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Academic Medicine:
Educating Physicians: Essays

Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement

Makoul, Gregory PhD

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Gregory Makoul, PhD, director of the Program in Communication and Medicine at Northwestern University Medical School, provided leadership in the writing process.

Correspondence and requests for reprints should be addressed to the Bayer Institute for Health Care Communication, 400 Morgan Lane, West Haven, CT 06516; e-mail: 〈〉.

The Bayer—Fetzer Conference on Physician—Patient Communication in Medical Education was held May 11–14, 1999. The Bayer Institute for Health Care Communication is a non-commercial, nonprofit, organization whose mission is to improve health through education, research, and advocacy in the area of clinican—patient communication. The Fetzer Institute is a nonprofit, private operating foundation that supports research, education, and service programs exploring the integral relationships among body, mind, and spirit. The conference site was Seasons, A Center for Renewal, owned and operated by the Fetzer Institute, in Kalamazoo, Michigan.

This consensus statement reflects the views of the conference participants; it does not necessarily imply endorsement by their institutions or associations.

Participants in the Bayer—Fetzer Conference on Physician—Patient Communication in Medical Education

The conference participants are listed in a box at the end of the text.

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In May 1999, 21 leaders and representatives from major medical education and professional organizations attended an invitational conference jointly sponsored by the Bayer Institute for Health Care Communication and the Fetzer Institute. The participants focused on delineating a coherent set of essential elements in physician—patient communication to: (1) facilitate the development, implementation, and evaluation of communication-oriented curricula in medical education and (2) inform the development of specific standards in this domain. Since the group included architects and representatives of five currently used models of doctor—patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models. Presentations about the five models encompassed their research base, overarching views of the medical encounter, and current applications. All attendees participated in discussion of the models and common elements. Written proceedings generated during the conference were posted on an electronic listserv for review and comment by the entire group. A three-person writing committee synthesized suggestions, resolved questions, and posted a succession of drafts on a listserv. The current document was circulated to the entire group for final approval before it was submitted for publication. The group identified seven essential sets of communication tasks: (1) build the doctor—patient relationship; (2) open the discussion; (3) gather information; (4) understand the patient's perspective; (5) share information; (6) reach agreement on problems and plans; and (7) provide closure. These broadly supported elements provide a useful framework for communication-oriented curricula and standards.

A growing emphasis on physician—patient communication in medicine and medical education is reflected in international consensus statements,1,2 guidelines for medical schools,3–6 and standards for professional practice and education.7–12 In May 1999, with work in these areas and related research13–17 as a backdrop, 21 people from medical schools, residency programs, continuing medical education providers, and prominent medical educational organizations in North America convened for three days in Kalamazoo, Michigan, for the Bayer—Fetzer Conference on Physician—Patient Communication in Medical Education. The aim of this invitational conference was to identify and specifically articulate ways to facilitate communication teaching, assessment, and evaluation.

The group used an open-ended, iterative process to identify and prioritize topics for discussion. A major topic of interest to the entire group was delineating a set of essential elements in physician—patient communication. Participants expressed three goals for the discussion:

1. Reaching consensus on a “short list” of elements that would characterize effective communication in several clinical contexts.

2. Providing tangible examples of skill competencies that would be useful for licensing bodies, organizations that accredit medical schools and residency programs, and directors of medical education programs at all levels.

3. Ensuring that the product generated by the group would be evidence based and appropriate for teaching, assessment, and evaluation.

Since the group included architects and representatives of five currently used models of doctor—patient communication, participants agreed that the goals might best be achieved through review and synthesis of the models' essential elements. Toward that end, brief presentations were delivered about each of the five models:

* Bayer Institute for Health Care Communication E4 Model18

* Three Function Model/Brown Interview Checklist19

* The Calgary—Cambridge Observation Guide20

* Patient-centered clinical method21

* SEGUE Framework for teaching and assessing communication skills22

Each presentation included an explicit description of the model, encompassing its research base, overarching views of the medical encounter, and current applications. After discussion of the models, attendees from the Accreditation Council for Graduate Medical Education (ACGME), the CanMEDS 2000 Project, the Educational Commission for Foreign Medical Graduates (ECFMG), and the Macy Health Communication Initiative provided information about their efforts to develop criteria for teaching and evaluating physician—patient communication. The group then began looking for commonalities among the models as well as points of departure. This process was enriched by the number and diversity of organizations represented by conference participants.

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Consensus on the essential elements of physician—patient communication was reached by using the three goals outlined above to guide and ground discussion. The group's perspective on essential elements is consistent with the task approach, a concept that has been well supported in communication skills teaching since the early 1980s.3,18–25 As noted by Makoul and Schofield,2 “focusing on tasks provides a sense of purpose for learning communication skills. The task approach also preserves the individuality of [learners] by encouraging them to develop a repertoire of strategies and skills, and respond to patients in a flexible way.”

By identifying specific communication tasks, the group worked to highlight behaviors that are embedded in existing consensus statements, guidelines, and standards. While the list is by no means exhaustive, the intent was to make it easier for people working in this area to identify not only the key tasks, but the relevant knowledge, skills, and attitudes as well. References for the supporting research are listed and discussed in a number of texts.20,21,23–28

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Build a Relationship: The Fundamental Communication Task

A strong, therapeutic, and effective relationship is the sine qua non of physician—patient communication.29,30 The group endorses a patient-centered, or relationship-centered, approach to care, which emphasizes both the patient's disease and his or her illness experience.31,32 This requires eliciting the patient's story of illness while guiding the interview through a process of diagnostic reasoning. It also requires an awareness that the ideas, feelings, and values of both the patient and the physician influence the relationship.2,15,33 Further, this approach regards the physician—patient relationship as a partnership, and respects patients' active participation in decision making.34–36 The task of building a relationship is also relevant for work with patients' families and support networks. In essence, building a relationship is an ongoing task within and across encounters: it undergirds the more sequentially ordered sets of tasks identified below.

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Open the Discussion

* Allow the patient to complete his or her opening statement

* Elicit the patient's full set of concerns

* Establish/maintain a personal connection

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Gather Information

* Use open-ended and closed-ended questions appropriately

* Structure, clarify, and summarize information

* Actively listen using nonverbal (e.g., eye contact) and verbal (e.g., words of encouragement) techniques

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Understand the Patient's Perspective

* Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status, spirituality)

* Explore beliefs, concerns, and expectations about health and illness

* Acknowledge and respond to the patient's ideas, feelings, and values

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Share Information

* Use language the patient can understand

* Check for understanding

* Encourage questions

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Reach Agreement on Problems and Plans

* Encourage the patient to participate in decisions to the extent he or she desires

* Check the patient's willingness and ability to follow the plan

* Identify and enlist resources and supports

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Provide Closure

* Ask whether the patient has other issues or concerns

* Summarize and affirm agreement with the plan of action

* Discuss follow-up (e.g., next visit, plan for unexpected outcomes)

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This outline of essential elements in effective physician—patient communication provides a coherent framework for teaching and assessing communication skills, determining relevant knowledge and attitudes, and evaluating educational programs. In addition, the outline can inform the development of specific standards in this domain. Most of the elements included in this document are present in each of the five models examined during the process of consensus building. A major strength of the outline is that it represents the collaboration and consensus of individuals with a variety of backgrounds and interests in medical education. Further, the basic outline can be tailored to meet the needs of different specialties, settings, and health problems. Conscientious efforts to address these essential elements across practice settings will help increase the efficiency and effectiveness of physician—patient communication,37 enhance patient and physician satisfaction,38,39 and improve health outcomes.40

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1. Simpson M, Buckman R, Stewart M, et al. Doctor—patient communication: the Toronto consensus statement. BMJ. 1991;303:1385–7.

2. Makoul G, Schofield T. Communication teaching and assessment in medical education: an international consensus statement. Patient Educ Couns. 1999;137:191–5.

3. Association of American Medical Colleges. Medical School Objectives Project, Report III. Contemporary Issues in Medicine: Communication in Medicine. Washington, DC: Association of American Medical Colleges, 1999.

4. Workshop Planning Committee: Consensus statement from the Workshop on the Teaching and Assessment of Communication Skills in Canadian Medical Schools. Can Med Assoc J. 1992;147:1149–52.

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6. Bass EB, Fortin AH 4th, Morrison G, Wills S, Mumford LM, Goroll AH. National survey of clerkship directors in internal medicine on the competencies that should be addressed in the medicine core clerkship. Am J Med. 1997;102:564–71.

7. Liaison Committee on Medical Education. Functions and Structure of a Medical School. Washington, DC: Liaison Committee on Medical Education, 1998.

8. Klass D, De Champlain A, Fletcher E, King A, Macmillan M. Development of a performance-based test of clinical skills for the United States Medical Licensing Examination. Fed Bull. 1998;85:177–85.

9. Whelan GP. Educational Commission for Foreign Medical Graduates: clinical skills assessment prototype. Med Teach. 1999;21:156–60.

10. Committee for Review of Program Requirements. Agenda Book. Chicago, IL: Accreditation Council for Graduate Medical Education Accreditation, 1999.

11. Communications Self-Evaluation Process (COM-SEP) Committee. Minutes. Philadelphia, PA: American Board of Internal Medicine, 1999.

12. Tate P, Foulkes J, Neighbour R, Campion P, Field S. Assessing physicians' interpersonal skills via videotaped encounters: a new approach for the Royal College of General Practitioners Membership Examination. J Health Comm. 1999;4:143–52.

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18. Keller V, Carroll JG. A new model for physician—patient communication. Patient Educ Couns. 1994;23:131–40.

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20. Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. Abingdon, Oxon, U.K.: Radcliffe Medical Press, 1998.

21. Stewart M, Belle Brown J, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage, 1995.

22. Makoul G. Communication research in medical education. In: Jackson L, Duffy BK (eds). Health Communication Research: A Guide to Developments and Directions. Westport, CT: Greenwood Press, 1998:17–35.

23. Riccardi VM, Kurtz SM. Communication and Counseling in Health Care. Springfield, IL: Charles C Thomas, 1983.

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26. Lipkin M Jr, Putnam SM, Lazare A (eds). The Medical Interview: Clinical Care, Education, and Research. New York: Springer-Verlag, 1995.

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29. Novack DH. Therapeutic aspects of the clinical encounter. J Gen Intern Med. 1987;2:346–55.

30. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47:213–20.

31. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–36.

32. Kleinman A. The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books, 1988.

33. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician: personal awareness and effective patient care. JAMA. 1997;278:502–9.

34. Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care. 1998;21:1644–51.

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36. Gudagnoli E, Ward P. Patient participation in decision making. Soc Sci Med. 1998;47:329–39.

37. Stewart MA. Effective physician—patient communication and health outcomes: a review. Can Med Assoc J. 1995;152:1423–33.

38. Williams S, Weinman J, Dale J. Doctor—patient communication and patient satisfaction: a review. Fam Pract. 1995;15:480–92.

39. Suchman AL, Roter D, Green M, Lipkin M Jr. Physician satisfaction with primary care office visits. Collaborative Study Group of the American Academy on Physician and Patient. Med Care. 1993;31:1083–92.

40. Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med. 1985;102:520–8.

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Participants in the Bayer–Fetzer Conference on Patient—Physician Communication in Medical Education, May 1999
Patrick H. Brunett, MD

Assistant Professor of Emergency Medicine, Oregon Health Sciences University; member of Society for Academic Emergency Medicine

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Thomas L. Campbell, MD

Professor of Family Medicine and Psychiatry, University of Rochester School of Medicine; member of Society of Teachers of Family Medicine; Advisory Council, Bayer Institute for Health Care Communication

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Kathleen Cole-Kelly, MS, MSW

Associate Professor of Family Medicine, Case Western Reserve University School of Medicine; Director of Curriculum and Faculty Development at Case Western for the Macy Health Communication Initiative

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Deborah Danoff, MD

Assistant Vice President, Division of Medical Education, Association of American Medical Colleges

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Robert Frymier, MD

National Director, Educational and Partnerships Division, Veterans Affairs Learning University; Associate Professor of Family Medicine, Case Western Reserve University School of Medicine

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Michael G. Goldstein, MD

Associate Director, Clinical Education and Research, Bayer Institute for Health Care Communication; Adjunct Professor of Psychiatry, Brown University School of Medicine

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Geoffrey H. Gordon, MD

Associate Director, Clinical Education and Research, Bayer Institute for Health Care Communication; Assistant Clinical Professor of Medicine and Psychiatry, Yale University School of Medicine

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Daniel J. Klass, MD

Director, Standardized Patient Project, National Board Medical Examiners

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Suzanne Kurtz, PhD

Professor of Communication, Faculties of Medicine and Education, University of Calgary

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Jack Laidlaw, MD

Head, Division of Education, Cancer Care Ontario; Advisory Council, Bayer Institute for Health Care Communication

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Forrest Lang, MD

Vice Chair, Department of Family Medicine, East Tennessee State University; member of Society of Teachers of Family Medicine

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Anne-Marie MacLellan, MD

Faculty of Medicine, McGill University; member of Association of Canadian Medical Colleges

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Gregory Makoul, PhD

Associate Professor and Director, Program in Communication and Medicine, Northwestern University Medical School

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Steven Miller, MD

Director, Pediatric Medical Student Education, Columbia University School of Medicine; Council on Medical Student Education in Pediatrics

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Dennis Novack, MD

Professor of Medicine and Associate Dean for Education, Medical College of Pennsylvania Hahnemann School of Medicine; member of American Academy on Physician and Patient

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Elizabeth A. Rider, MSW, MD

Clinical Instructor in Pediatrics and Instructor in Medical Education, Harvard Medical School; Office of Educational Development, Harvard Medical School

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Frank A. Simon, MD

Director, Division of Graduate Medical Education, American Medical Association

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David Sluyter, EdD

Vice President for Education, Fetzer Institute

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Susan Swing, PhD

Director of Research, Accreditation Council for Graduate Medical Education

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Wayne Weston, MD

Professor of Family Medicine, University of Western Ontario; member of College of Family Physicians of Canada

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Gerald P. Whelan, MD

Vice President for Clinical Skills Assessment, Educational Commission for Foreign Medical Graduates

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Patient Education in Neurology
Hunderfund, ANL; Bartleson, JD
Neurologic Clinics, 28(2): 517-+.
Patient Education and Counseling
Core assumptions and research opportunities in clinical communication
Salmon, P; Young, B
Patient Education and Counseling, 58(3): 225-234.
Archives of Disease in Childhood
Teaching and learning consultation skills for paediatric practice
Howells, RJ; Davies, HA; Silverman, JD
Archives of Disease in Childhood, 91(4): 367-370.
Journal of Health Communication
Factors associated with patients' perceptions of health care providers' communication behavior
Rutten, LJF; Augustson, E; Wanke, K
Journal of Health Communication, 11(): 135-146.
Health Communication
Using standardized patients to assess the interpersonal skills of physicians: Six years' experience with a high-stakes certification examination
van Zanten, M; Boulet, JR; McKinley, D
Health Communication, 22(3): 195-205.

Journal of General Internal Medicine
Depressive Symptoms and Perceived Doctor-Patient Communication in the Heart and Soul Study
Schenker, Y; Stewart, A; Na, B; Whooley, MA
Journal of General Internal Medicine, 24(5): 550-556.
Mayo Clinic Proceedings
Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life
Buse, DC; Rupnow, MFT; Lipton, RB
Mayo Clinic Proceedings, 84(5): 422-435.

Social Science & Medicine
Interacting with cancer patients: the significance of physicians' communication behavior
Arora, NK
Social Science & Medicine, 57(5): 791-806.
PII S0277-9536(02)00449-5
Annals of Internal Medicine
Processes for effective communication in primary care
Weiner, SJ; Barnet, B; Cheng, TL; Daaleman, TP
Annals of Internal Medicine, 142(8): 709-714.

Patient Education and Counseling
Enhancing clinician communication skills in a large healthcare organization: A longitudinal case study
Stein, T; Frankel, RM; Krupat, E
Patient Education and Counseling, 58(1): 4-12.
Patient Education and Counseling
Women's satisfaction with physicians' communication skills during an infertility consultation
Leite, RC; Makuch, MY; Petta, CA; Morais, SS
Patient Education and Counseling, 59(1): 38-45.
Zeitschrift Fur Gesundheitspsychologie
Psycho-social distress in patients with chronic somatic diseases - The Department of Rehabilitation Psychology and Psychotherapy at the University of Freiburg (abteilung fur rehabilitationspsychologie und psychotherapie)
Helmes, A; Kramer, L; Bengel, J
Zeitschrift Fur Gesundheitspsychologie, 16(3): 104-107.
Journal of Health Communication
The Role of the Clinician in Cancer Clinical Communication
Eggly, SS; Albrecht, TL; Kelly, K; Prigerson, HG; Sheldon, LK; Studts, J
Journal of Health Communication, 14(): 66-75.
Family Medicine
Assessing communication competence: A review of current tools
Schirmer, JM; Mauksch, L; Lang, F; Marvel, MK; Zoppi, K; Epstein, RM; Brock, D; Pryzbylski, M
Family Medicine, 37(3): 184-192.

Patient Education and Counseling
Comparing genetic counseling with non-genetic health care interactions: Two of a kind?
Smets, E; Van Zwieten, M; Michie, S
Patient Education and Counseling, 68(3): 225-234.
Journal of General Internal Medicine
A Method to Quantify Residents' Jargon Use During Counseling of Standardized Patients About Cancer Screening
Deuster, L; Christopher, S; Donovan, J; Farrell, M
Journal of General Internal Medicine, 23(): 1947-1952.
Anz Journal of Surgery
Guide to the Assessment of Competence and Performance in Practising Surgeons
Dickinson, I; Watters, D; Graham, I; Montgomery, P; Collins, J
Anz Journal of Surgery, 79(3): 198-204.
Journal of Bone and Joint Surgery-American Volume
Communication skills for patient-centered care - Research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients
Tongue, JR; Epps, HR; Forese, LL
Journal of Bone and Joint Surgery-American Volume, 87A(3): 652-658.

Teaching and Learning in Medicine
A model for educational feedback based on clinical communication skills strategies: Beyond the "feedback sandwich"
Milan, FB; Parish, SJ; Reichgott, MJ
Teaching and Learning in Medicine, 18(1): 42-47.

Journal of Moral Education
Defining features of moral sensitivity and moral motivation: pathways to moral reasoning in medical students
Morton, KR; Worthley, JS; Testerman, JK; Mahoney, ML
Journal of Moral Education, 35(3): 387-406.
Bmc Family Practice
Characteristics of communication guidelines that facilitate or impede guideline use: a focus group study
Veldhuijzen, W; Ram, PM; van der Weijden, T; Niemantsverdriet, S; van Der Vleuten, CPM
Bmc Family Practice, 8(): -.
Journal of General Internal Medicine
Interpersonal skill in medicine: The essential partner of verbal communication
Dyche, L
Journal of General Internal Medicine, 22(7): 1035-1039.
Supportive Care in Cancer
Ways to obtain a breast cancer diagnosis, consistency of information, patient satisfaction, and the presence of relatives
Brake, H; Sassmann, H; Noeres, D; Neises, M; Geyer, S
Supportive Care in Cancer, 15(7): 841-847.
Journal of Cystic Fibrosis
European best practice guidelines for cystic fibrosis neonatal screening
Castellani, C; Southern, KW; Brownlee, K; Roelse, JD; Duff, A; Farrell, M; Mehta, A; Munck, A; Pollitt, R; Sermet-Gaudelus, I; Wilcken, B; Ballmann, M; Corbetta, C; de Monestrol, I; Farrell, P; Feilcke, M; Ferec, C; Gartner, S; Gaskin, K; Hammermann, J; Kashirskaya, N; Loeber, G; Macek, M; Mehta, G; Reiman, A; Rizzotti, P; Sammon, A; Sands, D; Smyth, A; Sommerburg, O; Torresani, T; Travert, G; Vernooij, A; Elborn, S
Journal of Cystic Fibrosis, 8(3): 153-173.
Medical Education
Trained lay observers can reliably assess medical students' communication skills
Bergus, GR; Woodhead, JC; Kreiter, CD
Medical Education, 43(7): 688-694.
Medical Teacher
Patient-centred attitudes among medical students: Gender and work experience in health care make a difference
Wahlqvist, M; Gunnarsson, RK; Dahlgren, G; Nordgren, S
Medical Teacher, 32(4): E191-E198.
Jama-Journal of the American Medical Association
Communication skills education in medical school and beyond
Makoul, G
Jama-Journal of the American Medical Association, 289(1): 93.

British Medical Journal
Doctors communication of trust, care, and respect in breast cancer: qualitative study
Wright, EB; Holcombe, C; Salmon, P
British Medical Journal, 328(): 864-867.
Advances in Health Sciences Education
Communication skills in standardized-patient assessment of final-year medical students: A psychometric study
Guiton, G; Hodgson, CS; Delandshere, G; Wilkerson, L
Advances in Health Sciences Education, 9(3): 179-187.

Journal De Radiologie
Improving overall patient care during imaging studies: the radiologist's CREDO and PERLES
Leclere, J; Ollivier, L; Ruszniewski, M; Neuenschwander, S
Journal De Radiologie, 87(): 1831-1836.

Tohoku Journal of Experimental Medicine
Identifying medical interview behaviors that best elicit information from patients in clinical practice
Takemura, Y; Atsumi, R; Tsuda, T
Tohoku Journal of Experimental Medicine, 213(2): 121-127.

Academic Radiology
Patients as partners in radiology education: An innovative approach to teaching and assessing patient-centered communication
Lown, BA; Sasson, JP; Hinrichs, P
Academic Radiology, 15(4): 425-432.
Current Pain and Headache Reports
Facilitating communication with patients for improved migraine outcomes
Buse, DC; Lipton, RB
Current Pain and Headache Reports, 12(3): 230-236.

Quality of Life Research
A conceptual framework for patient-provider communication: a tool in the PRO research tool box
Feldman-Stewart, D; Brundage, M
Quality of Life Research, 18(1): 109-114.
Medical Education
Comparing narrative and multiple-choice formats in online communication skill assessment
Kim, S; Spielberg, F; Mauksch, L; Farber, S; Duong, C; Fitch, W; Greer, T
Medical Education, 43(6): 533-541.
Journal of the American Board of Family Medicine
Patients prefer the method of "Tell Back-Collaborative Inquiry" to assess understanding of medical information
Kemp, EC; Floyd, MR; McCord-Duncan, E; Lang, F
Journal of the American Board of Family Medicine, 21(1): 24-30.
Health Psychology
Physician and patient communication training in primary care: Effects on participation and satisfaction
Haskard, KB; Williams, SL; DiMatteo, MR; Rosenthal, R; White, MK; Goldstein, MG
Health Psychology, 27(5): 513-522.
Patient Education and Counseling
Vocational trainees' views and experiences regarding the learning and teaching of communication skills in general practice
Van Nuland, M; Thijs, G; Van Royen, P; Van den Noortgate, W; Goedhuys, J
Patient Education and Counseling, 78(1): 65-71.
Family Medicine
Communication assessment using the common ground instrument: Psychometric properties
Lang, F; McCord, R; Harvill, L; Anderson, DS
Family Medicine, 36(3): 189-198.

Nursing Outlook
Advancing practice inquiry: Research foundations of the practice doctorate in nursing
Magyary, D; Whitney, JD; Brown, MA
Nursing Outlook, 54(3): 139-151.
New England Journal of Medicine
The developing physician - Becoming a professional
Stern, DT; Papadakis, M
New England Journal of Medicine, 355(): 1794-1799.

Archives of Internal Medicine
Relationship, communication, and efficiency in the medical encounter - Creating a clinical model from a literature review
Mauksch, LB; Dugdale, DC; Dodson, S; Epstein, R
Archives of Internal Medicine, 168(): 1387-1395.

European Journal of Dental Education
The effect of undergraduate education in communication skills: a randomised controlled clinical trial
Haak, R; Rosenbohm, J; Koerfer, A; Obliers, R; Wicht, MJ
European Journal of Dental Education, 12(4): 213-218.
Supportive Care in Cancer
Ways of talking about illness and prognosis in palliative cancer care consultations-two interactional frames
Liden, E; Ohlen, J; Hyden, LC; Friberg, F
Supportive Care in Cancer, 18(4): 399-408.
Teaching and Learning in Medicine
Development of a Communication Curriculum for Emergency Medicine Residents
Sullivan, C; Ellison, SR; Quaintance, J; Arnold, L; Godrey, P
Teaching and Learning in Medicine, 21(4): 327-333.
Mayo Clinic Proceedings
Two words to improve physician-patient communication: What else?
Barrier, PA; Li, JTC; Jensen, NM
Mayo Clinic Proceedings, 78(2): 211-214.

Medical Education
In their own words: presenting the patient's perspective using research-based theatre
Rosenbaum, ME; Ferguson, KJ; Herwaldt, LA
Medical Education, 39(6): 622-631.
Medical Education
Impact of student ethnicity and patient-centredness on communication skills performance
Hauer, KE; Boscardin, C; Gesundheit, N; Nevins, A; Srinivasan, M; Fernandez, A
Medical Education, 44(7): 653-661.
Teaching and Learning in Medicine
Assessing residents' competency in care management: Report of a consensus conference
Frohna, JG; Cox, M; Kalet, A; Halpern, R; Kachur, E; Hewson, MG; Zabar, S; Yedidia, MJ; Williams, BC
Teaching and Learning in Medicine, 16(1): 77-84.

Journal of Pain and Symptom Management
Patient-physician communication in the context of persistent pain: Validation of a modified version of the patients' perceived involvement in care scale
Smith, MY; Winkel, G; Egert, J; Diaz-Wionczek, M; DuHamel, KN
Journal of Pain and Symptom Management, 32(1): 71-81.
Medical Education
Comparison of two instruments for assessing communication skills in a general practice objective structured clinical examination
Van Nuland, M; Van Den Noortgate, W; Degryse, J; Goedhuys, J
Medical Education, 41(7): 676-683.
Patient Education and Counseling
Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation
Salmon, P
Patient Education and Counseling, 67(3): 246-254.
Feuillets De Radiologie
Improving communication between the radiologist, the patients and their families in onco-pediatric radiology
Leclere, J; Ollivier, L; Ruszniewski, M; Neuenschwander, S
Feuillets De Radiologie, 47(1): 62-67.

Journal of General Internal Medicine
Teaching medical students about communicating with patients with major mental illness
Iezzoni, LI; Ramanan, RA; Lee, S
Journal of General Internal Medicine, 21(): 1112-1115.
Child and Adolescent Psychiatric Clinics of North America
Fostering Ecologic perspectives in child psychiatry
Storck, MG; Stoep, AV
Child and Adolescent Psychiatric Clinics of North America, 16(1): 133-+.
Medical Teacher
Why medical students should learn how to teach
Dandavino, M; Snell, L; Wiseman, J
Medical Teacher, 29(6): 558-565.
Medical Teacher
Critical care recognition, management and communication skills during an emergency medicine clerkship
Ellison, S; Sullivan, C; Quaintance, J; Arnold, L; Godfrey, P
Medical Teacher, 30(): E228-E238.
Patient Education and Counseling
A method to quantify and compare clinicians' assessments of patient understanding during counseling of standardized patients
Farrell, MH; Kuruvilla, P; Eskra, KL; Christopher, SA; Brienza, RS
Patient Education and Counseling, 77(1): 128-135.
Archives of Disease in Childhood
Assessment of doctors' consultation skills in the paediatric setting: the Paediatric Consultation Assessment Tool
Howells, RJ; Davies, HA; Silverman, JD; Archer, JC; Mellon, AF
Archives of Disease in Childhood, 95(5): 323-329.
Medical Education
Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes
Razack, S; Meterissian, S; Morin, L; Snell, L; Steinert, Y; Tabatabai, D; MacLellan, AM
Medical Education, 41(5): 441-449.
Teaching and Learning in Medicine
Integrative clinical experience: An innovative program to prepare for internship
Fisher, JW; Thompson, BM; Garcia, AD
Teaching and Learning in Medicine, 19(3): 302-307.

Internal and Emergency Medicine
The morning report: how do faculty members perceive medical educational needs?
Virgili, G
Internal and Emergency Medicine, 3(1): 1-2.
Journal of Transcultural Nursing
"They Get a C-Section ... They Gonna Die": Somali Women's Fears of Obstetrical Interventions in the United States
Brown, E; Carroll, J; Fogarty, C; Holt, C
Journal of Transcultural Nursing, 21(3): 220-227.
Family Medicine
Integrating the art and science of medical practice: Innovations in teaching medical communication skills
Haq, C; Steele, DJ; Marchand, L; Seibert, C; Brody, D
Family Medicine, 36(): S43-S50.

Javma-Journal of the American Veterinary Medical Association
Use of the Roter interaction analysis system to analyze veterinarian-client-patient communication in companion animal practice
Shaw, JR; Adams, CL; Bonnett, BN; Larson, S; Roter, DL
Javma-Journal of the American Veterinary Medical Association, 225(2): 222-229.

Academic Emergency Medicine
Assessing Interpersonal and Communication Skills in Emergency Medicine
Chan, TM; Wallner, C; Swoboda, TK; Leone, KA; Kessler, C
Academic Emergency Medicine, 19(): 1390-1402.
Postgraduate Medical Journal
Sophia Title
Crotty, BH; Mostaghimi, A; Landon, BE
Postgraduate Medical Journal, 89(): 554-559.
Patient Education and Counseling
Re-thinking shared decision-making: Context matters
Matthias, MS; Salyers, MP; Frankel, RM
Patient Education and Counseling, 91(2): 176-179.
Patient Education and Counseling
How doctors move from generic goals to specific communicative behavior in real practice consultations
Veldhuijzen, W; Mogendorff, K; Ram, P; van der Weijden, T; Elwyn, G; van der Vleuten, C
Patient Education and Counseling, 90(2): 170-176.
Patient Education and Counseling
Communication guidelines as a learning tool: An exploration of user preferences in general practice
Veldhuijzen, W; Ram, PM; van der Weijden, T; van der Vleuten, CPM
Patient Education and Counseling, 90(2): 213-219.
Patient Education and Counseling
Frequency of high-quality communication behaviors used by primary care providers of heterozygous infants after newborn screening
Farrell, MH; Christopher, SA
Patient Education and Counseling, 90(2): 226-232.
Medical Education
Adjusting medical school admission: assessing interpersonal skills using situational judgement tests
Lievens, F
Medical Education, 47(2): 182-189.
Comparing doctors' and nurses' accounts of how they provide emotional care for parents of children with acute lymphoblastic leukaemia
Forsey, M; Salmon, P; Eden, T; Young, B
Psycho-Oncology, 22(2): 260-267.
Medical Education Online
Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors
Langenau, EE; Zhang, XY; Roberts, WL; DeChamplain, AF; Boulet, JR
Medical Education Online, 17(): -.
ARTN 18812
Patient Education and Counseling
Education in patient-physician communication: How to improve effectiveness?
Wouda, JC; van de Wiel, HBM
Patient Education and Counseling, 90(1): 46-53.
Patient Education and Counseling
What parents want from emails with their pediatrician: Implications for teaching communication skills
Schiller, JH; Christner, JG; Stansfield, RB; Watnick, CS; Mullan, PB
Patient Education and Counseling, 92(1): 61-66.
Patient Education and Counseling
Pathways towards designing effective medical communication curricula
Wouda, JC; Hulsman, RL
Patient Education and Counseling, 93(1): 1-2.
Patient Education and Counseling
A European consensus on learning objectives for a core communication curriculum in health care professions
Bachmann, C; Abramovitch, H; Barbu, CG; Cavaco, AM; Elorza, RD; Haak, R; Loureiro, E; Ratajska, A; Silverman, J; Winterburn, S; Rosenbaum, M
Patient Education and Counseling, 93(1): 18-26.
American Journal of Gastroenterology
2012 David Sun Lecture: Helping Your Patient by Helping Yourself-How to Improve the Patient-Physician Relationship by Optimizing Communication Skills
Drossman, DA
American Journal of Gastroenterology, 108(4): 521-528.
Academic Psychiatry
Improving Physician-Patient Communication Through Coaching of Simulated Encounters
Ravitz, P; Lancee, WJ; Lawson, A; Maunder, R; Hunter, JJ; Leszcz, M; McNaughton, N; Pain, C
Academic Psychiatry, 37(2): 87-93.

Academic Medicine
Characterizing the Patient-Centeredness of Hidden Curricula in Medical Schools: Development and Validation of a New Measure
Haidet, P; Kelly, PA; Chou, C; The Communication, Curriculum, and Culture Study Group,
Academic Medicine, 80(1): 44-50.

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Academic Medicine
Communication Skills Training: Describing a New Conceptual Model
Brown, RF; Bylund, CL
Academic Medicine, 83(1): 37-44.
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Academic Medicine
Teaching Inpatient Communication Skills to Medical Students: An Innovative Strategy
Losh, DP; Mauksch, LB; Arnold, RW; Maresca, TM; Storck, MG; Maestas, RR; Goldstein, E
Academic Medicine, 80(2): 118-124.

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Academic Medicine
Commentary: Communication Skills: How Simulation Training Supplements Experiential and Humanist Learning
Makoul, G
Academic Medicine, 81(3): 271-274.

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Academic Medicine
Assessing Medical Students' Skills in Working With Interpreters During Patient Encounters: A Validation Study of the Interpreter Scale
Lie, D; Bereknyei, S; Braddock, CH; Encinas, J; Ahearn, S; Boker, JR
Academic Medicine, 84(5): 643-650.
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Academic Medicine
Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II Report
Duffy, FD; Gordon, GH; Whelan, G; Cole-Kelly, K; Frankel, R; All Participants in the American Academy on Physician and Patient's Conference on Education and Evaluation of Competence in Communication and Interper,
Academic Medicine, 79(6): 495-507.

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Academic Medicine
Satisfying the Patient, But Failing the Test
Egener, B; Cole-Kelly, K
Academic Medicine, 79(6): 508-510.

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Academic Medicine
Teaching Communication in Clinical Clerkships: Models from the Macy Initiative in Health Communications
Kalet, A; Pugnaire, MP; Cole-Kelly, K; Janicik, R; Ferrara, E; Schwartz, MD; Lipkin, M; Lazare, A
Academic Medicine, 79(6): 511-520.

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Academic Medicine
Integrating Communication Training into a Required Family Medicine Clerkship
Egnew, TR; Mauksch, LB; Greer, T; Farber, SJ
Academic Medicine, 79(8): 737-743.

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Patterns of Communication during the Preanesthesia Visit
Zollo, RA; Lurie, SJ; Epstein, R; Ward, DS
Anesthesiology, 111(5): 971-978.
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Medical Care
The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes
Swenson, SL; Rose, M; Vittinghoff, E; Stewart, A; Schillinger, D
Medical Care, 46(3): 257-265.
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Medical Care
The Use of Patient Satisfaction Surveys and Alternative Coding Procedures to Predict Malpractice Risk
Fullam, F; Garman, AN; Johnson, TJ; Hedberg, EC
Medical Care, 47(5): 553-559.
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Medical Care
Patient-Centered Communication During Primary Care Visits for Depressive Symptoms: What is the Role of Physician Personality?
Chapman, BP; Duberstein, PR; Epstein, RM; Fiscella, K; Kravitz, RL
Medical Care, 46(8): 806-812.
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Pediatric Critical Care Medicine
Difficult conversations: Improving communication skills and relational abilities in health care*
Meyer, EC; Sellers, DE; Browning, DM; McGuffie, K; Solomon, MZ; Truog, RD
Pediatric Critical Care Medicine, 10(3): 352-359.
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