J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Attitudes of Alexandria Medical Students towards
Communication Skills Learning
Khashab S S *
*
Community Medicine Department, Faculty of Medicine,Alexandria University.
ABSTRACT
By the end of their training, medical students should have
demonstrated a proficiency in communication and acquired attitudes
consistent with effective medical practice. Few studies have explored
medical students' attitude within a communication skills learning and
teaching context. The current study aims to identify the attitudes of medical
students towards communication skills learning and to consider their
relationships with students,
demographic and
education-related
characteristics. To achieve such aim, a total of 470 medical students from
Alexandria Medical School (4th and 5th year) completed the 26-item
Communication Skills Attitude Scale and a personal details questionnaire
satisfactorily. Univariate and multivariate analysis were used to find out The
relationship between students' attitude and, some demographic and
education- related characteristics. The results showed that, the attitude of
medical students towards communication skills learning was significantly
more positive among 5th year batch than their counterparts. In addition,
students born to a father or a mother who was a doctor had a significantly
lower score on the negative subscale compared to students born to parents in
other occupations. Being a student in the 5th year independently predict
higher scores on the positive attitude subscale. As revealed by multivariate
analysis, being a student in the 5th year and having a father who is a doctor
independently predict lower scores on the negative attitude subscale. It is
then recommended to consider teaching communication skills in advanced
years when students are exposed to clinical settings. Learning
communication skills should go hand in hand with the practice in clinical
setting as this will add more to its tangible value. Further longitudinal
studies are recommended in this respect.
Corresponding Author:
Dr. Sahar Khashab Said Khashab.
Faculty of Medicine
Community Medicine Department
University of Alexandria
E.mail: saharkhashab@hotmail.com
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Keywords: Communication Skills- Attitude –Medical Students
INTRODUCTION
Doctors should be good listeners and should be able to provide
advice and explanations that are comprehensive to patients and their
relatives. Surprisingly few people seem to worry about the technical
competence of doctors. What they worry about is their doctor's ability
to understand the patient as a person and to provide the right guidance.
The priority need of patients is high touch and not high tech. (1) The
essential unit of medical practice is the occasion when in the intimacy of
the consulting room, a person who is ill or believes himself to be ill,
seeks the advice of a doctor whom he trusts .This is the consultation,
and all else in the practice of medicine derives from it. (2)
In response to patients' needs, medical schools are now considering
teaching communication skills to undergraduate students. In the United
Kingdom (UK), communication skills learning became an integral part
of undergraduate medical curriculum since 1993.
(3)
Recently (2001), the
General Medical Council (GMC) in the United Kingdom recommended
that, by the end of their training, medical students should have
demonstrated a proficiency in communication and acquired attitudes
consistent with effective medical practice. (4) Students learning should be
also based on curiosity, that they have the capacity and incentive to
acquire new knowledge and the ability to engage in reflective practice.(5)
Hence, the upgrading of communication courses in medical schools
teaching undergraduates became mandatory in order to respond to
their needs in a way conclusive to attainment of treatment objectives. (6)
356
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
In spite of the wealth of literature regarding communication
curricula within the undergraduate courses, yet, few studies have
explored medical students' attitude within a communication skills
learning and teaching context. (5,7,8,)
Given that teaching programs within the social sciences often
encounter varying degrees of student resistance, studies are needed to
explore medical students' attitudes towards communication skills
learning.
(9)
Hajek et al. (2000) found that medical students' main
concerns involved communicating with certain category of patients
namely those who were in pain and who showed strong negative
emotions.
(8)
Batenburg & Saml (1997) found that medical students'
attitudes did not change substantially as a result of the communication
skills teaching intervention, suggesting that students' attitudes towards
patients, illness and care were very stable and considerable effort is
needed to initiate a change in attitudes.
(10)
Moreover, in a recent
qualitative study, participants suggested that medical students'
attitudes towards communication skills learning were related to other
extra curricular factors such as their previous educational experience,
their age, and their communicative abilities.
(7)
Other studies suggested
different demographic characteristics such as gender, language and
ethnicity as factors influencing the attitudes of students in learning
communication.(5,11) Hence, it was important to explore the possible
characteristics of students that might be behind their attitudes.
The current study aims to identify the attitudes of medical students
of Alexandria Medical School enrolled in the 4th and 5th year during the
academic year 2004/2005 using an attitude scale developed by Rees et al.(7)
and to consider their relationships with medical students, demographic
and education-related characteristics.
357
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
MATERIAL AND METHODS
The target population of the present study was 4th and 5th year
medical students. In the beginning of their community medicine
training, all students were exposed to a two hours communication skills
session administered by the same educator. The session focused on
providing
students
with
knowledge
addressing
the
types
of
communication, factors improving communication skills with emphasis
on: doctor-patient interpersonal skills, information gathering skills,
information giving skills and patient's education. By the end of the
session, the educator selected a group of students to practice
communication skills during a doctor-patient encounter by role play to
their colleagues. The rest of students were requested to rate the practice
and point to the positive and negative aspects of the role played. The
main objective was to equip under graduate students with the skills to
communicate effectively with patients. All students attending training
during January and February 2005 were enrolled in this study. The
inclusion of two different batches not only enabled the exploration of
the difference in attitude between 4th year and 5th year students but also
allowed the prediction of the changes in the views and needs of
students when the circumstances changed around them. This change is
brought about in the 5th year as a result of daily exposure to clinical
rounds with the subsequent multiple student-patient contacts.
Study tool is comprised of a self-administered questionnaire consisting
of the following:
1- Demographic and educational characteristics
This part included demographic characteristics and education-related
items. Demographic characteristics included sex, residence, parent's
education and occupation with emphasis on whether mother or father is
358
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
a doctor, family size and income. The education-related items included
batch, schooling, educational system and whether respondents sought
private lessons during studying medicine. Respondents were also asked
to answer if they thought that their communication skills are in need for
improvement.
2- Communication Skills Attitude Scale
The scale was designed by Rees et al.(7) and measures attitudes of
medical students towards communication skills. This scale consists of 26
items with two subscales; the first subscale consists of 13 items that
represents positive attitudes towards communication skills learning
including its positive impact on interacting with patients, establishing
good patient-doctor relationship and enabling team work and interaction.
The second subscale consists of 13 questions that represent negative
attitudes towards communication skills learning including not being
able to perceive the importance and relevance of communication in
medical practice. All of the 26 items are accompanied by 5-point Likert
scales, ranging from strongly agree (score 5) to strongly disagree (score 1).
Separate scores were generated for positive attitude scale (PAS) and
negative attitude scale (NAS). The score for each scale ranged form 13 to
65 where higher scores indicate stronger positive attitudes or stronger
negative attitudes towards communication skills learning. This tool has been
tested and showed satisfactory internal consistency and test-retest reliability.
Before the distribution of the questionnaire, the author reviewed
with students the objective of teaching communication skills and its relevance
to medical practice. Students were briefed about the communication skills
attitude scale, objective of its application and method of filling it.
Students were motivated to complete the study materials. They were
also notified that incomplete forms will be discarded.
359
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
A total of 551 questionnaire forms were distributed to 4th and 5th
medical students and 500 returned the questionnaire at the end of the
session resulting in a non-response rate of 9.07%. Only 470 forms were
complete and included in the analysis.
Data were analyzed using the SPSS version 10. The mean and
standard deviation were computed. The student’s t-test was applied to
test the significance of the obtained results. The linear regression was
used to identify the predictors of positive and negative attitudes
towards communication skills learning. Significance of the obtained
results was judged at the 5% level.
RESULTS
Participant's demographic and education-related characteristics
(Table 1) :
The age of enrolled students ranged from 20 to 25 years
(mean=20.7979 ±0.7968 years).The majority of students were fourth year
students (n=367, 78.09%), females (n =254, 54.04%) and residing in
Alexandria (n = 334, 71.06%). Most of the students completed their
preparatory and secondary education in public schools (n=297,63.19%
and n =365,77.70% respectively),were subjected to the national system
of education (n=439,93.40%), admitted directly to the Alexandria
medical
school
(n=448,95.32%)
and
passed
the
previous year
successfully with Good score and above (n= 403,85.74%). Although the
majority of students did not have fathers or mothers who were doctors
(n =410,87.23% and n =423,90% respectively),yet most of the
participants’ parents were holding a university degree or higher
(fathers: n = 360,76.6% and mothers: n = 309,65.75% respectively) and
fell in professional/semiprofessional occupational category (fathers: n=
360
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
427, 90.85% and mothers: n=265,56.48%). The majority of the students
also belonged to families ranging in size from 5 to 7 members, with
monthly income of 1000 L.E and above and did not take any private
lessons at the university (n=348,74.04%,n=319,67.87% and n=357,75.96%
respectively). Finally, almost all of the students thought that their
communication skills need improvement (n=448, 95.32%).As students
were recruited from two different batches, their demographic and
education related characteristics are presented separately in Tables 1 & 2.
On the positive attitude subscale, students’ scores ranged from
21 to 65 with a mean of 50.96 + 7.539 and a median of 52. On the
negative attitude subscale, students’ scores ranged from 16 to 64 with a
mean of 32.48 + 5.404 and a median of 32.
Table (3) portrays the scores of students on the positive and
negative attitude subscale in relation to their characteristics. The table
shows that on the positive attitude subscale, the mean scores of students
enrolled in the 5th batch was 52.26 + 5.518 while it was 31.33 + 4.845 on
the negative attitude subscale. The scores of these students on the
positive attitude subscale was significantly higher than that of their
counterparts in the 4th year (p= 0.046) while it was significantly lower
on the negative attitude subscale (p= 0.014). However no significant
differences were observed in students’ scores on the positive and
negative attitude subscale in relation to their sex and place of residence.
The mean scores of students on the two subscales were examined
in relation to the educational system and type of schooling during the
preparatory and secondary stage of education. Nearly equal mean
scores on the positive and negative attitude subscales were obtained by
students who were enrolled in the national and international system of
education during the school years. Moreover, no significant difference
361
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
was observed on students’ scores on any of the subscales in relation to
the type of schooling and system of admission to the medical college.
Furthermore, students’ scores in the previous year as well as received
private tuition did not significantly affect their scores on either subscale
(Table 3).
No significant difference was observed in the mean score of
students on the positive and negative communication skill attitude
subscales in relation to neither parents’ level of education nor
occupational categories. However, students born to a father or a mother
who was a doctor had a significantly lower score on the negative
subscale (p=0.004 and 0.044 respectively) compared to students born to
parents in other occupations. However no significant difference was
observed in the positive attitude scale in this respect. As regards family
income, students with low family income (< 500 L.E.) and high family
income (>2000 L.E) showed significantly lower scores on the negative
subscale (p=0.046) compared to those in the middle income categories
(500-<2000 L.E). (Table 4)
Table (5) shows the independent predictors of scores on the
positive and negative subscale of the communications skills learning
attitude. Students’ batch and fathers’ occupation predicted students’
scores. Being a student in the 5th year independently predicts higher
scores on the positive attitude subscale (p=0.046). Being a student in the
5th year and having a father who is a doctor independently predicts
lower scores on the negative attitude subscale (p=0.021 and 0.006
respectively).
362
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Table (1): The Characteristics and Educational Background of Enrolled
Medical Students.
The characteristics and educational
background of enrolled medical students
Batch
4th
5th
Age
X+S
Min – Max
Gender
Male
Female
Residence
In Alexandria
Outside Alexandria
Preparatory school
Public
Private
Language
Secondary school
Public
Private
Language/special
Admission
Direct
Transferred from other universities
Education System
National
International
Previous year grades
Excellent
Very good
Good
Fair
Poor
Students seeking private lessons
Yes
No
Students thinking their communication skills
need improvement
Yes
No
No.
(470)
%
367
103
78.09
21.91
20.7979±0.7968
20-25
216
254
45.96
54.04
334
136
71.06
28.94
297
75
98
63.19
15.96
20.85
365
14
91
77.66
2.98
19.36
448
22
95.32
4.68
439
31
93.40
6.60
103
152
148
39
28
21.91
32.34
31.49
8.30
5.96
113
357
24.04
75.96
448
22
95.32
4.68
363
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Table (2): Family Characteristics of Enrolled Medical Students.
Family characteristics of
enrolled medical students
Parents Education
Father
Illiterate/read & write
Primary/preparatory
Secondary/diploma
University + Postgraduate
Mother
Illiterate/read & write
Primary/preparatory
Secondary/diploma
University + Postgraduate
Parents Occupation
Father
Professional/semi-professional
Skilled/semi-skilled
Manual laborers
Unemployed
Mothers
Professional/semi-professional
Skilled/semi-skilled
Manual laborers
House wives
Students having father doctor
Yes
No
Students having mother doctor
Yes
No
Students family size
2-4
5-7
8+
Students family income
<500
500-<1000
1000-<2000
 2000
No.
(470)
%
21
24
65
360
4.47
5.10
13.83
76.60
41
32
88
309
8.72
6.81
18.72
65.75
427
22
12
9
90.85
4.68
2.55
1.91
265
16
189
56.38
3.41
40.21
60
410
12.77
87.23
47
423
10
90
102
348
20
21.70
74.04
4..26
37
114
150
169
7.87
24.26
31.91
35.96
364
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Table (3): The Positive and Negative Attitude Subscales in Relation to
Characteristics and Educational Backgrounds of Students
Characteristics and
educational
backgrounds
of students
PAS
NAS
No.
(470)
x
S
Test of sig.
x
S
Test of sig.
Batch
4th
5th
367
103
50.59
52.26
7.984
5.518
t=1.997*
(p=0.046)
32.804
31.330
5.514
4.845
t=2.459*
(p=0.014)
Sex
Male
Female
216
254
51.43
50.55
7.650
7.436
t=1.261
(p=0.208)
32.44
32.51
5.818
5.037
t=0.135
(p=0.893)
Residence
Alex
Outside
334
136
50.57
51.89
7.757
6.916
t=1.732
(p=0.084)
32.52
32.38
5.460
5.283
t=0.271
(p=0.787
Preperatory school
Public
Private
Language
297
75
98
51.36
49.46
50.85
7.766
6.237
7.676
f=1.913
(p=0.149)
32.67
31.79
32.44
5.257
5.225
5.962
f=0.803
(p=0.449)
Secondary school
Public
Private
Language/Special
365
14
91
51.00
49.57
50.98
7.577
4.879
7.765
f=0.243
(p=0.785)
32.54
32.43
32.26
5.215
5.515
6.144
f=0.093
(p=0.911)
Admission
Direct
Transferred
448
22
50.94
51.27
7.466
9.119
t=0.202
(p=0.840)
32.56
30.91
5.292
7.309
t=1.399
(p=0.163)
Educational System
Traditional
International
439
31
50.92
51.42
7.541
7.628
t=0.354
(p=0.723)
32.59
30.94
5.352
5.983
t=1.650
(p=1.000)
Score (previous year)
Excellent
Very good
Good
Fair
Poor
103
152
148
39
28
50.50
51.28
50.48
50.54
50.25
8.137
7.748
6.811
7.254
8.159
32.34
32.16
32.63
33.62
32.39
5.028
5.085
5.905
5.456
5.724
Private lessons
No
Yes
357
113
50.85
51.30
7.608
7.342
32.55
32.26
5.260
5.855
f=1.006
(p=0.404)
t=0.559
(p=0.577)
f=0.610
(p=0.655)
t=0.506
(p=0.613)
365
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Table (4): The Positive and Negative Attitude Subscales in Relation to
Family Characteristics of Enrolled Medical Students.
Family characteristics of
enrolled medical students
Father's education
Illiterate/read write
Primary/preparatory
Secondary/diploma
University+
Mother's education
Illiterate/read write
Primary/preparatory
Secondary/diploma
University+
Father's occupation
Professional/semiprofessional
Skill/Semiskilled
Manual
Unemployed
Mother's occupation
Professional/semiprofessional
Skill/semiskilled/ manual
Unemployed (housewife)
Father doctor
Yes
No
Mother doctor
Yes
No
Family Size
2-4
5-7
8+
Family income
<500
500-<1000
1000-<2000
>2000
PAS
No.
(470)
x
21
24
65
360
NAS
S
Test of
sig.
x
S
Test of
sig.
52.71
49.92
52.54
50.64
6.566
7.324
6.152
7.802
f=1.711
(p=164)
32.86
32.88
31.77
32.56
5.092
5.376
4.656
5.557
f=0.477
(p=0.698)
41
32
88
309
52.66
51.28
50.85
50.72
5.998
6.873
7.936
7.674
f=0.818
(p=0.669)
33.15
32.59
33.17
32.18
5.416
4.309
5.414
5.498
f=0.999
(p=0.393)
427
22
12
9
50.92
51.36
53.00
49.00
7.628
7.068
3.643
8.602
f=0.519
(p=669)
32.51
32.77
31.42
31.89
5.438
5.255
4.188
6.214
f=0.215
(p=0.886)
265
16
189
51.04
48.69
51.96
7.280
9.638
7.716
f=0.748
(p=0.474)
32.43
35.31
32.32
5.388
6.258
5.315
f=2.309
(p=1.000)
60
410
50.67
50.99
7.754
7.517
t=0.317
(p=0.751)
30.60
32.76
5.533
5.337
t=2.909*
(p=0.004)
47
423
51.47
50.89
6.567
7.645
t=0.491
(p=0.624)
30.98
32.65
4.748
5.452
t=2.015*
(p=0.044)
102
348
20
50.75
50.93
52.40
8.079
7.424
6.870
f=0.404
(p=0.668)
32.81
32.42
31.80
5.989
5.319
3.518
f=0.372
(p=0.690)
37
114
150
169
51.81
51.56
50.16
51.07
7.094
7.432
7.776
7.493
31.97
32.57
33.93
31.72
4.952
5.846
5.149
5.328
f=0.972
(p=0.406)
f=2.684*
(p=0.046)
366
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
Table (5): The Independent Predictors of Attitude towards Communication
Skills Learning
Independent predictors of
attitude towards communication
skills learning
Standardized
coefficient (B)
t
p-value
0.092
1.997
0.046
-0.127
2.781
0.006
-0.105
2.307
0.021
PAS
Batch
(4th=0; 5th=1)
Adjusted R 2 =0.006
NAS
Father doctor
(No=0; Yes=1)
Batch
th
th
(4 =0; 5 =1)
DISCUSSION
Generally, students enrolled in the present study displayed a lower
negative attitude and higher positive attitude as indicated by their mean
scores.
This
finding
reflects
the
acceptance
of
students
for
communication skills learning. Besides, almost all of the students
admitted that their communication skills need improvement. This is
similar to the findings reported by Rees & Shread and others
(11 ,4, 5)
in
which students were more likely to have positive attitudes towards
communication skills learning especially if they sense that they are poor
communicators and if their communication skills needed improvement.
Simultaneously, medical students with negative attitudes towards
communication skills learning were significantly more likely to think
that their communication skills were proficient.
Rees & Shread (2003) reported
(11,4)
On the contrary,
that medical students rated their
communication skills as being significantly lower at the end of the
367
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
communication skills course in comparison with the start of the course.
They also reported a significant reduction in positive attitudes towards
communication skills learning which may have resulted from students
believing that they are poor communicators.
(5)
It was also suggested
that students' negative attitudes may result from communication skills
being seen as a subjective social science taught by non-clinicians,(4) but
was not the case in the present setting as communication was taught by
a medical professional specialized in preventive medicine.
However,
further studies are required to test the association between a sense of
proficiency
in
communication
and
students'
attitudes
toward
communication skills learning, especially that the overestimation and
underestimation of students to their communication skills is well
documented. (12, 13 )
Students' batch was found to have a significant effect on attitudes
towards communication even after the control for other variables.
Students of the 5th batch showed significantly higher positive attitudes
towards communication skills learning than 4th batch students. This
finding reflects that academic maturation result in more positive
attitudes towards learning communication skills. This is consistent with
Rees & Garrud (2001),
(5)
who suggested that mature students were
more positive towards learning communication skills than younger
students. It was suggested that communication skills training in clinical
clerkships may be more effective than in preclinical courses, possibly
because of students' attitudes towards such learning.
(14,15)
Among our
sample, 5th year students had to interact with patients in wide variety of
settings within their clinical rounds in the previous year. As a result,
they started to recognize the values, relevance and implications of good
communication skills. This showed to be reflected on their attitudes
towards learning communication skills. However, this is in contrast to
368
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
the findings of Rees et al. (2002),(11) who found that younger students
are more eager to learn communication skills and attributed this
observation to their lower experience in communicating with people
they do not know. In view of this contradiction, the relation between
academic maturation and students attitudes needs further exploration
in a longitudinal study.
In this sample, students' gender was found not to have a
significant association with the positive attitude subscale mean score.
This is in accordance with Batenburg &Smal (1997)
(10)
who reported
that female students scored the same as male students in a study to
measure professional attitudes before and after a communication skills
course. However, several studies found that male students were slower
at learning communication skills than female students,
(16,17)
and they
tended to have significantly lower positive attitude scores than females,
suggesting
that
women
had
communication skills learning.
more
positive
attitudes
towards
(11)
This study revealed the lack of significant relation between parents’
level of education and occupational categories and their children's score
on the positive and negative communication skill attitude subscales.
However, students who had a father or a mother who was a doctor had
a significantly lower score on the negative subscale and having a father
who is a doctor independently predicted lower scores on the negative
attitude subscale. These findings suggested a significantly lower
negative attitude towards communication skills learning of students
with doctor parents than students born to parents in other occupations.
The possible explanation for this finding is that being raised with a
doctor parent created cultural beliefs about valuing communication
skills within the medical practice. The attitude of students born to
doctor parents towards subjects they studied positively developed
369
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
towards medicine since their early years of childhood. They usually
chose to be physicians to imitate their parents and to have more
supported education and secured careers. As a result they may value
doctor-patient relationships to the same extent as scientific knowledge.
Indeed, some researchers
(18,19)
have suggested that attitudes are
transferred from practicing and experienced health care professionals to
students and other less experienced workers. However, in an earlier
study, students with doctor parents were found to have significantly
lower scores on the positive attitude subscale and higher scores on the
negative attitude subscale suggesting that they had less positive
attitudes towards communication skills learning than students who did
not have doctor parents. The explanation suggested was that, doctor
parents have poor attitudes towards communication skills learning
because communication skills were not taught when they were
undergraduates, and that their children are socialized into adopting
these negative attitudes.(11)
In Egypt, family income is not always related to parents'
educational attainment or occupational categories. Among enrolled
students a significant lower scores on the negative subscale was
observed among those with low and high family income compared to
those in the middle income categories. This could be explained by the
fact that students of low economic status are aware of their
incompetence in communication and their need to improve it. Those of
the upper economic strata value the role of communication in their dayto-day interaction and their need to communicate effectively with
patients who are of a different socio-cultural background. Specially that
ideas on cultural relativity are rarely taught in medical or other schools
for health workers,(20) in UK where family income is related to parents'
educational attainment and occupational category, Rees&Shread (2002)
370
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
reported an insignificant relation between family income and students'
attitudes towards communication skills learning.
(11)
In spite of that, It
was recommended that communication skills courses should be
designed conforming with the cultural characteristics of students. (5)
The attitudes of students towards communication skills learning
were significantly associated with demographic and education-related
characteristics.
Students
with
more
positive
attitudes
towards
communication skills learning tended to be in an advanced batch. It is
then recommended to consider teaching communication skills in
advanced years when students are exposed to clinical settings. Learning
communication skills should go hand in hand with the practice in
clinical setting as this will add more tangible value to its learning. In
this respect, further longitudinal studies are recommended. Upgrading
of communication courses in medical schools should be always
considered to have physicians capable to interact effectively with their
patients and to respond to their needs.
REFERENCES
1.
Freeman JW, Landis J. Alternative and complementary therapies. South
Dakota Journal of Medicine 1997; 50 (2):65-6.
2.
Boland M. What do people expect from their doctors? World Health
Forum 1995;16: 22-7.
3.
General Medical Council. Tomorrow's Doctors. Recommendations on
Undergraduate Medical Education. London: General Medical
Council;1993.
4.
Rees CE, Shread CE, McPherson AC. A qualitative study to explore
undergraduate medical students' attitudes towards communication skills
learning. Med Teacher 2002;24(3):289-93.
5.
Rees CE, Garrud P. Identifying undergraduate medical students'
attitudes towards communication skills learning: a pilot study. Med
Teacher 2001; 23: 400-60.
371
J Egypt Public Health Assoc
Vol. 81 No. 5 & 6, 2006
6.
Abou Khatwa S.Cure seeking behavior in squatter
Alexandria.Bull High Inst Public Health 1998;28(2):287-317.
areas
in
7.
Rees C, Sheard C, Davies S. The development of a scale to measure
medical students' towards communication skills learning: the Communication Skills Attitude Scale (CSAS). Med Educ; 2002; 36: 141-7.
8.
Hajek P,Najberg E,Cushing A. Medical students' concerns about
communicating with patients.Med Educ 2003;34:656-8.
9.
Benbassat J. Teaching the social sciences to undergraduate medical
students.
Isrl J Med Scn 1996;32:217-21.
10.
Batenburg V, Smal JA. Does a communication skills course influence
medical students' attitudes? Med Teacher 1997; 19:263-9.
11.
Rees C, Shread C. The relationship between medical students' attitudes
towards communication skills learning and their demographic and
education-related characteristics.Med Educ 2002;36:1017-27.
12.
Marteau TM, Humphrey C , Matoon G, Kidd, J, Lloyd M , Horde J.
Factors influencing the communication skills of first-year clinical medical
students. Med Educ 1991;25: 127-34.
13.
Farnhill D, Hayes SC,Todisco J. Interviewing skills: self-evaluation by
medical students . Med Educ 1997; 31: 122-7.
14.
Aspergren K. Teaching and learning communication skills in medicine: a
review with qualitative grading of articles.2nd edition. Dundee:
Association of medical education in Europe ; 1999.
15.
Vaugn S, Schumm JS, Sinagub J. Focus group interviews in education
and psychology .Thousand Oaks,CA,Sage;1996.
16.
Holm U. The Affect Reading Scale: a method of measuring the
prerequisites for empathy. Scand F Educational Res 1996; 40:239 - 53.
17.
Holm U, Aspegren K. Pedagogical methods and affect tolerance in
medical students. Med Educ 1999; 33: 14-8.
18.
Kassebaum DG, Cutler ER. On the culture of students abuse in medical
school. Acad Med 1998; 73: 1149-58.
19.
Rezler AG. Attitude change during medical school: a review of the
literature. F Med Education 1974; 49 : 1023-30.
20.
Jelliffe DB, Jelliffe EP. The cultural cul–de–sac of western medicine.
Trans R Soc Trop Med Hyg 1977; 71: 331.
372