Table 1 Expert consensus of content (learning outcomes) for a communication skills core curriculum for undergraduate medical students
A) Communication with patients (diada) | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
 A.1. General Aspects of Clinical Interviews with patients (The student recognises the value of medical interviews for clinical purposes; knows, integrates and structures the various components) | ||||
The student… | ||||
 1. Explains the principles and characteristics of human communication. | 7,4 | 7,5 | 2,0 | 13,6 |
 2. Explains the professional and patient relationship models (focused on the professional, on the patient, on tasks, on the process, mixed…). | 8,0 | 8,0 | 2,0 | 2,3 |
 3. Describes the various content elements of a patient history (medical history: illness and disease, physical and complementary exams, diagnostic approach, care plan, evolution). | 8,1 | 9,0 | 1,0 | 6,8 |
 4. Describes the various useful procedural elements for preparing a patient history (communication or relational skills). | 7,7 | 8,0 | 2,0 | 13,6 |
 5. Delimits the structure of a clinical interview from the beginning to the end (introduction, initiating the interview, sharing information: gathering and giving it, planning, setting up next meeting, closing the interview). | 8,1 | 9,0 | 1,0 | 9,1 |
 6. Identifies the aspects of doctor-patient communication that have been proven efficient in scientific studies (due to the positive relationship with the outcome of the care). | 8,0 | 8,0 | 2,0 | 9,1 |
 7. Recognises the mechanisms through which clinical communication generally leads to improved care outcomes through intermediate outcomes. | 7,5 | 8,0 | 1,0 | 13,6 |
 8. Conducts a clinical interview by integrating the content (medical history, exam, diagnosis, care plan and evolution) with the process (communication or relational skills). | 8,7 | 9,0 | 0,0 | 2,3 |
 9. Demonstrates acceptance of the importance of the relational context in which the clinical interview is conducted by using adequate behaviours. | 8,1 | 9,0 | 1,5 | 9,1 |
 10. Demonstrates a willingness to involve the patient in the interaction, establishing a therapeutic relationship using a patient-centred approach. | 8,6 | 9,0 | 1,0 | 2,3 |
 A.2. Tasks and Skills for communication with patients | ||||
  A.2.1. Establishes and maintains a therapeutic relationship (Connects) (The student establishes and maintains a therapeutic relationship through a patient-centred approach) | ||||
The student… | ||||
 11. Knows the most relevant aspects of non-verbal communication (eye contact, gestures, facial expressions, proxemics, paralanguage…) and their influence on the establishment of an effective relationship. | 8,4 | 9,0 | 1,0 | 6,8 |
 12. Verifies the patient feels attended and listened to using techniques such as active listening, questions, checks, etc. | 8,8 | 9,0 | 0,0 | 0,0 |
 13. Perceives the patient’s non-verbal language and responds adequately given the context. | 8,6 | 9,0 | 1,0 | 2,3 |
 14. Uses clinical history records (manual/computerised) when communicating with the patient in a way that does not interfere. | 8,1 | 9,0 | 1,0 | 6,8 |
 15. Applies social communication skills to welcome patients that foster an effective relationship (greeting, calling the patient by name, making them feel comfortable…). | 8,7 | 9,0 | 0,0 | 2,3 |
 16. Applies social communication skills to take leave of patients that foster an effective relationship (saying goodbye, accompanying them to the door…). | 8,7 | 9,0 | 0,0 | 2,3 |
 17. Demonstrates empathy at the right times (emotional reactions, difficult situations…). | 8,6 | 9,0 | 0,5 | 2,3 |
 18. Recognises difficult situations and communication challenges (crying, strong emotions, interruptions, aggression, anger, anxiety, sensitive or embarrassing topics, cognitive difficulties, bad news, first meeting…). | 8,6 | 9,0 | 1,0 | 4,6 |
 19. Uses techniques to sensitively and constructively handle difficult situations and communication challenges. | 8,4 | 9,0 | 1,0 | 4,6 |
 20. Relates with the patient in a respectful manner considering their rights (confidentiality, privacy, autonomy, respect for their values and beliefs). | 8,8 | 9,0 | 0,0 | 2,3 |
 21. Considers the patient as a collaborator in building the relationship and treats the patient as such. | 7,8 | 9,0 | 1,5 | 13,6 |
 22. Demonstrates genuine interest in the relationship with the patient and their situation. | 8,1 | 9,0 | 1,5 | 9,1 |
 23. Adequately uses a sense of humour in the relationship with the patient (in situations that need calming, to show proximity…). | 7,2 | 8,0 | 3,0 | 27,3 |
  A.2.2. Exchange Information and Understand it | ||||
   A.2.2.1. Gather information (The student gathers the relevant information to make reasoned clinical decisions) | ||||
The student… | ||||
 24. Differentiates illness from disease, recognising the importance of exploring both perspectives. | 8,4 | 9,0 | 1,0 | 2,3 |
 25. Recognises the advantages and disadvantages of various communication skills when gathering information (open/closed questions, eliciting…). | 8,2 | 9,0 | 1,5 | 6,8 |
 26. Accurately establishes the reasons for the patient’s visit (open question, no interruptions, explores different reasons…). | 8,4 | 9,0 | 1,0 | 4,6 |
 27. Examines and gathers the content of the patient’s bio-psycho-social history (somatic, mental, psychological, family, work…) when the situation requires. | 8,3 | 9,0 | 1,0 | 6,8 |
 28. Adds any other element of interest from a people-centred medical approach to the clinical history (spiritual needs, financial difficulties, interferences with leisure time…) which are not commonly recorded on history forms. | 8,2 | 8,5 | 1,0 | 6,8 |
 29. Uses different types of questions (open, closed and guided…) as appropriate for each situation. | 8,1 | 9,0 | 1,0 | 9,1 |
 30. Uses verbal and non-verbal active listening techniques (reflection, picks up on clues from the patient, paraphrasing, eliciting, summarising…). | 8,6 | 9,0 | 1,0 | 0,0 |
 31. Briefly repeats the information gathered to the patient for verification. | 8,1 | 9,0 | 2,0 | 13,6 |
 32. Assesses how the illness affects the patient’s daily life, socio-family environment and work environment. | 8,5 | 9,0 | 1,0 | 4,6 |
 33. Considers other factors that can influence a patient’s needs when enquiring (ideas, fears, feelings, preferences, prior experiences…). | 8,5 | 9,0 | 1,0 | 2,3 |
 34. Establishes adequate support for the physical exam (requesting permission, explaining what is going to be done and why, sharing findings with the patient…). | 8,5 | 9,0 | 1,0 | 2,3 |
 35. Recognises the divergences between medical and a patient’s values and standards, respecting them without judgement. | 8,4 | 9,0 | 1,0 | 2,3 |
 36. Demonstrates openness and a willingness to appropriately handle any aspect that is important to the patient as concerns healthcare using appropriate behaviours. | 7,9 | 8,0 | 2,0 | 6,8 |
   A.2.2.2. Give information (The student gives the information the patient needs to make decisions in a way that is clear and personalised) | ||||
The student… | ||||
 37. Critically assess the scientific findings on transferring information to patients and the implications in clinical practice. | 7,9 | 8,0 | 2,0 | 11,4 |
 38. Describes the basic principles of adequately informing patients of risks (avoiding any type of manipulation and/or partiality when presenting figures and likelihoods…). | 8,3 | 9,0 | 1,0 | 6,8 |
 39. Communicates the risk to the patient, making personalised use of the indicators (risk measures). | 7,7 | 8,0 | 2,0 | 18,2 |
 40. Supplements this verbal information with diagrams, models, written information and instructions, when necessary. | 8,1 | 8,5 | 1,0 | 11,4 |
 41. Estimates the patient’s level of knowledge of their problem and to what extent the patient wishes to be informed to provide the information the patient actually requires. | 8,5 | 9,0 | 1,0 | 2,3 |
 42. Gives the patient the information properly (adequate circumstance). | 8,3 | 9,0 | 1,0 | 6,8 |
 43. Adapts communication to the patient’s level of understanding and language, avoiding any medical jargon. | 8,7 | 9,0 | 0,0 | 0,0 |
 44. Provides patient-centred information from their perspective and making it meaningful for the patient. | 8,4 | 9,0 | 1,0 | 4,6 |
 45. Discusses benefits, risks and expected outcomes in a patient-centred manner. | 8,1 | 9,0 | 1,0 | 9,1 |
 46. Verifies the patient understands the information provided by eliciting any questions. | 8,6 | 9,0 | 0,0 | 2,3 |
 47. Explains precise information to the patient to minimise any uncertainty when making decisions. | 8,1 | 9,0 | 1,0 | 6,8 |
 48. Shares the information with third parties (colleagues, family and others) with the patient’s consent. | 8,0 | 9,0 | 2,0 | 15,9 |
  A.2.3. Make joint decisions and Help the patient carry out what was decided (The student makes decisions considering the patient’s participation and responsibility as well as their preferences) | ||||
The student… | ||||
 49. Differentiates the various ways patients can participate in the decision making (paternalism, consumerism, collaborative…). | 7,3 | 8,0 | 2,5 | 25,0 |
 50. Establishes what should be the most appropriate physician role in the decision making process with each patient. | 7,8 | 8,0 | 2,0 | 13,6 |
 51. Accepts the role of uncertainty as a substantial element in clinical reasoning and decision making. | 7,9 | 9,0 | 2,0 | 13,6 |
 52. Recognises the elements that contribute to the presence of uncertainty (lack of professional knowledge, lack of evidence…) in clinical decision making. | 7,6 | 8,5 | 2,0 | 20,5 |
 53. Communicates the fact that there is uncertainty to the patient in a way that adapts to the patient’s level of tolerance. | 7,8 | 8,0 | 2,0 | 22,7 |
 54. Explores the patient’s needs, resources (information, autonomy, trust, responsibility, psychological features…) and willingness to get them involved in the decision making. | 8,3 | 9,0 | 1,0 | 4,6 |
 55. Reaches agreements with the patient using negotiation skills. | 8,0 | 9,0 | 1,5 | 6,8 |
 56. Understands the role of aids in clinical practice when making decisions (decision aids). | 6,9 | 7,5 | 2,0 | 29,6 |
 57. Teaches the patient about using decision aids so they may be used in the discussion. | 6,9 | 8,0 | 3,0 | 29,6 |
 58. Clarifies how and when the decision must be made with the patient. | 7,7 | 8,0 | 2,0 | 15,9 |
 59. Discusses the spectrum of possible consequences of a decision with the patient (explains the consequences of choosing/not choosing the option discussed). | 8,0 | 8,0 | 1,0 | 6,8 |
 60. Offers the patient the option of opening up and enriching the decision-making discussion by including third parties (colleagues, family members). | 7,9 | 8,0 | 2,0 | 11,4 |
 61. Uses informed consent in a way that the patient understands the characteristics and consequences of the procedure. | 8,3 | 9,0 | 1,0 | 6,8 |
 62. Adapts the plan/treatment to the patient’s resources and strengths. | 8,5 | 9,0 | 1,0 | 0,0 |
 63. Closes the process at the end of the visit by using the adequate communication strategies (summarising, highlighting key aspects, anticipating possible evolutions and offering guidance…). | 8,7 | 9,0 | 0,5 | 0,0 |
 64. Assumes the patient’s involvement and responsibility in the decision-making process and uses adequate behaviours in doing so. | 7,8 | 8,0 | 2,0 | 20,5 |
   65. Is willing to re-assess and review own decisions. | 8,2 | 9,0 | 1,0 | 9,1 |
B) Communication with the patient’s family | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
  B.1. The patient’s family context (The student recognises and assesses the family’s role in the patient’s clinical care and establishes effective communication with the family in patient’s benefit) | ||||
The student… | ||||
 66. Knows the family’s role as a system in patient care. | 8,2 | 9,0 | 1,5 | 9,1 |
 67. Describes the basic models that explain family and patient behaviour as if one of the members (the individual and family life cycle). | 7,6 | 8,0 | 2,0 | 20,5 |
 68. Knows and uses methods and tools to identify the family structure and functioning (genograms or family trees, family function, stressful events, social network…). | 7,2 | 7,0 | 3,0 | 27,3 |
 69. Considers the family’s response pattern to the disease and the stressful life events when caring for a patient. | 7,6 | 8,0 | 2,0 | 15,9 |
 70. Identifies the family member(s) who fulfil the role of main caretaker in order to involve them in the process and assess them in this role. | 7,9 | 9,0 | 1,0 | 11,4 |
 71. Requests and synthesizes relevant information from other family members and patient caretakers, if necessary and they are available. | 8,0 | 8,0 | 1,5 | 9,1 |
 72. Establishes effective communication with the patient and their family to identify problems, detect resources and implement action plans that benefit the patient. | 8,4 | 9,0 | 1,0 | 2,3 |
 73. Helps the family make decisions when the patient is a minor or incapacitated (dementias, patients in a coma, incapacitating mental illnesses…). | 8,5 | 9,0 | 1,0 | 2,3 |
 74. Recognises specific family-related communication challenges (confidentiality, secrecy, ill companions…). | 8,4 | 9,0 | 1,0 | 0,0 |
 75. Demonstrates a willingness to include the family and work with them for the patient’s benefit. | 8,3 | 9,0 | 1,5 | 4,6 |
 76. Demonstrates a willingness to ease communication among the patient’s family members by using adequate behaviours. | 7,6 | 8,5 | 2,0 | 13,6 |
 77. Demonstrates sensitivity toward the family’s fears and concerns, using adequate behaviours. | 8,3 | 9,0 | 1,0 | 2,3 |
C) Intra-personal communication (self-perception) | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
  C.1. Doctors as people (self-awareness, self-reflection, self-criticism, self-care) (The student habitually reflects upon their own behaviour and means of communication, developing and improving their self-awareness, self-reflection, self-criticism, self-care) | ||||
The student… | ||||
 78. Describes the factors that influence the relationship between the professional and the patient (stereotypes, sociocultural prejudices, experiences, interests…). | 7,9 | 8,5 | 2,0 | 15,9 |
 79. Critically reflects upon their own communication and behavioural style, considering possible alternatives. | 8,3 | 9,0 | 1,0 | 4,6 |
 80. Recognises the barriers that make self-awareness difficult and uses techniques and strategies to foster it such as reflection, a personal perspective… | 8,3 | 9,0 | 1,0 | 6,8 |
 81. Identifies the signs of work and stress overload (insomnia, anxiety, sleep alterations…). | 8,3 | 9,0 | 1,0 | 4,6 |
 82. Distinguishes the main sources of medical errors (deficient information or assessment of patient’s needs, inadequate communication…). | 8,1 | 9,0 | 1,5 | 4,6 |
 83. Recognises the technical errors, cognitive bias and emotional reactions that hinder the development of therapeutic relationships. | 8,2 | 9,0 | 1,0 | 4,6 |
 84. Uses strategies to reduce stress and overload (relaxation, focus groups, Balint groups, supervision and support…). | 7,8 | 9,0 | 2,0 | 18,2 |
 85. Controls own emotional reactions and works efficiently even in difficult situations (high degree of patient suffering, a demanding patient…). | 8,0 | 9,0 | 1,0 | 11,4 |
 86. Develops the necessary mental habits to recognise own biases through the use of specific techniques (thought-provoking questions, perspective observation, mindfulness, suspension of judgement, non-prejudiced attitudes…). | 8,0 | 8,0 | 2,0 | 6,8 |
 87. Recognises own errors (and those of others), assumes them as a part of the job and seeks solutions for them (assistance from superiors…). | 8,5 | 9,0 | 1,0 | 0,0 |
 88. Recognises own emotions (insecurity, sympathy/antipathy, attraction…) in relation to others (patients, colleagues). | 8,1 | 9,0 | 1,0 | 6,8 |
 89. Values certain self-perceived personal strengths and weaknesses in the proper teaching contexts (guidance, mentorship, focus groups…). | 8,2 | 8,5 | 1,0 | 6,8 |
 90. Accepts and approaches own uncertainty in a way that is adequate to the educational stage. | 7,7 | 8,0 | 2,0 | 13,6 |
D) Inter-intra professional communication | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
  D.1. The professional medical context: Inter- and intra-personal communication (The student communicates efficiently with the professionals within or outside their team) | ||||
The student… | ||||
 91. Identifies the basic principles of group dynamics as well as supporting and inhibiting factors. | 7,7 | 8,0 | 2,0 | 15,9 |
 92. Identifies the different members of the various inter-professional healthcare teams and their respective responsibilities. | 8,0 | 9,0 | 1,0 | 9,1 |
 93. Clarifies own role and responsibilities as a student in the professional teams with which they interact. | 8,1 | 9,0 | 1,0 | 11,4 |
 94. Identifies when to seek assistance from professionals/institutions/agencies that can help solve a given problem. | 8,2 | 9,0 | 1,5 | 6,8 |
 95. Describes the principles and strategies for negotiating and resolving conflicts with other professionals and uses them adequately. | 7,5 | 8,0 | 2,0 | 22,7 |
 96. Discusses decisions appropriately with colleagues, patients and family members and, if necessary, re-assesses own decisions. | 8,2 | 9,0 | 1,0 | 9,1 |
 97. Ensures all of the patient’s relevant clinical information is available. | 7,4 | 8,5 | 2,0 | 18,2 |
 98. Facilitates the flow of information concerning opinions in the group and encourages the members of the team to offer divergent opinions. | 7,9 | 9,0 | 2,0 | 13,6 |
 99. Gives feedback to members of the team in an appropriate manner (first-person comments, highlights the positive aspects first, does not judge). | 8,0 | 9,0 | 2,0 | 9,1 |
 100. Effectively contributes to care continuity when patients are referred and returned to and from different care levels (primary, specialised). | 7,8 | 8,5 | 2,0 | 13,6 |
 101. Makes clinical or scientific presentations in public effectively. | 7,6 | 8,0 | 2,0 | 15,9 |
 102. Gives instructions clearly and precisely. | 8,3 | 9,0 | 1,0 | 9,1 |
 103. Helps create a positive working atmosphere (supports and includes the different members of the team, mentions the positive side of unpleasant aspects, values the team’s success…). | 8,4 | 9,0 | 1,0 | 6,8 |
 104. Respects individuality, the subjective perspectives of the members of the team and the mastery (expert skills) of the various healthcare professionals. | 8,4 | 9,0 | 1,0 | 6,8 |
 105. Maintains confidentiality when making decisions as a team. | 8,5 | 9,0 | 1,0 | 6,8 |
 106. Is assertive with the rest of the members of the team. | 7,8 | 8,0 | 2,0 | 13,6 |
 107. Demonstrates a negotiating attitude in order to reach agreements, using adequate behaviours. | 8,2 | 8,0 | 2,0 | 4,6 |
 108. Demonstrates flexibility in changing roles within a team. | 8,3 | 9,0 | 1,0 | 4,6 |
E) Communication through different channels | ||||
  E.1. Communication channels (The student efficiently uses the various means of communication) | ||||
   E.1.1. Direct communication (face-to-face) | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
The student… | ||||
 109. Identifies environmental factors (physical and social) that can hinder interpersonal communication in different contexts. | 8,3 | 9,0 | 1,0 | 4,5 |
 110. Identifies whether there is any discrepancy between the verbal and non-verbal components of communication. | 8,2 | 9,0 | 1,5 | 9,1 |
 111. Adequately uses proxemics (physical distance when communicating). | 8,2 | 9,0 | 1,0 | 6,8 |
   E.1.2. Written communication |  |  |  |  |
The student… | ||||
 112. Recognises the clinical history forms and resources and the documents habitually used for written communication with patients and among professionals (discharge reports, referrals, test requests…). | 8,1 | 9,0 | 1,5 | 13,6 |
 113. Records the initial assessment of a patient as well as any later daily clinical evolution in concise and clear written language. | 8,1 | 9,0 | 1,0 | 13,6 |
 114. Writes a structured, comprehensible, sufficient and clear discharge report and referral. | 8,2 | 9,0 | 1,0 | 11,4 |
 115. Writes tests requests and prescriptions precisely, clearly and in a justified manner. | 8,0 | 9,0 | 2,0 | 11,4 |
 116. Maintains clear and appropriate records on relevant information relating to the clinical meeting. | 8,2 | 9,0 | 1,0 | 9,1 |
 117. Writes the habitual legal documents (death certificates, health certificates…). | 8,3 | 9,0 | 1,0 | 6,8 |
   E.1.3. Electronic or computerised communication |  |  |  |  |
The student… | ||||
 118. Recognises the various information technologies most often used in healthcare. | 7,7 | 8,0 | 2,0 | 15,9 |
 119. Is aware of the patients’ electronic records as well as the prescription and referral systems. | 8,0 | 8,0 | 2,0 | 6,8 |
 120. Handles information technologies (emails, WhatsApp, web 2.0…) for healthcare issues in a way that ensures confidentiality. | 7,9 | 8,0 | 2,0 | 15,9 |
   E.1.4. Telephone communication |  |  |  |  |
The student… | ||||
 121. Recognises the uses and limits of telephone communication with patients. | 8,0 | 9,0 | 2,0 | 11,4 |
 122. Communicates with patients by telephone, attending to their specific requests and the communication adaptations this channel requires. | 7,8 | 8,0 | 2,0 | 13,6 |
F) Communication in special situations | ||||
 F.1. Specific communication contests (The student applies and adapts the core communication skills in specific clinical situations and uses the specific skills required in each situation) | ||||
  F.1.1. Sensitive situations | \( \overline{\mathrm{x}} \) | M | IQR | % out M |
The student… | ||||
 123. Recognises delicate situations that represent communication challenges (giving bad news, handling end-of-life topics, grief situations, sexual history, gender violence, child abuse, HIV infection, explaining situations of clinical uncertainty…). | 8,5 | 9,0 | 1,0 | 4,5 |
 124. Approaches some of them in a sensitive and constructive manner by applying and adapting the core communication skills and using the specific strategies and skills that each may require. | 8,2 | 9,0 | 1,0 | 9,1 |
 125. Is aware of the essential legal aspects in effect in each jurisdiction relating to how some of these situations must be handled. | 7,9 | 9,0 | 2,0 | 13,6 |
  F.1.2. Managing emotions |  |  |  |  |
The student… | ||||
 126. Recognises situations of emotional tension during visits (stress, fear, anger, aggressiveness, denial, collusion, embarrassment…). | 8,3 | 9,0 | 1,0 | 4,5 |
 127. Approaches some of them in a sensitive and constructive manner by applying and adapting the core communication skills and using the specific strategies and skills that each may require. | 7,9 | 8,5 | 1,5 | 9,1 |
  F.1.3. Cultural and social diversity |  |  |  |  |
The student… | ||||
 128. Recognises patients’ cultural and social diversity (ethnicity, nationality, socio-economic status, language, religion, gender, values, sexuality…) and the communication difficulties involved. | 8,4 | 9,0 | 1,0 | 6,8 |
 129. Approaches some of them in a sensitive and constructive manner by applying and adapting the core communication skills and using the specific strategies and skills that each may require. | 8,0 | 8,5 | 1,0 | 13,6 |
  F.1.4. Health promotion and behaviour change |  |  |  |  |
The student… | ||||
 130. Describes the basic principles of motivation. | 7,7 | 8,5 | 2,0 | 13,6 |
 131. Recognises the stages of change a patient is in when modifying behaviours or following treatments. | 8,0 | 8,5 | 2,0 | 9,1 |
 132. Explores the patient’s level of motivation for change. | 8,2 | 9,0 | 1,5 | 6,8 |
 133. Applies effective communication strategies to change behaviours. | 8,1 | 9,0 | 1,0 | 11,4 |
 134. Assumes a prevention and health promotion approach when caring for patients and uses adequate behaviours. | 8,4 | 9,0 | 1,0 | 2,3 |
  F.1.5. Specific clinical contexts |  |  |  |  |
The student… | ||||
 135. Approaches some specific clinical contexts (psychiatric, patients with dementia, with sensory problems: hearing, visual, verbal expression) by applying and adapting the core communication skills and using the specific strategies and skills each of them require. | 8,1 | 9,0 | 2,0 | 11,4 |
  F.1.6. Patients of different ages |  |  |  |  |
The student… | ||||
 136. Communicates with patients of different age groups (children and parents, adolescents, the elderly) by applying and adapting the core communication skills and using the specific strategies and skills that each one may require. | 8,3 | 9,0 | 1,5 | 2,3 |