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What's Wrong with this Medical Student Today? Dysfluency on Inpatient Rounds

Catherine V. Caldicott, MD
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State University of New York; Syracuse, NY 13202 Acknowledgments: The author thanks Laura M. Ahearn, PhD; Rodney A. Hayward, MD; Joel D. Howell, MD, PhD; Laurence F. McMahon Jr., MD, MPH; and A. Lesley Milroy, PhD, for their critical reviews of earlier drafts of this manuscript, and Clare Weipert for her expert assistance in the preparation of this paper. Grant Support: This paper was written while the author was a Rober Wood Johnson Clinical Scholar at the University of Michigan, Ann Arbor, Michigan. Requests for Reprints: Catherine V. Caldicott, MD, Department of Medicine, State University of New York Health Science Center, 90 Presidential Plaza, Syracuse, NY 13202.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(7):607-610. doi:10.7326/0003-4819-128-7-199804010-00037
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As they strive to improve student and resident training in patient care, many medical educators refer to the extensive literature on physician–patient communication [13]. However, physicians speak differently in front of patients than they do among themselves, and studies of communication among physicians appear less frequently in the medical literature. Conversations between medical teachers and their students can illuminate attitude and value conflicts that affect a trainee's skills and knowledge acquisition, as well as professional development [45]. In this paper, I show how a medical trainee's verbal delivery can provide clues to detrimental conditions that may exist in his or her medical learning environment. Specifically, I examine the dysfluency-pauses, fillers, laughter, and self-interruptions-of previously fluent speakers in the setting of an inpatient medical service. Using tenets of effective physician–patient communication as a model, I argue that medical trainees would be better served by faculty who listen to their students with the same attentive skills that are considered essential to good patient care.

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