Sir, - I fear Rosita Boland's article (February 21st) describing the teaching of communication skills to undergraduate medical students at the Royal College of Surgeons is rather trivialised by its headline: "Charm school for doctors".
This rather suggests that what is taking place is some effort to put icing on the cake of medical education whereas the teaching of communication skills is now widely recognised as absolutely fundamental to the training of doctors. It is, for instance, a policy of the Medical Council that all undergraduate medical courses in this country should include teaching in communication skills.
The assertion that clinical communication was pioneered by the Royal College of Surgeons could be challenged by other medical schools. Clinical communication has been an integral part of medical education since time immemorial. It has been called bedside teaching or history taking, or by some other appellation.
Even the use of video is not so very new. I was taught clinical communication using video under the tutelage of Professor Marcus Webb of the Department of Psychiatry in Trinity College over 20 years ago. Video feedback of their communication skills has also been part of the teaching in psychiatry here at University College, Cork, over a similar length of time under the direction of Professor Bob Daly.
Professor O'Boyle's contention, quoted by Ms Boland, that the Royal College of Surgeons is the only medical school looking at students holistically, likewise cannot be allowed go unchallenged. We at UCC, and I am sure it is the case for other medical schools, take an increasingly holistic view of our students and their medical education.
This drive towards a more holistic medical education is manifest in all our medical schools, for instance, by the establishment of departments of general practice one of whose major contributions is a broader, more humanistic and more holistic curriculum. What Professor Shannon has, undoubtedly, pioneered in Ireland, at least, is the deployment of former patients and actors simulating patients in the endeavour to teach clinical communication. The additional benefit of this new dimension to clinical communication teaching is very effectively conveyed in Ms Boland's article.
I have previously worked in the University of Manchester, one of the pioneers of these techniques in the UK, where I experienced the profound impact on students of being told by simulated patients "in role" or, indeed, by real patients encouraged to provide feedback, where their communication was and was not effective. I am currently striving to develop similar teaching for our undergraduate medical students at University College, Cork.
Your readers should appreciate, though, that such teaching is extremely resource intensive. Students need to be in very small groups - there were five in the group reported on by Ms Boland - and sessions need to be resourced by one teacher and two or more actor/patients. For a class of 100 medical students to have two hours of this type of teaching requires 120 man hours. Under current Higher Education Authority methods for accrediting teaching input, though, this would count as only two hours of teaching time.
Because this method is so powerful and effective, and its potential benefits to patients so enormous, we must find new mechanisms for resourcing it properly, - Yours, etc., Colin P. Bradley,
Professor of General Practice, University College, Cork.