Towards a concept of Communicative Competence in Health: a qualitative study in medical residents

Rodolfo A. Cabrales


Despite the wealth of literature surrounding the importance of effective communication in the clinical practice, there is a dearth of consensus in the literature on what communicative competence in health (CCH) is, and the practices of meaningful health communication. Seventeen residents (17) were invited to share their thoughts on the concept of communicative competence in health and on difficulties they encounter during their clinical practice related with communication. The aim of this study was to gain a better understanding of CCH with emphasis on the implications in the medical curriculum, teaching, learning and assessment. Three focus group discussions were conducted with the clinical supervisor. The results were audio-taped, transcribed verbatim and analyzed using principles from grounded theory for qualitative data analysis. The 135 open codes and defined axial codes were discussed and a number of conceptual frameworks were utilized to disentangle the concept of CCH. The focus group themes related to the concept of communication in health, its importance and difficulties, the role of the physician and health personnel. The participants felt their own training did not prepare them to establish effective communication with patients and relatives. Some barriers include lack of time and lack of institutional priority given to communication issues. The techniques originating from grounded theory permitted to define a broader concept of CCH with the following three specific scopes: biological perspective (objective world), social (social world) and subjective world (expressive-aesthetic). This new concept of CCH is central to understanding how the health communication process occurs, where a myriad of individual (physician, patient, staff, relatives), organizational and societal interrelated factors influence health decisions and practice. These components need to be addressed by medicine schools, health institutions and other stakeholders in the planning and designing a new model of curricula.


health communication; communicative competence; medical competences; medical communication skill; medical education


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