (1) observing faculty and residents; (2) conducting interviews themselves; and (3) through feedback on patient presentations. Teacher role modeling tended to not reinforce what they had learned pre-clinically about CCS and clinical teachers rarely discussed CCS. Feedback on patient presentations affected students' communication styles, at times prompting them to omit use of CCS they had learned pre-clinically.
CONCLUSIONS: Students reported that clinical learning experiences often do not reinforce the CCS they learn pre-clinically. PRACTICAL IMPLICATIONS: Disconnects between pre-clinical and clinical CCS teaching need to be reconciled through more explicit pedagogical attention to CCS issues during clinical rotations both in the formal and informal curriculum.