Teaching medical students the important connection between communication and clinical reasoning
Abstract
Background Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care.Objective To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice.Design In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process.Participants Second-year medical students.Measurements All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion.Results Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important.Conclusions Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Feedback from both standardized patients and instructors provides a dual perspective, helping learners refine their communication approach while enhancing emotional intelligence and professionalism.
“Feedback from both the SP and instructors provides a dual perspective, helping learners refine their communication approach while enhancing emotional intelligence and professionalism [105,106].”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [106]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Curriculum development for medical education a six-step approach
Thomas, P. A., Kern, D. E., Hughes, M. T., Tackett, S. A., & Chen, B. Y. (2022) · Cited by 1,244 · see citing works
Self-citationLittle, P. S., Everitt, H., Williamson, I. G., Warner, G. T., Moore, M. V., Gould, C., Ferrier, K., & Payne, S. A. (2001) · BMJ · doi:10.1136/bmj.323.7318.908 · Cited by 892 · see citing works
Teaching and Learning Communication Skills in Medicine
Kurtz, S. M., Silverman, J., Draper, J., van Dalen, J., & Platt, F. W. (2017) · CRC Press eBooks · doi:10.1201/9781315378398 · Cited by 846 · see citing works
Soliciting the Patient's Agenda
Marvel, M. K., Epstein, R. M., Flowers, K., & Beckman, H. (1999) · JAMA · doi:10.1001/jama.281.3.283 · Cited by 741 · see citing works
Accreditation Council on Graduate Medical Education (ACGME)
Rovner, J. (2009) · Health Care Policy and Politics A to Z · doi:10.4135/9781452240121.n6 · Cited by 671 · see citing works
Patient-centred consultations and outcomes in primary care: a review of the literature
Mead, N., & Bower, P. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(02)00099-x · Cited by 613 · see citing works
ROTER, D. L. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.155.17.1877 · Cited by 581 · see citing works
Kurtz, S. M., & Silverman, J. (1996) · Medical Education · doi:10.1111/j.1365-2923.1996.tb00724.x · Cited by 525 · see citing works
Association of American Medical Colleges (AAMC)
M.Mullner, R. (2009) · Encyclopedia of Health Services Research · doi:10.4135/9781412971942.n39 · Cited by 476 · see citing works
The SEGUE Framework for teaching and assessing communication skills
Makoul, G. (2001) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00136-7 · Cited by 457 · see citing works
The Medical School Objectives Writing Group (1999) · Journal of the Association of American Medical Colleges · doi:10.1097/00001888-199901000-00010 · Cited by 452 · see citing works
Improving Physicians' Interviewing Skills and Reducing Patients' Emotional Distress
ROTER, D. L. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.1995.00430170071009 · Cited by 421 · see citing works
Curriculum Development for Medical Education
Kern, D. E. (1998) · Johns Hopkins University Press eBooks · doi:10.56021/9780801858444 · Cited by 386 · see citing works
ROTER, D. L., Hall, J. A., & Katz, N. R. (1987) · Medical Care · doi:10.1097/00005650-198705000-00007 · Cited by 380 · see citing works
Teaching and Learning Communication Skills in Medicine
Hughes, C. (1999) · Physiotherapy · doi:10.1016/s0031-9406(05)61258-8 · Cited by 337 · see citing works
ROTER, D. L., Hall, J. A., Kern, D. E., Barker, L. R., Cole, K. A., & Roca, R. P. (1995) · PubMed · Cited by 250 · see citing works
A new model for physician-patient communication
Keller, V. F., & Carroll, J. G. (1994) · Patient Education and Counseling · doi:10.1016/0738-3991(94)90051-5 · Cited by 172 · see citing works
Quantitative assessment of diagnostic ability
Bordage, G., Grant, J., & Marsden, P. D. (1990) · Medical Education · doi:10.1111/j.1365-2923.1990.tb02650.x · Cited by 153 · see citing works
Physicians’ psychosocial beliefs correlate with their patient communication skills
Levinson, W., & Roter, D. (1995) · Journal of general internal medicine · doi:10.1007/bf02599834 · Cited by 152 · see citing works
Integrating the Teaching of Basic Sciences, Clinical Sciences, and Biopsychosocial Issues
Schmidt, H. J. (1998) · Academic Medicine · doi:10.1097/00001888-199809001-00006 · Cited by 118 · see citing works
Teaching medical interviewing. A basic course on interviewing and the physician-patient relationship
Novack, D. H. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.152.9.1814 · Cited by 114 · see citing works
The Three-Function Model of the Medical Interview
Bird, J., & Cohen‐Cole, S. A. (2015) · Advances in psychosomatic medicine · doi:10.1159/000418260 · Cited by 100 · see citing works
Effects of communication skills training on students' diagnostic efficiency
Evans, B. J., Stanley, R. O., MESTROVIC, R., & ROSE, L. (1991) · Medical Education · doi:10.1111/j.1365-2923.1991.tb00105.x · Cited by 96 · see citing works
Do Clerkship Directors Think Medical Students Are Prepared for the Clerkship Years?
Windish, D. M., Paulman, P. M., Goroll, A. H., et al. (2004) · Academic Medicine · doi:10.1097/00001888-200401000-00013 · Cited by 86 · see citing works
Self-citationThe three-function model of the medical interview. An educational device.
Bird, J., & Cohen‐Cole, S. A. (1990) · PubMed · Cited by 85 · see citing works
Novack, D. H. (1992) · Archives of Internal Medicine · doi:10.1001/archinte.1992.00400210046008 · Cited by 77 · see citing works
Understanding our mistakes: a primer on errors in clinical reasoning
Kempainen, R. R., Migeon, M. B., & Wolf, F. M. (2003) · Medical Teacher · doi:10.1080/0142159031000092580 · Cited by 71 · see citing works
Integrating the teaching of basic sciences, clinical sciences, and biopsychosocial issues
Schmidt, H. J. (1998) · Academic Medicine · doi:10.1097/00001888-199809000-00032 · Cited by 46 · see citing works
Teaching medicine with cases: student and teacher opinion
THOMAS, R. (1992) · Medical Education · doi:10.1111/j.1365-2923.1992.tb00154.x · Cited by 31 · see citing works
Teaching medical decision making and students' clinical problem solving skills
ROGERS, J. C., Swee, D. E., & Ullian, J. A. (1991) · Medical Teacher · doi:10.3109/01421599109029025 · Cited by 29 · see citing works
Role play for the clinical tutor: towards problem-based learning
Menahem, S., & Paget, N. S. (1990) · Medical Teacher · doi:10.3109/01421599009010562 · Cited by 18 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Teaching history taking to medical students: a systematic review
Keifenheim, K. E., Teufel, M., Ip, J., Speiser, N., Leehr, E. J., Zipfel, S., & Herrmann-Werner, A. (2015) · BMC Medical Education · doi:10.1186/s12909-015-0443-x · Cited by 218 · see citing works
Physicians build less rapport with obese patients
Gudzune, K. A., Beach, M. C., Roter, D. L., & Cooper, L. A. (2013) · Obesity · doi:10.1002/oby.20384 · Cited by 171 · see citing works
Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189
Lipnevich, A. A., Mattern, K., & Feddock, C. (2026) · Medical Teacher · doi:10.1080/0142159x.2025.2569623 · Cited by 37 · see citing works
- Authors
- Windish, D. M., Price, E. G., Clever, S. L., Magaziner, J. L., & Thomas, P. A.
- Affiliations
- Yale University (US)
- Johns Hopkins University (US)
- Corresponding author
- Windish, Donna M.
- Venue
- Journal of General Internal Medicine
- Published
- 2005-12
- Volume
- 20
- Issue
- 12
- Pages
- 1108-1113
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- OpenAlex
- W1980243728
- Cited by
- 134
- References
- 31
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 8 · 2021: 7 · 2020: 10 · 2019: 8 · 2018: 6 · 2017: 5 · 2016: 10 · 2015: 5 · 2014: 6 · 2013: 6 · 2012: 8
- FWCI
- 3.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health (5t32hl007180-45)
- Health Resources and Services Administration
- U.S. Public Health Service (2-32-HP10025)
- National Heart, Lung, and Blood Institute (HL007180, T32-HL-007180)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
- Keywords
- physician-patient communication, clinical reasoning, medical education, standardized patients, role play, reflective practice, rapport building, psychosocial history, differential diagnosis, curriculum intervention
- MeSH terms
- Clinical Competence, Communication, Curriculum, Education, Medical, Undergraduate, Humans, Medical History Taking, Physician-Patient Relations, Students, Medical, Patient Simulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
