Table 2.

Primary themes from student critical analyses and sample quotes

Theme 1: role that effective communication skills play in the delivery to good patient care (35%)
“My observations of Dr. [… ] has made it clear that communication skills are always necessary when interacting with patients and is an effective tool both for gathering patient information as well as building a solid physician-patient relationship.” “I felt the communication skills I used during this appointment positively impacted the effectiveness of patient care because the patient was able to comfortably describe to me what was going on and what she was worried about without feeling embarrassed.” “When interacting with patients, I believe I should ask myself on a regular basis whether I am actively employing communication skills in order to engage in dialogue with the patient.” “[… ] seeing good clinicians work and then coming home to write these reflections has really allowed me to further my understanding about what motivates me to become a physician. Yes, like everyone here I want to help people, but the skills that we are asked to discover and reflect upon during these experiences show that medicine is not only a science, but also an art. There is genuine talent that is needed to show empathy, communicate effectively, and think critically all at once, and I want to be able to do all these things to perfection.” “When the doctor came in while I was still talking with her, it was clear the doctor never has gotten to see the inner struggle that I had just witnessed. While this may not hinder the doctor’s job to assess risk of surgery, it just made me aware of how much a doctor can miss about a patient’s struggle when he/she is just focused on the illness.”
Open questions (11%)	“I learned after the first few questions of this interaction that this patient had a lengthy past medical history, and 4-5 present illnesses. With so many different aspects of her care, I would have never learned even a fraction of her history if I just asked “closed” questions. I talked with [patient] for about 25 minutes, but by asking her open questions or to “tell me more” I was able to gather information about her present illness and concerns, her past medical history and journey to her current diagnosis, and a surprising amount about her family, work, and hobbies.”
Active listening (8%)	“During future patient encounters, I hope to do a better job of giving patients enough time to respond. During a couple simulated patient interviews, I have made the mistake of asking another question too soon before the patient is done responding. This makes the patient feel rushed and they may not share all the relevant information with me if they do not feel comfortable and/or if they are not given enough time to respond.”
Rapport building (8%)	“This experience taught me how important establishing initial rapport with a patient really is. Without making an emotional connection and both of us sharing some of our history with each other, I doubt the patient would have felt as comfortable as he did raising the many concerns he had in this visit.”
Empathy (5%)	“I gained some valuable insight about what it is like to be ill and be in [patient’s] shoes. As a future clinician, I think it will be a test to remain non-judgmental and show empathy for a patient.”
Signposting (5%)	“It was very inspiring to see how the physician truly seemed to care for her patients and did an excellent job making sure they felt comfortable and knew what was coming by signposting. I could tell that the patients appreciated her for that and trusted her expertise as she really included them in the decision-making process.” “[The doctor] used less signposting and summary than we have been learning about in class. This may have been more helpful for his patients to understand where the interview was headed.”
Theme 2: integration between ECE experiences and the classroom and small group learning (11%)
“It has been valuable to have more exposure to real clinical situations and see how the more artificial experiences we have via modules and small group sessions translate in the real world.” “I found it very beneficial how integrated the ECE was with the [classroom] skills sessions. I think that the pacing of learning communication skills to having to apply them in the ECE visit was well thought out and allowed me sufficient time between visits to see real change in my skills. Otherwise, I greatly enjoyed the opportunity of consistent patient exposure and physician shadowing.” “I felt that the ECE experience brought us back to the patient, which was appreciated. It provided a time for you to apply what you had learned up to that point and realize that you have something to show for the time you have put in studying.” “I thought it was very valuable to be exposed to the clinical setting early on. It allowed me to relate what we are learning in class to what I will be doing in the future. It always helps to see how you will be using certain aspects of the coursework and it keeps me more motivated!”
Theme 3: adaptability of communication skills to specific clinical contexts and patient needs (8%)
“What I learned from this interview, and from my visit to the clinic in general, is that there’s no set way to ask a patient questions. The interview needs to be adjusted to suit every individual patient’s needs.” “Currently, we are given a fairly rigid structure in terms of the patient interview process. This is fair given that we need to make sure every aspect of the interview is properly addressed and covered while meeting with patients. I have come to understand however, that our current guide towards the patient interview is more of an informative, detailed outline that prepares us to accommodate for each situation, to tailor our interview to each individual patient.” “What I learned from this interview and from my visit to the clinic in general, is that there’s no set way to ask a patient questions. The interview needs to be adjusted to suit every individual patient’s needs—some are more than willing to share while others need a little more work to uncover some of the concerns that aren’t directly symptom-related.” “I’m also looking forward to using some of the tips that the physician gave me. He described patient interviewing as being an actor without a complete script. You go in to interview the patient and sometimes they throw you a curve ball. You have to be ready for the unpredictable to be a competent physician!”