2) The becoming oriented to the communication tasks of a physician. 3) The beginning to build a base of skills and strategies associated with these tasks. But it is essential that teaching communication skills not be confined to the preclinical years. In subsequent years there should be both enforcement of the material learnt earlier as well as NLG919 order instruction in dealing with more difficult and challenging communication

problems, such dealing with the dying patient, the angry patient, and delivering bad Inhibitors,research,lifescience,medical news. These are best taught in the related clinical settings. Thus such subjects as dealing with breaking bad news and the handling of difficult situations might well be part of the teaching in oncology, in the intensive care unit, or in the premature nursery. It is also essential to prevent the erosion of the attitudes and skills achieved in the early years by contacts with many role models who have not the appropriate attitudes Inhibitors,research,lifescience,medical and skills, yet have an active teaching role and influence. SPECIAL PATIENT GROUPS

In recent years increasing attention is being paid to cultural competences36 In our globalization era physicians will be called upon frequently to deal with patients from cultures vastly different than their own. Ann Inhibitors,research,lifescience,medical Fadiman’s book The Spirit Catches You and You Fall Down37 is a dramatic description of the tragic failure of communication between conscientious physicians in dealing with illness in a family whose values were foreign and not understood by the health professionals. Physicians must learn how to deal effectively with different

cultures. It is important too that physicians learn how to communicate with Inhibitors,research,lifescience,medical patients who are handicapped by blindness, deafness, mental retardation, and psychiatric problems. We have had remarkably favorable feedback from our students by a weeklong exposure to such individuals during the students’ clinical week in the first year of medical school. 38 QUALIFICATION OF TEACHERS Inhibitors,research,lifescience,medical The question of who shall do the teaching is often a critical one. Unquestionably professionals in the behavioral sciences, particularly the applied ones, have the specialized academic training in the field, rarely matched by most clinicians. However, for a whole variety of reasons, some good and some bad, it is critical to have practicing physicians in major of roles in the teaching. They have practical experience, and medical students relate better to them than they do to non-physicians. The more senior the physicians who play an active role in teaching communication skills, the more likely it is for students to take the teaching seriously. When teaching communication skills is left to junior house staff a clearly negative message is conveyed as to the priority assigned to such teaching.