<p>Response to “Medical students’ attitudes toward communication skills learning: comparison between two groups with and without training” [Letter]</p>

Sophia von Widekind Matthew Machin 1Imperial College School of Medicine, Charing Cross Hospital, London, UK; 2Department of Surgery and Cancer, Imperial College London, London, UK Dear editor We read with great interest the study by Ruiz Moral et al regarding medical students’ attitudes toward communication skills (CS) teaching. Of particular interest were the findings that “affective” attitude scores, which reflect feelings toward the delivery of CS teaching, were lower in fourth-year students than first-year students. The fourth-year students also scored lower for “positive attitudes” toward CS training. The authors concluded that “students’ attitudes toward CS could decline as a result of CS training”. Multivariate analysis demonstrated a statistically significant difference between the scores of firstand fourth-year students. However, the difference was as little as 2.0 for the affective dimension and 2.2 for positive attitudes. It is unclear whether this represents a tangible difference in attitudes between the two groups. Furthermore, reported baseline characteristic data for the included populations were limited to gender, parent–doctor status, and education fees. Other important variables including, but not limited to, overall satisfaction with the medical course and prior CS teaching were not assessed. Analysis was based on a cross-sectional design with unpaired comparisons performed. It is unclear whether fundamental baseline differences existed between the two populations which could explain the differing scores. Therefore, the study cannot validly conclude that attitudes decline due to previous exposure to CS as comparisons were made using two distinct populations with little adjustments for baseline characteristics. Although costly and timely, a prospective cohort study with paired comparisons of the same group of students in their first and fourth year would be enlightening and increase the validity of the conclusions. The authors proposed that medical students’ changes in attitude toward CS may be due to the pressure of performing in small groups and under the scrutiny of peers. This is supported by current evidence. Nilsen and Baerheim investigated the opinions of students on video-based feedback in a focus-group based qualitative study and commented on the importance of carefully designing CS programmes to reassure and support students (eg, effective debriefing). Correspondence: Sophia von Widekind Imperial College School of Medicine, Charing Cross Hospital, Margravine Rd, Hammersmith, London W6 8RP, UK Email scv14@ic.ac.uk Advances in Medical Education and Practice Dovepress open access to scientific and medical research