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Year : 2016  |  Volume : 29  |  Issue : 2  |  Page : 132-135

A comparison of medical students', residents' and tutors' attitudes towards communication skills learning

1 Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, Autonomous University of Barcelona, Barcelona, Spain
2 Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain
3 Pere Virgili Health Care Park, Barcelona, Spain
4 Doctor Robert Foundation, Barcelona, Spain

Date of Web Publication19-Aug-2016

Correspondence Address:
Beatriz Molinuevo
Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Campus de Bellaterra, s/n, 08193 Bellaterra, Barcelona
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1357-6283.188755

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Background: The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students', residents' and tutors' attitudes towards learning communication skills, and examined the association with gender and year of residency. Methods: We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. Results: In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P < 0.01). Females showed higher scores on the CSAS-PAS (P < 0.05) and lower scores on the CSAS-NAS (P < 0.01) than males in all subsamples. The effect sizes were medium. There were no significant differences according to year of residency. Discussion: Medical students, residents and tutors consider training in communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.

Keywords: Attitudes, communication skills, learning, medical students, residents, tutors

How to cite this article:
Molinuevo B, Aradilla-Herrero A, Nolla M, Clèries X. A comparison of medical students', residents' and tutors' attitudes towards communication skills learning. Educ Health 2016;29:132-5

How to cite this URL:
Molinuevo B, Aradilla-Herrero A, Nolla M, Clèries X. A comparison of medical students', residents' and tutors' attitudes towards communication skills learning. Educ Health [serial online] 2016 [cited 2022 Aug 17];29:132-5. Available from:

  Background Top

Communication skills (CS) are considered as a core medical competence to achieve optimal health outcomes. Curricular programs and standards for professional practice have recommended teaching CS during medical training. [1] CS can be taught and learned, but are easily forgotten if not maintained through practice. Efforts have been made at the undergraduate level, but postgraduate CS training is challenging. [2] Despite the acknowledgment of its relevance, there is no guarantee that students and faculty perceive the usefulness of CS for clinical practice.

Learning in a clinical environment is necessary, but not sufficient, for high quality achievement of CS. Students learn competencies within the formal curriculum and internalize values, attitudes, beliefs and related behaviors through a "hidden curriculum." [3] Doctor role-modeling is central to the guidance of residents. To act as good role models, tutors should obtain previous training, exhibit CS with patients/relatives/other professionals, and show optimal attitudes towards CS learning. However, studies have found obstacles to the acquisition and application of CS, such as lack of training of tutors and negative attitudes towards the doctor-patient relationship. [4]

Attitudes are a type of feelings, often based on beliefs, which predispose one to respond in a particular way to objects, people and events. [5] Doctors' attitudes appear to influence the quality of communication with patients. [6] Whereas causality between attitudes and behavior is currently under debate, students' and faculty attitudes may influence the effectiveness of training.

Literature about residents' and tutors' attitudes towards CS has mainly employed a qualitative approach. [2],[4],[6] To our knowledge, there are no studies that have compared attitudes at all levels of medical education. The Communications Skills Attitudes Scale (CSAS) was designed to measure attitudes towards learning CS and has generated surveys aimed at identifying undergraduate medical students' attitudes worldwide. [7],[8]

The goals of this study were: (1) To assess medical students', residents' and tutors' attitudes towards learning CS through the CSAS; (2) to explore differences in attitudes between groups; and (3) to test the association between attitudes and demographic (gender) and education-related characteristics (year of residency training).

  Methods Top

Subjects and procedure

Participants were recruited from second-year students of the Faculty of Medicine of the 'Universitat Autònoma de Barcelona' (UAB) in the academic year 2012-13, and from hospitals at the "Network of Teaching and Advisory Committees of Catalonia" in the Spring of 2012. We chose the second-year to test attitudes during the basic science curriculum in students who have had contact with a clinical environment. Participation was anonymous and voluntary. The survey was approved by the ethics review committee of the authors' institution.


The CSAS was designed to measure attitudes towards CS learning. [8] It consists of a two-factor scale, the Positive Attitudes Scale (CSAS-PAS; 13 items) and the Negative Attitudes Scale (CSAS-NAS; 13 items). Items are scored from 1 (strongly disagree) to 5 (strongly agree). Higher scores designate positive and negative attitudes on the CSAS-PAS and CSAS-NAS, respectively. In this study, we used the Catalan version, which has shown satisfactory internal consistency and test-retest reliability. [7] The internal consistencies (Cronbach's α) were: 0.87, 0.85 and 0.82 for the CSAS-PAS for students, residents and tutors, respectively; and 0.63, 0.67 and 0.60 for the CSAS-NAS.

Data analysis

All analyses were conducted using IBM SPSS Statistics Version 19 (SPSS, Inc., Chicago, IL, USA). Internal consistency of the CSAS was measured with Cronbach's alpha. To check for differences in attitudes according to medical status and year of residency, we conducted analyses of variance (ANOVAs) and Duncan post hoc comparisons. To test for differences in attitudes according to gender, we performed Student's t-test for independent samples. Cohen's d was calculated as a measure of effect size. The level of significance was set at P < 0.05.

  Results Top

The final sample consisted of 492 participants: 282 second-year students, 131 residents, and 79 tutors. See [Table 1] for socio-demographic and academic information.
Table 1: Sociodemographic and academic characteristics for the samples of students (n=282), residents (n=131) and tutors (n=79) responding to questions on communication skills

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The mean values of the CSAS showed that participants have positive attitudes towards learning CS [Table 2]. Nine out of the 13 items of the CSAS-PAS were rated above the average score on a Likert scale by at least 80% of participants in each sample. The mean values of the CSAS-NAS ranged around 25 (theoretical rank: 10-50).
Table 2: Comparison of attitudes towards learning communication skills according to medical status, gender and training year

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There were no significant differences between samples in the CSAS-PAS. Differences were found in the CSAS-NAS [Table 2]. Duncan post-hoc analysis indicated that residents showed higher scores than students, that is, they revealed more negative attitudes.

Differences in attitudes according to gender were statistically significant in all the samples, especially for the CSAS-NAS [Table 2]. Females obtained higher CSAS-PAS scores and lower CSAS-NAS scores than males. The effect sizes were medium. There were no significant differences according to the year of residency.

  Discussion Top

To our knowledge, this is the first study that compares attitudes towards learning CS at all levels of medical education. Overall, data revealed that undergraduate students, residents and tutors show positive attitudes and do not differ from each other. Findings are in line with prior research about the CSAS in undergraduate students from other countries [9] and with qualitative surveys with residents and tutors. [4],[6]

Although results can be interpreted in several ways, the numerous clinical encounters of the everyday clinical practice may influence attitudes. Working with real patients (or observing them) may help individuals to notice the relevance of CS for solving problems where scientific and technical expertise is not enough (e.g. language barriers, motivation and illness behavior). It might account for the absence of differences according to status and year of residency. Nevertheless, data could be partly influenced by social desirability, the most common problem of the direct measurement of attitudes.

The fact that residents reported more negative attitudes than second-year students could indicate a tendency of a decline in patient-centered attitudes signaled in previous research. [10] The strongest impact of the hidden curriculum is generally found in the clinical learning environment. Longitudinal studies aimed at following up attitudes toward learning CS from undergraduate to postgraduate levels in order to detect influences (e.g. hidden curriculum, validity of measures or changes in expectancies) are needed. Findings regarding gender are consistent with previous studies with undergraduate medical students. [7] They support the construct validity of the CSAS.

Certain limitations need to be taken into account. Because of the cross-sectional design, data may be due to cohort effects. The generalization of results is limited. The voluntary nature of the sample may have biased the representativeness of participants with little interest in CS.

  Conclusion Top

Medical students, residents and tutors of medicine positively value the learning of CS independently of their status and year of residency. Nonetheless, a tendency toward decline in residents' attitudes as compared to that of students' has been detected. The study highlights the need of measuring attitudes at all levels of medical education through longitudinal surveys. In order to explore needs for and barriers to teaching and learning CS, and to design CS courses, more attention should be paid to measuring attitudes at all levels of medical education. Students exposed to models with positive attitudes towards learning CS may be enriched in their patient-centered training. The CSAS is a standardized instrument that allows evaluation of attitudes towards learning CS during medical career in an objective, fast and cost-effective way.


We thank all students, residents, tutors and medical centers that participated in the study. Special thanks to the members of the Health Communication Area from the Institute of Health Studies (Government of Catalonia) and Doctor Robert Foundation (Autonomous University of Barcelona), especially to R. Garcia-Guasch, C, Llubià and G. Tolchinsky.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

General Medical Council. Tomorrow's Doctors: Outcomes and Standards for Undergraduate Medical Education. London: General Medical Council; 2009.  Back to cited text no. 1
van den Eertwegh V, van Dalen J, van Dulmen S, van der Vleuten C, Scherpbier A. Residents' perceived barriers to communication skills learning: Comparing two medical working contexts in postgraduate training. Patient Educ Couns 2014;95:91-7.  Back to cited text no. 2
Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med 1994;69:861-71.  Back to cited text no. 3
Perron NJ, Sommer J, Hudelson P, Demaurex F, Luthy C, Louis-Simonet M, et al. Clinical supervisors' perceived needs for teaching communication skills in clinical practice. Med Teach 2009;31:e316-22.  Back to cited text no. 4
Myers DG. Social Psychology. 4 th ed. New York: McGraw-Hill Book Company; 1993.  Back to cited text no. 5
Junod Perron N, Sommer J, Hudelson P, Demaurex F, Luthy C, Louis-Simonet M, et al. Residents' perceived needs in communication skills training across in- and outpatient clinical settings. Educ Health (Abingdon) 2009;22:280.  Back to cited text no. 6
Molinuevo B, Torrubia R. Validation of the Catalan version of the communication skills attitude scale (CSAS) in a cohort of south European medical and nursing students. Educ Health (Abingdon) 2011;24:499.  Back to cited text no. 7
Rees C, Sheard C, Davies S. The development of a scale to measure medical students' attitudes towards communication skills learning: The communication skills attitude scale (CSAS). Med Educ 2002;36:141-7.  Back to cited text no. 8
Rees C, Sheard C. Evaluating first-year medical students' attitudes to learning communication skills before and after a communication skills course. Med Teach 2003;25:302-7.  Back to cited text no. 9
Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Acad Med 2009;84:1182-91.  Back to cited text no. 10


  [Table 1], [Table 2]

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