Educational interventions to ensure provision of doctors in rural areas - a systematic review.

INTRODUCTION: Recruiting doctors in rural areas is challenging. Various educational interventions have been introduced in many countries. This study aimed to explore undergraduate medical education interventions introduced to recruit doctors to rural areas, and the results of these interventions. METHODS: We undertook a systematic search using search words 'rural', 'remote', 'workforce', 'physicians', 'recruitment' and 'retention'. We included articles meeting the following criteria: educational interventions clearly described; study population consisted of medical graduates; and outcome measures included place of work (rural/non-rural) after graduation. RESULTS: The analysis included 58 articles and encompassed educational interventions in ten countries. There were five main types of interventions, often used in combination: preferential admission from rural areas; curriculum relevant to rural medicine; decentralised education; practice-oriented learning in rural areas; and compulsory service periods in rural areas after graduation. The majority of the studies (42) compared place of work (rural/non-rural) of doctors graduated with and without these interventions. In 26 studies, odds ratio for rural place of work was significant at a level of 5%, with odds ratios between 1.5 and 17.2. Significant differences in the proportion with a rural/non-rural place of work were shown in 14 studies, differences ranging from 11 to 55 percentage points. DISCUSSION: Changing focus of undergraduate medical education towards development of knowledge, skills and teaching arenas that equip doctors with competencies to work in rural areas has an impact on the recruitment of doctors in rural areas. Concerning preferential admission from rural areas, we will discuss if national and local contexts makes a difference.

Educational interventions to ensure provision of doctors in rural areas - a systematic review. / Tiltak i grunnutdanningen for å sikre leger til distrikt ­ en systematisk oversikt.

BACKGROUND: Recruiting doctors in rural areas is challenging, and various educational interventions to ensure the provision of doctors in rural areas have been introduced in many countries. This study aimed to collect knowledge about the undergraduate medical education interventions that have been introduced in order to recruit doctors to rural areas, and the results of these interventions. MATERIAL AND METHOD: We undertook a systematic search in the databases Cinahl, Eric, Medline and PsycInfo using the search words rural, remote, workforce, physicians, recruitment and retention. We included articles that met the following criteria: the educational interventions were clearly described, the study population consisted of medical graduates, and outcome measures included place of work (rural/non-rural) after graduation. RESULTS: The analysis included 58 articles and encompassed educational interventions in ten countries. There were five main types of interventions, often used in combination: preferential admission from rural areas, curriculum relevant to rural medicine, decentralised education, practice-oriented learning in rural areas, and compulsory service periods in rural areas after graduation. The majority of the studies (42) compared place of work (rural/non-rural) of doctors who had graduated with and without these interventions - only two of the studies reported non-significant differences in place of work. In 26 studies, the odds ratio for rural place of work was significant at a level of 5 %, with odds ratios between 1.5 and 17.2. In 14 studies there were significant differences in the proportion with a rural/ non-rural place of work, with differences ranging from 11 to 55 percentage points. INTERPRETATION: Changing the focus of undergraduate medical education towards the development of knowledge, skills and teaching arenas that equip doctors with competencies to work in rural areas has an impact on the recruitment of doctors in rural areas.

Doctors educated in Bodø - who are they and where do they work? / Leger utdannet i Bodø ­ hvem er de og hvor blir de av?

BACKGROUND: Every year since 2009, up to 24 medical students at UiT The Arctic University of Norway have undertaken the last two years of their undergraduate medical education in Bodø (referred to as the Bodø model). We mapped the municipalities where the students had grown up, their preferences as to future specialties, where they worked and what they worked with after Part 1 of their specialist training. MATERIAL AND METHOD: Medical students who graduated from the Bodø model in the period 2012-18 completed a questionnaire in the first week of their sixth year of study, containing questions about where they had grown up and their preferences for future place of work and specialty. We mapped their place of work and specialty as of January 2021 as well as that of the two cohorts graduating in 2010-11. The place where the latter had grown up was mapped via direct contact, contact with their cohort or open internet sources. The covariation between where they grew up and their place of work, specialty preferences and choice of specialty were analysed using chi-square tests and logistic regression. RESULTS: Out of a total of 146 doctors, 91 of whom were women (62.3 %), who had completed their undergraduate medical education under the Bodø model as well as Part 1 of their specialist training, 40 (27.4 %) had grown up in Bodø municipality and for 56 (38.4 %) this was their place of work. For the remainder of the county of Nordland, the corresponding figures were 54 (37.0 %) and 38 (26.0 %), for Troms og Finnmark 23 (15.8) and 19 (13 %) and for the remainder of Norway 29 (19.9 %) and 33 (22.6 %). A total of 51 (34.9 %) worked as GPs, of whom 34 (66.7 %) worked in rural municipalities. There was a higher probability of working in a rural area if the doctor had grown up in a rural community (odds ratio (OR) 3.0 (95 % CI 1.5 to 6.1)) and of working in general medicine if this had been their preference as a student (OR 3.7 (95 % CI 1.8 to 7.6)). INTERPRETATION: The Bodø model has mainly attracted students with an affiliation to the region. At the time of the survey, a large percentage of the graduates who took part of their undergraduate medical education in Bodø worked at the Nordland Hospital in Bodø and in general practice, particularly in rural municipalities.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study.

BACKGROUND: Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. METHODS: The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. RESULTS: Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. CONCLUSIONS: Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Do medical students and young physicians assess reliably their self-efficacy regarding communication skills? A prospective study from end of medical school until end of internship.

BACKGROUND: This prospective study from end of medical school through internship investigates the course and possible change of self- reported self-efficacy in communication skills compared with observers' ratings of such skills in consultations with simulated patients. METHODS: Sixty-two medical students (43 females) from four Norwegian universities performed a videotaped consultation with a simulated patient immediately before medical school graduation (T1) and after internship (internal medicine, surgery and family medicine, half a year each - T2). Before each consultation, the participants assessed their general self-efficacy in communication skills. Trained observers scored the videos and applied a well-validated instrument to rate the communication behaviour. Results from the two assessment methods were correlated at both time points and possible differences from T1 to T2 were explored. RESULTS: A close to zero correlation between self-efficacy and observed communication skills were found at T1. At T2, participants' self-efficacy scores were inversely correlated with levels of observed skills, demonstrating a lack of concordance between young physicians' own assessment of self-efficacy and observers' assessment. When dividing the sample in three groups based on the observers' scores (low <1/3-, medium 1/3 to 2/3-, high competence >2/3), the group of male physicians showed higher levels of self-efficacy than females in all the three performance groups at T1. At T2, those having a high performance score yielded a low self-efficacy, regardless of gender. CONCLUSIONS: The lack of positive correlations between self-efficacy assessment and expert ratings points to limitations in the applicability of self-assessment measures of communication skills. Due to gender differences, groups of female and male physicians should be investigated separately. Those obtaining high-performance ratings from observers, through the period of internship, may become more conscious of how demanding clinical communication with patients may be. This insight may represent a potential for growth, but could in some physicians represent too much of a self-critical attitude. Active supervision of young physicians throughout internship is important in order to help physicians to be more aware of their strengths and weaknesses, in order to gain increased mastery in the art of doctoring.

Adult physical, sexual, and emotional abuse and postpartum depression, a population based, prospective study of 53,065 women in the Norwegian Mother and Child Cohort Study.

BACKGROUND: Postpartum depression (PPD) has detrimental consequences to the women, their infants and families. The aim of the present study was to assess the association between adult abuse and PPD. METHODS: This study was based on data from 53,065 pregnant women in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Women were recruited through a postal invitation in relation to a routine ultra-sound invitation at week 18 of gestation. Exposure to adult emotional, sexual, physical abuse was based on self-report at week 30, also differentiating if the perpetrator was known or a stranger, and whether the abuse was recent or not (<12 month since abuse). PPD was measured with a four items version of the Edinburgh Postnatal Depression Scale (EDS) at six months postpartum. The associations between different types of adult abuse and PPD were performed with logistic regression, adjusting for age, parity, civil status, education, child abuse, social support, and depression prior to pregnancy. RESULTS: Altogether, 11% had PPD, and 19% had been exposed to adult abuse. Women reporting adult abuse had an 80% increased fully adjusted odds of PPD (OR 1.8 95% CI 1.7-1.9) compared to non-abused women. There was a tendency towards higher odds of PPD for women reporting combinations of adult abuse (emotional, sexual and physical), as compared with those reporting sexual, emotional or physical abuse only. Exposure from known perpetrator was more strongly associated with PPD than exposure from an unknown perpetrator. Compared with women without adult abuse, the fully adjusted odds of PPD was 2.6 (95% CI 2.4-2.9) higher for women with any recent adult abuse and 1.5 (95% CI 1.5-1.7) higher for women with any adult abuse, but not recent. CONCLUSIONS: The results from this large prospective population-based cohort study support initiatives aiming to assess and adequately address abuse when counseling and treating women of PPD.

Same description, different values. How service users and providers define patient and public involvement in health care.

BACKGROUND: Patient and public involvement in health care is important, but the existing definitions of the concept do not integrate the stakeholders' own perceptions. OBJECTIVE: To investigate and compare service users' and service providers' own definitions of patient and public involvement and their implications. DESIGN, SETTING AND PARTICIPANTS: Qualitative study with mainly individual in-depth semi-structured interviews conducted between June 2007 and June 2009. Data were analysed using a grounded theory approach. RESULTS: A total of 20 patients, 13 public representatives and 44 health service providers/managers in both somatic and mental health care were interviewed. A common definition of patient and public involvement emerged: It is founded on mutual respect, carried out through dialogue aiming at achieving shared decision making. Nevertheless, users and providers assigned different values to the core aspects: Respect was imperative for service users and implied for providers, dialogue was a way to gain respect for service users and to achieve good outcome for providers, and both worried that the other party wanted to make sole decisions. CONCLUSIONS: Users and providers need to consider that although they have a common definition of involvement in health care, they assign different values to its aspects. Increasing and improving patient and public involvement therefore requires knowledge on and dialogue between the parties about these differences.

Prevalence of sexual, physical and emotional abuse in the Norwegian mother and child cohort study.

BACKGROUND: Abuse of women occurs in every society of the world. Increased information about the prevalence in industrialized countries, like Norway, is required to make strategies to prevent abuse. Our aim was to investigate the prevalence of self-reported sexual, physical and emotional abuse in a large obstetric population in Norway, and the associations between exposure to adult abuse, socio-demographics and other characteristics. METHODS: Our study is based on the Norwegian Mother and Child (MoBa) Cohort study, conducted by the Norwegian Institute of Public Health. The current study included 65,393 women who responded to two extensive postal questionnaires during pregnancy. Any adult abuse is defined as being exposed to one or more types of adult abuse, any child abuse is defined as being exposed to one or more types of child abuse, and any lifetime abuse is defined as being exposed to abuse either as a child and/or as an adult. Perpetrators were categorized as known or stranger. RESULTS: Overall, 32% of the women reported any lifetime abuse, 20% reported any adult abuse, 19% reported any child abuse and 6% reported abuse both as adults and as children. Emotional abuse was the most frequently reported type of abuse both as adults (16%) and children (14%). Adult sexual abuse was reported by 5% and child sexual abuse by 7%. Physical abuse was reported by 6% as adults and by 6% as children. Approximately 30% of those reporting adult or child abuse reported exposure to two or three types of abuse. Five percent of the women reported exposure to any abuse during the last 12 months. For all types of abuse, a known perpetrator was more commonly reported. Logistic regression showed that being exposed to child abuse, smoking and drinking alcohol in the first trimester of pregnancy, living alone, and belonging to the eldest age group were significantly associated with being exposed to any adult abuse. CONCLUSION: The reported prevalence of any lifetime abuse was substantial in our low-risk pregnant population. Antenatal care is an opportunity for clinicians to ask about experiences of abuse and identify those at risk.

A few more minutes make a difference? The relationship between content and length of GP consultations.

OBJECTIVES: To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information. DESIGN: A prospective, longitudinal follow-up study. SETTING: Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians. MAIN OUTCOME MEASURES: Content lists. RESULTS: Pearson's r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals. CONCLUSIONS: A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians' use of time in consultations.

Psychological safety in European medical students' last supervised patient encounter: A cross-sectional survey.

OBJECTIVE: To investigate the association between European medical students' psychological safety in and experiences from their last supervised patient encounter. MATERIALS AND METHODS: A cross-sectional online survey among European medical students. Bivariable and multivariable linear regression was used to explore the associations between the dependent variable psychological safety and independent variables concerning students' experiences from their last supervised patient encounter. RESULTS: A total of 886 students from more than 25 countries participated. The variables most strongly associated with psychological safety were supervisor coaching and modelling behaviour, adjusted beta 0.4 (95%CI 0.3 to 0.5) and 0.1 (95%CI 0.1 to 0.2) per unit respectively on a one-to-five-point scale, and studying in Northern Europe, adjusted beta 0.4-0.5 compared to other regions. There was a weak negative association (reduced score on psychological safety) for being supervised by a medical doctor with <5 years' experience and a positive association for student confidence. Student gender, student seniority, speciality, whether peers were present, number of previous encounters with the supervisor and supervisor articulation and exploration behaviour were not associated in multivariable analysis. CONCLUSION: Coaching might be a good primary focus to improve supervision practices, as participation with feedback is known to be beneficial for learning and coaching was strongly associated with psychological safety. Supervisors in western, eastern, and southern Europe might have to work harder to create psychological safety than their northern colleagues.

What Aspects of Supervised Patient Encounters Affect Students' Perception of Having an Excellent Learning Outcome? A Survey Among European Medical Students.

Background: To investigate whether supervisor behavior, students' participation and approach, and psychological safety were associated with self-reported excellent learning outcome from supervised encounters with patients among European medical students. Methods: A cross-sectional, online survey among European medical students asking about their latest clinical supervision experience. Associations were examined with logistic regression. Results: Students (N=908) from >25 countries reported on experiences from supervised patient encounters in most types of hospital departments and general practice. One out of six (17%) students perceived the learning outcome as excellent. In the multivariable logistic regression, this was independently associated with supervisor role modelling (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.5-3.0) and addressing learning goals (OR 1.4, 95% CI 1.1-1.7), students' approach to learning (OR 1.7, 95% CI 1.0-3.0) and psychological safety (OR 1.5, 95% CI 1.1-2.0). Supervisors being present during the patient encounter, coaching students or asking questions to have students express their thinking, and student participation in examination and/or history taking was not associated with perceived excellent learning outcome. Conclusion: We encourage supervisors to recognize that students are beginners in most supervised clinical settings and often appreciate having learning goals addressed, behavior and thinking role modelled, and psychological safety established before they participate more fully.

The short-term effect on alliance and satisfaction of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial.

BACKGROUND: The main aim was to investigate the effect of using two brief feedback scales in mental health out-patient treatment six weeks after starting treatment, compared to treatment as usual. Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction. METHODS: An open parallel-group randomised controlled trial was conducted in an out-patient unit in a mental health hospital in Central Norway. Eight therapists trained in using the feedback scales in the Partners for Change Outcome Management System (PCOMS) treated the intervention group. Seventeen therapists treated the controls, providing treatment without using feedback scales. The main outcome measures were treatment alliance and patient satisfaction. RESULTS: Seventy-five patients participated. There were no differences between the groups in the intention to treat (ITT) analyses on alliance (mean difference = 0.08, 95% CI -0.44, 0.59, p = 0.760) or satisfaction (mean difference = 0.24, 95% CI -1.85, 2.32, p = 0.819), and no statistically significant differences between the groups in the per protocol (PP, n = 58) analyses on alliance (mean difference = 0.32, 95% CI -0.84, 3.16, p = 0.137) or satisfaction (mean difference = 1.16, 95% CI -0.84, 3.16, p = 0.248) six weeks after the treatment started. The effect size in favour of the PCOMS group increased from 0.07 for alliance and 0.06 for satisfaction in the intention to treat analysis to 0.40 on alliance and 0.31 for satisfaction in the per protocol analysis. Among the other outcomes, the PCOMS group had better motivation for treatment (estimated mean difference ITT: 0.29, 95% CI 0.00 to 0.57, p = 0.05, PP: 0.28, 95% CI 0.04, 0.52, p = 0.024). CONCLUSION: Six weeks after starting treatment, there were no effects on alliance and satisfaction from using two brief feedback scales. Since the per protocol analyses showed higher effect sizes, future investigations in a larger study with longer follow-up are warranted.

Learning from clinical supervision - a qualitative study of undergraduate medical students' experiences.

INTRODUCTION: Clinical supervision is necessary to ensure students' learning and patient safety. There is limited research on how medical students' actions play into the dynamic of learning from clinical supervision. We aimed to explore undergraduate medical students' experiences with learning from clinical supervision, focusing on students' actions and interactions. MATERIALS AND METHODS: A qualitative study using semi-structured interviews with medical students at two English and four Norwegian universities. The main topics were students' experiences with clinical supervision, what students' felt helped them learn, and how they acted. Transcribed interviews were analysed thematically. RESULTS: 22 students participated. The actions participants described performing during supervision ranged from staying quiet to initiating active participation. They described that learning was more likely to take place when they took initiative, acted on opportunities to participate, and focused their attention on learning. When they did not feel safe, they were more likely to stay quietly in the background. When participants felt concerned for patients' welfare their attention shifted away from learning. While if they were appropriately confident, they engaged in learning. CONCLUSION: Feelings of safety, patients' being cared for, and confidence impacted on students' actions and thus learning. Our findings suggest that when students feel psychologically safe, they are more likely to act and interact during clinical supervision. One way to improve psychological safety is to foster relationships between students and supervisors.

Effect of an institutional development plan for user participation on professionals' knowledge, practice, and attitudes. A controlled study.

BACKGROUND: Governments in several countries attempt to strengthen user participation through instructing health care organisations to plan and implement activities such as user representation in administrational boards, improved information to users, and more individual user participation in clinical work. The professionals are central in implementing initiatives to enhance user participation in organisations, but no controlled studies have been conducted on the effect on professionals from implementing institutional development plans. The objective was to investigate whether implementing a development plan intending to enhance user participation in a mental health hospital had any effect on the professionals' knowledge, practice, or attitudes towards user participation. METHODS: This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals as a part of a larger re-organizational process. The plan included i.e. establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre's information and the professional culture. The professionals at the intervention hospital thus constituted the intervention group, while the professionals at two other hospitals participated as control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ) and additional questions, focusing on knowledge, practice, and attitudes towards user participation, two times with a 16 months interval. RESULTS: A total of 438 professionals participated (55% response rate). Comparing the changes in the intervention group with the changes in the control group revealed no statistically significant differences at a 0.05 level. The implementation of the development plan thus had no measurable effect on the professionals' knowledge, practice, or attitudes at the intervention hospital, compared to the control hospitals. CONCLUSION: This is the first controlled study on the effect on professionals from implementing a development plan to enhance user participation in a mental health hospital. The plan had no effect on professionals' knowledge, practice, or attitudes. This can be due to the quality of the development plan, the implementation process, and/or the suitability of the outcome measures.

Medical students' cognitive and affective attitudes towards learning and using communication skills--a nationwide cross-sectional study.

AIMS: We wanted to explore cognitive and affective attitudes towards communication skills among students in Norwegian medical schools. METHOD: 1833 (60% response rate) medical students at the four medical schools in Norway filled in questionnaires by the end of term in May 2003. The Communication Skills Attitudes Scale (CSAS) was used for assessing affective and cognitive attitudes separately. RESULTS AND CONCLUSIONS: Medical students have positive attitudes towards learning and using communication skills. Cognitive and affective attitudes displayed different patterns. Being female and having worked in the health services before admission to the medical school predicted more positive scores both towards cognitive and affective attitudes. Having worked as a junior doctor during medical school predicted more positive cognitive attitudes. Cognitive attitudes towards communication skills did not vary significantly between year groups in any of the medical schools. Scores reflecting affective attitudes gradually fell for each year in all schools, but rose again in the final year in two of them. Implications for curriculum design are discussed.

Assessing medical students' attitudes towards learning communication skills--which components of attitudes do we measure?

BACKGROUND: The Communication Skills Attitudes Scale (CSAS) created by Rees, Sheard and Davies and published in 2002 has been a widely used instrument for measuring medical students' attitudes towards learning communication skills. Earlier studies have shown that the CSAS mainly tests two dimensions of attitudes towards communication; positive attitudes (PAS) and negative attitudes (NAS). The objectives of our study are to explore the attitudes of Norwegian medical students towards learning communication skills, and to compare our findings with reports from other countries. METHODS: The CSAS questionnaire was mailed simultaneously to all students (n = 3055) of the four medical schools in Norway in the spring of 2003. Response from 1833 students (60.0%) were analysed by use of SPSS ver.12. RESULTS: A Principal component analysis yielded findings that differ in many respects from those of earlier papers. We found the CSAS to measure three factors. The first factor describes students' feelings about the way communication skills are taught, whereas the second factor describes more fundamental attitudes and values connected to the importance of having communication skills for doctors. The third factor explores whether students feel that good communication skills may help them respecting patients and colleagues. CONCLUSION: Our findings indicate that in this sample the CSAS measures broader aspects of attitudes towards learning communication skills than the formerly described two-factor model with PAS and NAS. This may turn out to be helpful for monitoring the effect of different teaching strategies on students' attitudes during medical school.

Observed communication skills: how do they relate to the consultation content? A nation-wide study of graduate medical students seeing a standardized patient for a first-time consultation in a general practice setting.

BACKGROUND: In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient. METHODS: Final-year medical school students (N = 111) carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately. RESULTS: The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content. CONCLUSION: Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.