Résumé :
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[BDSP. Notice produite par INIST-CNRS Y6R0xTYx. Diffusion soumise à autorisation]. Context : Although physicians'communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials. Objective : To determine whether communications training for medical students improves specific competencies known to affect outcomes of care. Design and Setting : A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention. Participants One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001). Intervention Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development. Main Outcome Measures : Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks : relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance. Results : Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4% ; 5.1% difference ; 95% confidence interval [Cl], 3.9% - 6.3% ; P<. relationship development and maintenance difference cl p organization time management ci subsets of cases addressing patient assessment negotiation shared decision making similar effects were found at each the schools though they differed in magnitude. conclusions : communications curricula using an established educational model significantly improved third-year students competence as well their skills building making-tasks that are important to positive outcomes. improvements observed despite adaptation intervention local curriculum culture.>
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