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The University of Southampton
Medical Education


The Communication theme runs through all years of medical education incorporating lectures, experiential learning, and, increasingly, working with ‘simulated patients'.

Since the development of the Communication theme the rather ‘old fashioned' approach of ‘clinical' and ‘communication' skills being learnt independently of each other - despite the obvious fact that doctors are required to communicate with patients whilst carrying out clinical examinations - has now changed.

A significant part of Communication is the time learners now spend with simulated patients. This increase has come from changing health care policy, curricular initiatives and an increasing emphasis on the assessment of clinical competencies.

Communication Skills Workshops

As part of the Communication theme, medical students are required to attend communication skills workshops, which were developed in order to bring these aspects of the medical curriculum together in a realistic yet ‘safe' environment, drawing on elements of problem-based learning.

A wide variety of scenarios, together with a corresponding set of learning outcomes, were developed. Scenarios were designed to reflect ‘real' situations that medical students may encounter at various stages of their training, rather than situations that they would be unlikely to face until later in their careers.


In designing these workshops, we were influenced by Kolb's (1993) experiential learning cycle. According to Kolb, learning occurs through a process of observation and experience, via reflection and experimenting with new ways of doing things.

The views of Kurtz et al (2005) have very much influenced the delivery of the workshops:

"...although understanding what it takes to communicate effectively is important, to actually improve communication it is essential to be able to use communication skills in practice."

One-to-one role play
One-to-one role play
Counselling role play
Counselling role play

The ‘experience' belongs to the learners, and the facilitator's role is to help them to get the most out of the experience - and to be open to the learners' evaluation of their endeavours to achieve this end.

Group sizes have been reduced to enable all participants to play an active role in each scenario; and the relevance of the scenarios to medical students has been made more explicit in order to make the learning more 'real'.

Providing a learning environment in which learners are comfortable both giving and receiving honest and constructive feedback is perhaps the biggest challenge in facilitating these sessions - and one which certainly cannot be taken for granted.

The facilitators strive to create effective and collaborative learning groups that are conducive to both personal and professional development, and in which learners feel able to 'take risks' and experiment with their behaviour.

Examples of role-play scenarios

Through experiential learning, students have the opportunity to practise, develop their skills and demonstrate their competence.

Communicating whilst undertaking an intimate examination

Purpose of Scenario: Communicating with sensitivity whilst carrying out a breast examination.

Learning Outcomes: Through experiential learning, the students will have the opportunity to practise, develop their skills and demonstrate their competence in being able to:

  1. Explain what they are doing sensitively
  2. Clarify and check understanding
  3. Use appropriate communication skills for the situation, pausing, reflecting, pacing
  4. Start and conclude appropriately
  5. Examine and talk to the patient simultaneously
  6. Demonstrate rapport-building and empathy skills
  7. Make appropriate use of open and closed questions
  8. Recognise and overcome barriers to effective communication

Participant: Medical student

Setting: Face-to-face, Well woman clinic

Scenario: Barbara Ross is a 60 year old lady who has come to the well woman clinic where you are on placement. The registrar took a full history from Mrs Ross, but was called away before having undertaken the examination. You have been fully briefed by the registrar, and you are now required to examine Mrs Ross.

History: Mrs Ross has been fit and well until two weeks ago when she started to become tired and experience some back pain.

PMH: 2 C sections, knee replacement after tennis injury 10 years ago.

Social: In local women's institute, plays bridge and golf regularly. Retired catering manager.

Family: Two daughters, both married and living in London. Divorced (7 years ago).

Medications: Nil

Supporting a patient after bad news

Purpose of Scenario: Supporting a patient facing the prospect of bad news.

Learning Outcomes: Through experiential learning, the students will have the opportunity to practise, develop their skills, and demonstrate their competence in being able to:

  1. Attend to the setting, using appropriate communication skills for the situation, e.g. pausing, reflecting, pacing and non verbal skills
  2. Discern the patient's perceptions by clarifying and checking understanding
  3. Obtain an invitation from the patient to share information
  4. Convey knowledge in plain language
  5. Acknowledge the patient's emotional response, showing rapport-building and empathy skills
  6. Conclude by summarising

Participant: Medical student

Setting: Face-to-face, Medical Ward

Scenario: Kevin Field is a 30 year old man who has been admitted for investigations following the discovery of a hard lump in his right testicle. He is usually fit and well and has never been in hospital before.

A biopsy and examination has strongly indicated testicular cancer, although histology results are necessary for full confirmation.

The consultant urologist has spoken to Mr Field, but had limited time.

Task: You have been asked to speak to Mr Field about any concerns that he may have.

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