Document Type : Original Article



Background: To have high‑quality primary health care services, an adequate doctor–patient
communication is necessary. Because of time restrictions and limited budget in health system,
an effective, feasible, and continuous training approach is important. The aim of this study is
to assess the appropriateness of a communication skills training program simultaneously with
routine programs of health care system. Materials and Methods: It was a randomized field
trial in two health network settings during 2013. Twenty‑eight family physicians through simple
random sampling and 140 patients through convenience sampling participated as intervention
and control group. The physicians in the intervention group (n = 14) attended six educational
sessions, simultaneous organization meeting, with case discussion and peer education method.
In both the groups, physicians completed communication skills knowledge and attitude
questionnaires, and patients completed patient satisfaction of medical interview questionnaire
at baseline, immediately after intervention, and four months postintervention. Physicians and
health network administrators (stakeholders), completed a set of program evaluation forms.
Descriptive statistics and Chi‑square test, t‑test, and repeated measure analysis of variance
were used to analyze the data. Results: Use of routine program as a strategy of training was
rated by stakeholders highly on “feasibility” (80.5%), “acceptability” (93.5%), “educational
content and method appropriateness” (80.75%), and “ability to integrating in the health
system programs” (approximate 60%). Significant improvements were found in physicians’
knowledge (P < 0.001), attitude (P < 0.001), and patients› satisfaction (P = 0.002) in intervention
group. Conclusions: Communication skills training program, simultaneous organization meeting
was successfully implemented and well received by stakeholders, without considering extra time
and manpower. Therefore it can be a valuable opportunity toward communication skills training.


1. Simpson M, Buckman R, Stewart M, Maguire P, Lipkin M,
Novack D, et al. Doctor‑patient communication: The Toronto
consensus statement. BMJ 1991;303:1385‑7.
2. Teutsch C. Patient–doctor communication. Med Clin North Amer
3. Hulsman RL, Ros WJ, Winnubst JA, Bensing JM. Teaching
clinically experienced physicians communication skills. A review
of evaluation studies. Med Educ 1999;33:655‑68.
4. Frederikson L, Bull P. An appraisal of the current status of
communication skills training in British medical schools. Soc Sci
Med 1992;34:515‑22.
5. Batelaan MA. Inventarisatie onderwijs communicatievaardigh‑eden
faculteiten genees‑kunde. Survey of communication skills training
in the Dutch medical schools. Amsterdam: Free University,
Department of Medical Psychology; 1995.
6. Tavakol M, Murphy M, Roger P, Torabi M. A need assessment
for a communication skills curriculum in Iran. Teach Learn Med
7. Levinson W, Roter DL. The effects of two continuing medical
education programs on communication skills of practising primary
care physicians. J Gen Intern Med 1993;8:318‑24.
8. Shekelle P. New Contract for general practitioners. BMJ
9. Cheraghi‑Sohi S, Bower P. Can the feedback of patient assessments,
brief training, or their combination, improve the interpersonal skills
of primary care physicians? A systematic review. BMC Health Serv
Res 2008;8:179.
10. Bertakis KD, Roter D, Putnam SM. The relationship of physician
medical interview style to patient satisfaction. J Fam Pract
11. Zamani A, Shams B, Moazzam E. Communication skills training
for physicians as a strategy for enhancing patients’ satisfaction:
A model for continuing education. Iran J Med Educ 2004;4:15‑22.
12. Meguerditchian AN, Dauphinee D, Girard N, Eguale T, Riedel K,
Jacques A, et al. Do physician communication skills influence
screening mammography utilization? BMC Health Serv Res
13. Ong LM, De Haes JC, Hoos AM, Lammes FB. Doctor‑patient
communication: A review of the literature. Soc Sci Med
14. Stewart M. Effective physician‑patient communication and health
outcomes: A review. CMAJ 1995;152:1423‑33.
15. Bashour HN, Kanaan M, Kharouf MH, Abdulsalam AA, Tabbaa MA,
Cheikha SA. The effect of training doctors in communication skills
on women’s satisfaction with doctor–woman relationship during
labour and delivery: A stepped wedge cluster randomised trial in
Damascus. BMJ open. BMJ Open 2013;3.pii:e002674.
16. Al Odhayani A, Ratnapalan S. Teaching communication skills. Can
Fam Physician 2011;57:1216‑8.
17. Barth J, Lannen P. Efficacy of communication skills training courses
in oncology: A systematic review and meta‑analysis. Ann Oncol
18. Ford S, Fallowfield L, Lewis S. Doctor‑patient interactions in
oncology. Soc Sci Med 1996;42:1511‑9.
19. Berkhof M, van Rijssen HJ, Schellart AJ, Anema JR, van der Beek AJ.
Effective training strategies for teaching communication skills to
physicians: An overview of systematic reviews. Patient Educ Couns
20. Gysels M, Richardson A, Higginson IJ. Communication training for
health professionals who care for patients with cancer: A systematic
review of training methods. Support Care Cancer 2005;13:356‑6.
21. Ashbury FD, Iverson DC, Kralj B. Physician communication skills:
Results of a survey of general/family practitioners in Newfoundland.
Medical Education Online: An electronic journal 2001;6:1191‑202.
22. Managheb SE, Firouzi H Jafarian J. The impact of communication
skills training based on calgary‑cambridge guideline on knowledge,
attitude and practice of family physicians in Jahromuniversity of
medical sciences 2007. Jahrom Med J 2008;6:74‑84.
23. Milstein RL, Wetterhall SF. Framework for program evaluation in
public health. MMWR Morb Mortal Wkly Rep 1999;48:1‑35.
24. Rhee H, McQuillan BE, Belyea MJ. Evaluation of a peer‑led asthma
self‑management program and benefits of the program for
adolescent peer leaders. Respiratory Care 2012;57:2082‑9.
25. Silverman J, Kurtz SM, Draper J, van Dalen J, Platt FW. Skills for
communicating with patients. Oxford, UK: Radcliffe Pub; 2005.
26. Kurtz SM, Silverman DJ, Draper J, van Dalen J, Platt FW. Teachingand learning communication skills in medicine. Oxford: Radcliffe
Pub; 2005.
27. Lloyd M, Bor R. Communication skills for medicine. Edinburgh:
Churchill livingstone (Elsevier Health Sciences); 2009.
28. Balaji M, Andrews T, Andrew G, Patel V. The acceptability, feasibility,
and effectiveness of a population‑based intervention to promote
youth health: An exploratory study in Goa, India. J Adolesc Health
29. Pond CD, Brodaty H, Stocks NP, Gunn J, Marley J, Disler P, et al.
Ageing in general practice (AGP) trial: A cluster randomised trial
to examine the effectiveness of peer education on GP diagnostic
assessment and management of dementia. BMC Fam Pract
30. Anvik T, Gude T, Grimstad H, Baerheim A, Fasmer OB,
Hjortdahl P, et al. Assessing medical students’ attitudes towards
learning communication skills–which components of attitudes do
we measure? BMC Med Educ 2007;7:4.
31. Fallowfield L, Jenkins V, Farewell V, Solis‑Trapala I. Enduring impact
of communication skills training: Results of a 12‑month follow‑up.
Br J Cancer 2003;89:1445‑9.
32. Malakouti M. Teaching in small groups (Group discussion). J Educ
Strateg 2010;2:183‑7.