Good Communication Should Start Early for Physicians

By Jennifer Larson, contributor

August 24, 2011 - Like many top-tier medical schools, the Stanford University School of Medicine carefully screens applications for the best candidates they can find. The admissions staff looks for outstanding academic records and impressive résumés.

But they also want to see how well candidates can think critically on their feet and effectively communicate those thoughts—because those are qualities that will help make the students become effective physicians.

Stanford is one of approximately a dozen American medical schools now using an interview format called the multiple mini interview, or MMI. The process was pioneered by McMaster University in Canada and is now in widespread use by Canadian medical schools. Other American medical schools that employ the MMI include the University of California, Los Angeles and the University of Arizona. Stanford began using the MMI process last year.

The MMI process has been compared to “speed dating.” Instead of two or three lengthy interviews, the process consists of a circuit of eight or 10 short encounters that might last 10 minutes each. After each short interview, a representative from the school rates the candidate on a scale (usually from 1-10 or 0-9).

The process is designed to give the prospective students the chance to consider a question or scenario and then to demonstrate both their critical thinking and communication skills by making a compelling case for their positions.

The format allows the school the chance to gauge how well the students can tap into their abilities to reason and demonstrate empathy, even possibly their ability to work with a team, said Charles Prober, M.D., senior associate dean for medical education at Stanford.

“It really is looking at how the person communicates, how they reason,” he said.

“It’s a tool that doctors have to use all the time,” added Gabe Garcia, M.D., professor of medicine and associate dean of admissions at the Stanford University School of Medicine.

Those types of skills are essential for physicians, agreed Henry Sondheimer, M.D., senior director of admissions for the Association of American Medical Colleges (AAMC), noting that the MMI conveys that importance to the students.

“There isn’t always one answer. There’s frequently two or three, and how you think about the different options in medicine and how you explain those options to the patient is what makes for good communication,” he said.

Good communication is indeed at the heart of the physician–patient relationship, said Garcia. If a physician doesn’t make the effort to establish an open line of communication with a patient, the possibility for misunderstanding increases. That can frustrate both doctors and patients.

“Those who are best at their work create an atmosphere in that treatment room that allows for shared decision-making and shared understanding that can only come from having good communication skills,” he said.

Oncologist Kenneth Blankstein, M.D., agreed.

“For you to have your patients’ trust, you have to be completely honest with them,” said Blankstein, president of the medical staff at Hunterdon Medical Center in New Jersey. “You have to communicate directly, you have to communicate appropriately, and you have to communicate openly.”

However, the new focus on communication doesn’t mean that a prospective student has to already be a great communicator to gain acceptance to Stanford or the other schools that use the MMI. Many schools are working to instill good communication skills in their students once they enroll, by requiring them to learn how to interview patients as part of their schooling.

“We do expect them to improve their communication skills as a result of their medical school experience,” Garcia said, noting that it’s easier to teach communication skills than critical thinking skills.

Blankstein noted that in the past the medical school admission process was focused much more on academic prowess than interpersonal skills. The fact that the importance of good communication for physicians is receiving more attention today is a positive development, he said.

“I think in order to be successful in medicine, you have to have good social skills,” he said.
And according to Sondheimer, medical schools are doing a much better job of helping students build their interpersonal skills than they did even 10 or 15 years ago.

For example, nearly every medical school now has a course that trains students how to interview patients. Students are required to interview standardized patients; the “patients” provide feedback, and the interview is recorded so the students can watch themselves and learn what they did well and what they could improve.

“Seeing yourself on tape is very revealing,” Sondheimer said.

Additionally, medical students now have to demonstrate those types of skills in order to be licensed. About a decade ago, the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners added a new section to the U.S. Medical Licensing Exam (USMLE) for fourth year students. The new section is a clinical skills section in which students visit a series of stations and interact with simulated patients. Medical schools know they must prepare their students to succeed in those interactions, Sondheimer said.

Medical schools are also starting to address the issue of inter-professional communication. “We are completely dependent on all the other healthcare professions…but I don’t think that, in the past, that has been emphasized,” he said.

Understanding that interdependence, Stanford has already begun drawing upon the feedback of people outside the field of medicine when it comes to the interviewing process. The admissions team has recruited a variety of people from different backgrounds to participate as “raters,” including former patients and other types of healthcare professionals, so they can lend their perspective about the students’ potential.

“They’re going to have all different kinds of patients who have different personalities. To be effective, they’re going to have to be able to communicate with different types of individuals with different personalities,” Prober said. “And they’re going to have to be working on teams with other personnel.”

“They need to be able to communicate effectively with other members of the healthcare team because medicine really is a team sport,” he added.