Context and setting Can innovation replace tradition in order to resolve a communication problem? This was the conundrum we faced at our university medical school in China. In a country with one-fifth of the world’s population, medical education was failing. Patients and doctors spoke Chinese, but medicine was a foreign language. A country steeped in the tradition of mentor-based, listen-and-learn teaching methods was challenged by dissatisfied patients and unhappy encounters in the hospital. The listen-and-learn method trained doctors to be passive listeners, without the skills to communicate with patients.
Why the idea was necessary Although the rapid development and implementation of scientific research had greatly improved the overall diagnosis and treatment of many diseases, doctors faced increasing resistance from unhappy patients. Escalating tensions between doctors and patients created charges of conflicts of interest on both sides. Tensions were particularly high in the surgical disciplines, which carry greater risks of morbidity and mortality. A doctor would tell a patient about his or her disease and the associated risks and prognosis, but the patient would not comprehend or accept the information. Unrealistic expectations and unhappy outcomes led to complaints and the erosion of trust in the health care system. In China, medical education has emphasised using natural science to identify the disease and select the appropriate treatment strategy. The concept of humanism, of understanding, treating and educating the patient, had been lost over the decades as traditional Chinese medicine turned its attention to science.
What was done Chinese medical education underwent a revolutionary change in 2004. Problem-based learning (PBL), humanism and communications skills training swept though the educational system and into our hospital.
In our training programme, we introduced the medical students to PBL and to the notion of how it prepares them to communicate with their patients efficiently and effectively. We set up scenarios of doctor–patient conflict and medical students took turns as patients and doctors in role-playing the interaction and resolving the problem. We raised questions about what is central to communications skills, the importance of understanding the core issue, and how this helps to establish a common ground between doctor and patient. The goals of these activities were to build up medical students’ confidence, encourage willingness to communicate and better prepare doctors for clinical practice. Currently, student performance on internship is not judged by an examination paper, but by a combination of class reviews, interview results with patients and case analyses to generate an overall assessment of the individual intern student.
Evaluation of results and impact The problems of making a transition from the mentor-based system, incorporating PBL into a system dominated by the mentor-based model, and meeting the needs of a society in transition were all experienced within the microcosm of our department. However, when we surveyed the medical students, we found widespread satisfaction with the programme. The doctors remained concerned about misdiagnosis and missed diagnosis, but they said role-playing enhanced their interest in medicine and their confidence with patients. If such a sea change can take place in tradition-bound China, it may very well be successful anywhere.