Performing physician-patient communication within objective structured clinical examinations

Cynthia Budyn, Zeev Neuwirth, Stuart M. Schrader

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Medical students have traditionally been taught patient-centered interviewing using a skills-based communicative approach. Teaching communication from a skills-based approach alone may result in students enacting principals of patient-centered interviewing without learning how to build collaborative relationships within the context of a medical interview. Physician-patient relationships are not reducible to the competent practice of communication skills alone. Medical students need to be taught to view relationship-building as an inherent part of the communicative process, whereby communication cues, invitations, and other relational interactions lead to an empowered patient and to collaborative decision making. This study examines how medical students and standardized patients negotiate relational identities during a third-year objective structured clinical examination (OSCE). Setting: A third-year formative medical school OSCE. Methods: In this study an interpretive method is used to thematically analyze OSCE case scenarios. Full transcripts and videotapes of one Alzheimer's case scenario were reviewed to explore how medical students' responses to the standardized patients' plotline led to the emergence of relational identities. Findings: Analysis suggests that the majority of these medical students have not yet mastered how to negotiate between the competing illness stories of patients and their caregivers. Conclusion: A performance-doctoring approach offers a different perspective on how students may narrowly focus on interpersonal communication skills, while not fully appreciating the importance of developing effective relationships when caring for and healing patients. A heightened awareness to the continuous relational shifts within medical conversations will likely improve a medical student's ability to collaboratively create improved health outcomes.

Original languageEnglish (US)
Pages (from-to)50-55
Number of pages6
JournalIntegrative Medicine
Issue number4
StatePublished - Aug 1 2005


  • Constructionism
  • Medical educaition
  • OSCEs
  • Physician-patient communication
  • Relationships

ASJC Scopus subject areas

  • Complementary and alternative medicine

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