Termites as Soil Engineers and Soil Processors

Abstract

Introduction Most physicians would agree that good communication with their patients is a desirable goal. In contrast, teaching and assessing communication skills often receives short shrift in the crowded medical training curriculum, though many medical schools and residency training programs are working to improve in this area. We now know that physicians do not acquire good interpersonal and communication skills from birth, nor via osmosis, and that communication skills must be learned and practiced, just like other clinical skills. Physicians’ interpersonal and communication skills correlate with improved health outcomes and healthcare quality, and have a significant impact on patient care. The central premise that communication is an essential factor in quality of care is supported by numerous evidence-based studies, including the Institute of Medicine’s 2001 report Crossing the Quality Chasm.2 The medical interview is the most commonly performed task in clinical medicine. The average physician performs between 160,000 and 200,000 interviews in a 40-year career.3 Medical organizations and regulatory bodies worldwide require competency in communication skills at all levels of medical training (Table 1.1). In 1999, the Accreditation Council for Graduate Medical Education (ACGME) endorsed six General Competencies, including interpersonal and communication skills, that residents should demonstrate.4 During the same year, the American Board of Medical Specialties (ABMS) adopted the same competencies for practicing physicians. Medical school guidelines reflect increasing international recognition of the importance of teaching and assessing communication skills during undergraduate medical training. As of 2004, U.S. medical students, as well as graduates of international medical schools who are applying to train or practice in the U.S., are required to demonstrate competence in clinical, interpersonal, and communication skills on the United States Medical Licensing Examination (USMLE) Clinical Skills Exam.5 Consensus statements (Kalamazoo6, Toronto7, International8) identify essential interpersonal and communication competencies that should be taught and assessed.