Communicative Skills in Value-Based Medical Education

Overview

This observational, prospective, cross-sectional study examined first-semester medical students' self-perceived communicative competencies within the framework of value-based medicine. The investigation was conducted at Universidad de Guayaquil between July and October 2025. Value-based medicine prioritizes patient outcomes and necessitates high-precision clinical communication; however, communicative skills development frequently remains underemphasized in foundational medical curricula. The study aimed to diagnose strengths and deficiencies in communicative competencies to inform evidence-based curricular integration.

Methods and approach

A probabilistic sample of 130 first-semester medical students completed a 15-item Likert-scale questionnaire assessing five dimensions of clinical communication. Internal consistency was established through Cronbach's alpha (0.83). Methodological rigor was maintained through expert validation and double data entry. Statistical analysis employed weighted averages and frequency distributions using SPSS v.26.0, with emphasis on internal consistency and methodological integrity.

Results

Analysis revealed disparate performance profiles across communicative dimensions. Students demonstrated high self-perceived competence in message adaptation (4.52), open-mindedness (4.38), and active listening (4.36). Conversely, critical deficiencies emerged in deep listening management, particularly in response planning during listening (3.56), handling of difficult interlocutors (3.78), and objectivity when confronted with divergent opinions (3.72). Although most students acknowledged the importance of communicative skills, they reported substantial formative deficits. Lowest scores correlated with systematic practice of active listening and empathy in clinical scenarios.

Implications

Within value-based medicine frameworks, identified gaps in deep listening and complex interpersonal scenario management compromise optimal patient outcome achievement. Current curricula insufficiently address communicative competencies as integrated technical and transversal skills. Communicative skills deficiencies may limit shared decision-making capacity, patient adherence, and healthcare system efficiency. Systematic integration of active listening, emotional management, and complex interpersonal competencies into foundational curricula is warranted. Early-stage development of these competencies, particularly deep listening and empathic engagement in clinical contexts, will prepare practitioners to advance effective, sustainable, and humanistic healthcare delivery models consistent with value-based medicine principles.