Intended for healthcare professionals

Rapid response to:


Clinical and communication skills

BMJ 2005; 330 doi: (Published 17 February 2005) Cite this as: BMJ 2005;330:374

Rapid Response:

Clinical and communication skills. Learnt side by side in Cuba

Dear Editor:

We carefully read the very interesting Kidd, Patel, Peile and Carter
editorial “Clinical and communication skills. Need to be learnt side by
side”. (1)

Last October 2004 we sent a Rapid Response (2) to another BMJ editorial
and one paper published in the same issue, about the benefits of early
contact with patients for medical students (3,4)
As we wrote at that time: “All Cuban Medical Faculties curriculum are
problem based, community oriented, fully horizontally integrated, and –as
an especial characteristic-, they provide very early and long clinical
experience. Since decade of 80´s of the last century, medical students in
Cuba start their first year “learning by doing”, at primary care services
(policlinics and family physicians´ offices). So, they can observe by
themselves, from the beginning, the “true world” and social context of
their future practice”. (2) In this real scenario the students learn
communication and clinical skills side by side, because, as Kidd, Patel,
Peile and Carter addressed “important skills for clinical practice can be
improved”.(1) Trained medical doctors and other health professionals of
different disciplines, who daily work at primary care, are the teachers in
practice. Students learn communication skills and how to do complete
physical examinations, at the same time, with many patients in this
scenario. In the Cuban medical education strategy, it is very difficult to
imagine how to teach –and more to learn- them, separatedly.

Kidd, Patel, Peile and Carter regret “the shortened hours of work with
limited windows of opportunity for training (that) oblige us to make the
most of the time available, and are conducive to integrated models of
medical education”. (1) In our country, when students arrive at the
hospitals, they have fulfilled a precedent curriculum, which was very
close to communication and clinical skills in clinical practice. From the
third year on, medical students go to different hospital wards, and they
participate in almost all activities of the clinical services (rounds,
different types of diagnostic discussions, duties, consultations, minor
surgical activities, etc.). We named all clinical practice activities
during the medical career as “educación en el trabajo” (“education in the
workplace”), and a lot of time is dedicated to them in each course. For
example, only in the two semesters of the third year they have to
fulfilled 520 hours of “education in the wokplace” activities in Semiology
(first semester) and also 520 hours in Internal Medicine (second
semester). In all of these activities, and in their evaluation,
communications skills are included as a very important issue.

Finally, we agree with Kidd, Patel , Peile and Carter that: “The
(clinical) scenario also gives students an opportunity to practise talking
to patients and relatives, who report lasting impact from doctors'
communication skills at a time of crisis. Learning side by side also
implies that trainee professionals of different disciplines learn some
team skills together so that interpersonal communication and role linkages
become embedded”.


Prof. Alfredo Espinosa-Brito, MD, PhD

Alfredo Espinosa-Roca, MD

Luis G. Del Sol-Padrón. MD

José M. Bermúdez-López, MD

Internal Medicine Department,
Teaching Hospital "Dr. Gustavo Aldereguia Lima", Ave 5 de Septiembre and
Calle 51A, Cienfuegos, 55100, CUBA



1. Kidd J, Patel V, Peile E and Carter Y. “Clinical and
communication skills. Need to be learnt side by side”. (editorial). BMJ
2005;330:374-375 (19 February).

2. Bermúdez-López JM, Espinosa-Brito AD, Espinosa-Roca AA. Early contact
with patients is beneficial in Cuba. BMJ 2004;329 Rapid Response. (10
October 2004)

3. Editorial. Early contact with patients is beneficial BMJ 2004;329 (9

4. Dornan T, Bundy C. What can experience add to early medical education?
Consensus survey. BMJ 2004;329:834.

Competing interests:
None declared

Competing interests: No competing interests

03 March 2005
Alfredo D. Espinosa-Brito
Professor of Internal Medicine
Alfredo A. Espinosa-Roca, Luis G. Del Sol-Padrón, José M. Bermúdez-López
Hospital Dr. Gustavo Aldereguía Lima, Ave 5 de Septiembre and Calle 51A, Cienfuegos 55 100, Cuba