Evaluation of the attitudes of preclinical and clinical students toward the basic elements of communication in the physician-patient relationship at Dokuz Eylül University Faculty of Medicine

Year 2026, Volume: 3 Issue: 1 , 10 - 17 , 30.04.2026

Serap Konakcı , Doğa Çiçek Suroğlu , Elif Gökçe Karaarslan , Hatice Nilsu Aydın , Sanem Polat , Selen Kaya , Bahar Eryilmaz , Nergiz Durmuş Sütpideler

https://doi.org/10.62425/jmefm.1862422

https://izlik.org/JA57BJ82YY

Abstract

Objective: This study aimed to assess the attitudes of preclinical (3rd-year students) and clinical (Interns) students at Dokuz Eylül University Faculty of Medicine toward basic communication elements in the physician–patient relationship and to assess the impact of clinical experience on these attitudes.

Methods: This cross-sectional analytical study was conducted during the 2024–2025 academic year and included 265 medical students. Data from 264 students who completed the questionnaire in full were included in the analysis (3rd-year students n=148; Interns n=116). Data were collected online using a 17-item attitude questionnaire developed by the researchers. Items were rated on a 5-point Likert scale, and the internal consistency coefficient (Cronbach’s α) was .646. The data were analyzed using an independent samples t test, a chi-square test, and a two-way ANOVA. A P value <.05 was considered to indicate statistical significance.

Results: The mean overall attitude scores of the students did not differ significantly between the two terms (60.84±7.33 vs 62.36±7.56, P=.101). The interaction between term and sex was significant at the threshold (P=.046). While female 3rd-year students had significantly higher mean scores than male students did (62.26±6.03 vs 59.43±8.24; P=.019), this difference was not observed for interns. Item-based analysis revealed significant differences between terms, particularly regarding the items “During treatment, patients should be given as much information as they wish to know” (P=.043), “I do not give false hope when speaking with a patient with a poor prognosis” (P=.000), “I take a patient’s sexual history without judgment” (P=.000), “I show my emotions when delivering bad news to a patient” (P=.004), and “I listen to everything the patient says without interruption” (P=.007).

Conclusion: The findings suggest that communication attitudes are largely comparable between preclinical and clinical students, with no significant overall difference between terms. Although a small interaction between term and sex was observed, its practical significance appears to be limited. These results may indicate that early structured communication training is associated with the development of stable communication attitudes. However, given the cross-sectional design, further longitudinal studies are needed to better understand how communication attitudes evolve throughout medical education and clinical training.

Keywords

medical education , communication attitudes , preclinical education , clinical training , gender differences

References

• Gordon T, Edwards SW. Making the Patient Your Partner: Communication Skills for Doctors and Other Caregivers. 1st ed. London, UK: Bloomsbury Academic; 1997.
• Silverman J, Kurtz S, Draper J. Skills for Communicating With Patients. 3rd ed. Boca Raton, FL: CRC Press; 2013.
• Ha JF, Longnecker N. Doctor–patient communication: a review. Ochsner J. 2010;10(1):38-43.
• Riedl D, Schüßler G. The influence of doctor–patient communication on health outcomes: a systematic review. Z Psychosom Med Psychother. 2017;63(2):131-150.
• Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796-804.
• Haskard Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826-834.
• Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am. 2005;87(3):652-658.
• Jahng KH, Martin LR, Golin CE, DiMatteo MR. Preferences for medical collaboration: patient–physician congruence and patient outcomes. Patient Educ Couns. 2005;57(3):308-314.
• Trummer UF, Mueller UO, Nowak P, Stidl T, Pelikan JM. Does physician–patient communication that aims at empowering patients improve clinical outcome? a case study. Patient Educ Couns. 2006;61(2):299-306.
• Beach MC, Roter DL, Wang NY, Duggan PS, Cooper LA. Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviors? Patient Educ Couns. 2006;62(3):347-354.
• Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA. 2002;288(6):756-764.
• Street RL Jr, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65(3):586-598.
• Gamsızkan Z, Cangür Ş. An evaluation of communication skills training results in the context of gender. Tip Egitimi Dunyasi. 2022;21(64):109-118.
• Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094-1102.
• Shaikh NQ, Noorali AA, Merchant AAH, et al. Communication skills of residents: are they as good as they think? Med Educ Online. 2024;29(1):2396165.
• Yükseköğretim Kurulu. Mezuniyet öncesi tıp eğitimi ulusal çekirdek eğitim programı 2020. Accessed November 11, 2025. https://eski.yok.gov.tr/Documents/Kurumsal/egitim_ogretim_dairesi/Ulusal-cekirdek-egitimi-programlari/mezuniyet-oncesi-tip-egitimi-cekirdek-egitimi-programi.pdf
• Chen DCR, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305-311.
• Demirbaş N, Karaoğlu N. The evaluation of empathy and communication skills in medical students: a descriptive study. Avrasya Saglik Bilim Derg. 2022;5(2):24-32.
• Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996-1009.
• Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med. 2008;83(3):244-249.
• Kay J. Traumatic deidealization and the future of medicine. JAMA. 1990;263(4):572-573.
• Dewi SP, Wilson A, Duvivier R, Kelly B, Gilligan C. Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment. Front Public Health. 2023;11:1168332.
• Gamsızkan Z, Cangür Ş. Evaluation of empathic tendency and communication skills in grade 3 students in faculty of medicine. J Turk Fam Physician. 2019;10(2):89-97.
• Taveira-Gomes I, Mota-Cardoso R, Figueiredo-Braga M. Communication skills in medical students: an exploratory study before and after clerkships. Porto Biomed J. 2016;1(5):173-180.
• Tavakol M, Dennick R. Making sense of Cronbach’s alpha. Int J Med Educ. 2011;2:53-55.
• Revicki D. Internal consistency reliability. In: Michalos AC, ed. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht, Netherlands: Springer; 2014.
• Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
• Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.
• Graf J, Smolka R, Simoes E, et al. Communication skills of medical students during the OSCE: gender-specific differences in a longitudinal trend study. BMC Med Educ. 2017;17:75.
• Kerr AM, Thompson CM. A longitudinal study of third-year medical students’ communication competence, communication anxiety, and attitudes toward patient-centered care. Patient Educ Couns. 2022;105(5):1298-1304.
• Andersen FA, Johansen ASB, Søndergaard J, Hvidt EA, Pedersen R. Revisiting the trajectory of medical students’ empathy and the impact of gender, specialty preferences and nationality: a systematic review. BMC Med Educ. 2020;20:52.
• Haidet P, Dains JE, Paterniti DA, et al. Medical student attitudes toward the doctor–patient relationship. Med Educ. 2002;36(6):568-574.
• Trullàs JC, Blay C, Sarri E, et al. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC Med Educ. 2022;22:104.