19 March 2025: Clinical Research
Evaluation of Attitudes to Learning Doctor-Patient Communication Skills in 427 Postgraduate Doctors Using the Communication Skills Attitude Scale (CSAS) Questionnaire
Agnieszka Pochrzęst-Motyczyńska
1ABCDEF, Janusz Ostrowski 1ADEF, Dorota Sys 2ABCD, Jarosław Pinkas 1ADEF, Urszula Religioni 1ADEF*
DOI: 10.12659/MSM.947276
Med Sci Monit 2025; 31:e947276
Abstract
BACKGROUND: Effective communication between doctors and patients is crucial for improving healthcare quality and ensuring patient safety. This study aimed to evaluate attitudes to learning doctor-patient communication skills in 427 postgraduate doctors, using the self-reported 26-item communication skills attitude scale (CSAS) questionnaire.
MATERIAL AND METHODS: The study was conducted online between October 2023 and May 2024 via the LimeSurvey platform, with 427 physicians (response rate: 21.35%) participating in specialist courses at the Centre of Postgraduate Medical Education in Warsaw. The survey used the Communication Skills Attitude Scale (CSAS), including 26 items divided into positive and negative affect scales. Responses were scored on a 5-point Likert scale, with negative attitude scale items reverse-scored, for a maximum score of 130 points. Descriptive statistics and sociodemographic analysis explored factors influencing attitudes.
RESULTS: Most participants (55.5%) were under 30 years of age, and 70% were women. Women demonstrated significantly more positive attitudes (M=52.53, SD=8.65) than men (M=50.65, SD=9.74; P=0.048). Physicians aged 41 to 50 years showed the most positive attitudes (M=55.78, SD=6.48), although age differences were not statistically significant (P=0.129). Divorced or separated participants had the highest scores (M=58.00, SD=6.08; P=0.010), while those with longer professional experience had more negative attitudes (P=0.004).
CONCLUSIONS: Sociodemographic factors, including sex, marital status, and professional experience, influenced attitudes toward learning communication skills. Training programs should consider these factors, to better meet the needs of diverse healthcare professionals.
Keywords: Health Communication, Physician-Patient Relations, Education, Quality of Health Care
Introduction
In the 21st century, the traditional paternalistic model of the doctor-patient relationship has transitioned toward a more collaborative and partnership-based approach. While doctors retain their expertise advantage, patients, empowered by easily accessible scientific research and online health information, bring new challenges to the physician’s role [1]. This evolving dynamic necessitates that clinical knowledge be complemented by strong social competencies, particularly in psychology and communication [2]. Patient feedback on doctor-rating platforms consistently highlights the critical importance of communication and interpersonal skills in healthcare interactions.
Numerous studies have demonstrated the pivotal role of effective communication between doctors and patients in the treatment process as contributing significantly to therapeutic success [3–6]. The World Health Organization (WHO) also underscores the essential role of communication in healthcare, including doctor-patient interactions and interdisciplinary team communication. In its Global Action Plan on Patient Safety 2021–2030: The Road to Eliminating Avoidable Harm in Healthcare [7], the WHO emphasizes that improving communication skills is fundamental for delivering safe, high-quality care. This includes training healthcare professionals in active listening and effective communication, both with patients and within teams, to achieve the best outcomes in diagnosis and treatment.
One key concept associated with doctor-patient cooperation is “compliance”, defined as adherence to medical recommendations, particularly regarding medication use [8]. Studies indicate that nearly 50% of patients with chronic diseases fail to follow prescribed medical recommendations [9]. Non-adherence is often assessed using thresholds, such as ≥80% proportion of days covered, categorizing patient medication use as adherent or non-adherent [10]. Factors contributing to poor adherence include complex treatment regimens, inadequate patient involvement in treatment planning, and communication barriers, such as insufficient discussions about adverse reactions.
Research highlights that better therapeutic outcomes are achieved when doctors engage in motivational dialogue and actively involve patients in therapy planning [11]. As patients increasingly seek active participation in the treatment process, the need for enhanced communication skills among healthcare professionals becomes evident. Developing these skills is a growing challenge for medical education systems, at both the undergraduate and postgraduate levels. In Poland, this challenge is particularly significant due to recent educational reforms.
Beginning in the 2024/2025 academic year, new standards will mandate that Polish medical universities introduce compulsory courses on communication with patients and teamwork skills for doctors, dentists, pharmacists, nurses, midwives, laboratory diagnosticians, physiotherapists, and paramedics [12]. Previously, such courses were offered on an optional basis. While these changes are a step forward, implementing them presents organizational and substantive challenges. Furthermore, Poland’s medical self-government has highlighted the lack of postgraduate training in essential soft skills, such as communication and stress management, within specialization programs [13].
Existing research on communication skills training has primarily focused on medical students, with over 5600 articles indexed in PubMed (keywords: communication skills, medical students). Fewer studies address attitudes toward learning communication skills among doctors in specialization training (residents), with approximately 4400 articles available on PubMed (keywords: communication skills, residents).
In Poland, most studies explore the attitudes of medical students, leaving a significant gap in understanding the perspectives of doctors during specialization training. To address this gap, this study used the Communication Skills Attitude Scale (CSAS), developed by Rees et al [14], a validated tool widely used to measure attitudes toward learning communication skills. This tool is recognized for its robust psychometric properties and has been adapted into multiple languages, including Polish [15,16], enabling cross-national and cross-disciplinary comparisons.
Therefore, this study aimed to evaluate attitudes to learning doctor-patient communication skills in 427 postgraduate doctors, using the self-reported 26-item CSAS questionnaire.
Material and Methods
ETHICAL CONSIDERATION:
This study was approved by the Bioethics Committee at the Centre of Postgraduate Medical Education in Warsaw (No. 197/2023, dated May 24, 2023). Participants completed the survey voluntarily and anonymously. They did not receive any form of compensation for their participation. Participants were informed that their data would be used solely for research purposes.
STUDY DESIGN:
In this study, a cross-sectional design was employed using a web-based survey. This report has been prepared in accordance with the STROBE guidelines (adapted for cross-sectional studies) and follows the CHEERIES recommendations for reporting web-based research [17,18].
SETTING AND PARTICIPANTS:
The study was conducted online between October 2023 and May 2024. The survey was administered via the LimeSurvey platform [19], licensed to the Centre of Postgraduate Medical Education (CMKP), Warsaw, Poland. The link to the survey was sent directly to the email addresses of 2000 physicians enrolled in mandatory specialization courses organized by the CMKP. These courses, provided by CMKP, a public entity responsible for most of the postgraduate medical training in Poland, focused on substantive medical issues rather than communication skills. The survey was presented as an optional component, available for voluntary completion by the participants. A total of 427 physicians responded, resulting in a response rate of 21.35%.
To ensure participant anonymity and confidentiality, no identifying information was collected during the survey. The LimeSurvey platform was configured to anonymize all responses, and data were stored on a secure server managed by CMKP. Access to the data was restricted to the research team, and all analyses were performed on de-identified datasets. Participants were informed about the anonymous nature of the survey and the use of their responses solely for research purposes, as outlined in the informed consent form presented at the start of the survey.
The methods of distribution involved emailing a unique survey link to the participants. Reminder emails were sent to increase participation, ensuring that responses remained anonymous even after multiple invitations.
The data acquisition process involved collecting responses directly through the LimeSurvey platform, which automatically aggregated and anonymized the data for analysis.
VARIABLES AND DATA SOURCES:
In this study, we used the CSAS, a standardized tool developed by Rees et al to measure attitudes toward learning communication skills [14]. To ensure cultural and linguistic appropriateness for our sample of physicians, we used the Polish version of the CSAS, which had been translated and validated by Panczyk et al in a study involving registered nurses [15]. This rigorous adaptation process guaranteed the tool’s suitability for the Polish medical context.
The CSAS is widely recognized as one of the most effective tools for assessing attitudes toward communication skills. Originally designed for medical students, it has been adopted across various disciplines and regions due to its strong psychometric properties and availability in multiple language versions. This versatility makes it suitable for cross-national and cross-disciplinary comparisons in medical education.
The questionnaire includes 26 statements addressing the importance of communication skills in professional practice, evaluated on a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). It is divided into 2 subscales: the Positive Affect Scale (PAS) and the Negative Affect Scale (NAS), each containing 13 statements. Responses are scored by summing the PAS items and the reverse-scored NAS items, resulting in a maximum possible score of 130 points.
In this study, the survey examined various aspects of communication skills among physicians in Poland. Key areas included whether physicians view communication as a crucial tool in their professional work and if they believe strong communication skills are essential for being a good doctor. The questionnaire explored their interest in developing communication skills, considering them as vital as expanding professional knowledge.
Additional items assessed physicians’ willingness to dedicate time to learning communication skills and whether they found such learning engaging. Respondents were also asked if they had initially regarded learning communication skills as a good idea when they began their medical training. Furthermore, the survey included statements about the challenges of admitting problems with one’s communication skills and whether prioritizing communication training for psychology students over medical students was appropriate.
By leveraging this comprehensive approach, the study provided nuanced insights into physicians’ attitudes toward learning communication skills, highlighting potential areas for enhancing communication training programs to better meet the needs of medical professionals.
Respondents also completed a demographic section, providing information on key sociodemographic characteristics, such as age, sex, education, marital status, and place of residence. This information enabled an analysis of the relationships between sociodemographic variables, professional background, and attitudes toward communication skills training among physicians.
STUDY SIZE:
The sample size was calculated based on the total number of physicians with a valid medical license who have not yet obtained a specialization, namely residents. The data on the number of physicians was obtained from the Signal Information of the Central Statistical Office of Poland dated November 22, 2022 [20]. The population of physicians meeting the criteria above amounted to 52 733. The sample size was calculated assuming a 95% confidence interval, a 5% margin of error, and a fraction of 0.5. The calculations were performed using a calculator available at https://www.naukowiec.org/dobor.html [21]. As a result of this analysis, the minimum required sample size was determined to be 381 respondents.
STATISTICAL ANALYSIS:
For data analysis, responses from the CSAS were scored using standard procedures. Scores for the PAS and NAS were calculated separately, with NAS responses reverse-scored before summing. Descriptive statistics were generated to summarize participant demographics and attitudes.
The analysis of the results from individual questions involved recoding and summing responses according to a predetermined key. All assumptions for statistical tests were thoroughly checked before analysis. Statistical tests were used, including
Results
CHARACTERISTICS OF THE STUDY GROUP:
The participants were diverse in terms of age, sex, marital status, place of residence, professional experience, specialization, and workplace. The largest group consisted of young doctors under the age of 30 years, representing 55.50% (237 people), indicating a significant involvement of the younger generation in the study. Women dominated the study population, accounting for almost 70% (297 people) of the respondents.
Most participants (63%) were married or in a partnership. Regarding residence, the majority lived in very large cities (39.11%), while only 8.20% resided in rural areas. Most respondents had up to 5 years of professional experience (65.81%), highlighting the involvement of early-career doctors. A similar trend was observed for workplace location, with most working in large cities. The most common specializations were internal medicine (15.46%), family medicine (9.84%), and pediatrics (8.90%).
PAS RESULTS:
Women achieved an average PAS score of 52.53 (SD=8.65), while men scored 50.65 (SD=9.74), indicating significantly more positive attitudes toward learning communication skills among women
Physicians with less than 5 years of experience had a mean PAS score of 51.63 (SD=8.87), while those with 5 to 10 years of experience had a mean PAS score of 51.05 (SD=10.84). Physicians with 11 to 20 years of experience had a mean PAS score of 54.06 (SD=6.73), and those with more than 20 years of experience had a mean PAS score of 54.68 (SD=7.67). These differences were not statistically significant (P=0.124). Analysis of PAS scores in the context of the respondents’ workplace also revealed minimal differences that were not statistically significant (Table 1). The analysis of PAS results in the context of specialization showed different attitudes toward learning communication skills.
NAS RESULTS:
Women achieved an average NAS score of 45.83 (SD=7.46), while men scored 44.48 (SD=7.56), although these differences were not statistically significant. In terms of age, NAS scores were as follows: under 30 years, M=45.19, SD=6.47); 31–40 years, M=44.68, SD=8.70; 41–50 years, M=49.85, SD=7.38; and over 50 years, M=48.27, SD=7.67. These differences were statistically significant
PROFESSIONAL EXPERIENCE:
Physicians with less than 5 years of experience had a mean NAS score of 45.35 (SD=7.07), while those with 5 to 10 years of experience had a mean of 43.79 (SD=8.72). Physicians with 11 to 20 years of experience had a mean of 46.33 (SD=7.26), and those with more than 20 years of experience had a mean of 49.95 (SD=7.36). These differences were statistically significant (P=0.006), indicating more frequent negative attitudes among physicians with longer professional experience. Analysis of NAS scores in the context of the respondents’ workplace, similarly to the PAS scale, showed minimal and insignificant differences (Table 2).
CSAS RESULTS:
The analysis of CSAS scores revealed sex differences in attitudes toward learning communication skills. Women achieved an average CSAS score of 98.36 (SD=14.28), while men had an average score of 95.13 (SD=15.56;
Respondents with more professional experience showed more positive attitudes toward learning communication skills. The highest mean CSAS values were achieved by physicians with more than 20 years of experience (M=104.64, SD=13.34) and those with 11 to 20 years of experience (M=100.40, SD=11.52). Physicians with up to 5 years of experience had a mean CSAS value of 96.98 (SD=14.01), and those with 5 to 10 years of experience had a mean CSAS value of 94.84 (SD=18.43,
Analysis of CSAS scores in the context of respondents’ workplace revealed minimal differences. Physicians working in primary health care had a mean CSAS score of 97.51 (SD=14.93), while respondents not working in primary health care had a mean CSAS score of 97.33 (SD=14.70). In outpatient specialist care (AOS), mean CSAS scores were similar between those working in outpatient specialist care (M=96.96, SD=14.40) and those not working in outpatient specialist care (M=97.43, SD=14.80). Respondents working in the emergency department had a mean CSAS score of 98.15 (SD=14.19), while those not working in emergency department had a mean CSAS score of 97.30 (SD=14.81). In the case of working in hospitals, respondents who worked in hospitals had a mean CSAS score of 97.32 (SD=13.87), while those who did not work in hospitals had a mean score of 97.59 (SD=17.70). Overall, these differences were minimal and not statistically significant; no statistically significant differences were observed (Table 3).
Analysis of CSAS scores in the context of specialization revealed significant variation. The highest mean CSAS scores were achieved by specialists in laboratory diagnostics (M=118), pediatric surgery (M=111), geriatrics (M=110), and cardiac surgery and medical rehabilitation (M=108). High scores were also noted in diabetology (M=107), dermatology and venereology (M=106.25), vascular surgery (M=106), and conservative dentistry with endodontics (M=106.67). Lower mean CSAS scores were noted in gastroenterology (M=66), thoracic surgery (M=75), forensic medicine (M=68), and rheumatology (M=79).
Discussion
STUDY LIMITATIONS:
Despite efforts to gather comprehensive data, the study can be subject to several biases. One potential source of bias is selection bias, as the sample was drawn exclusively from physicians participating in mandatory courses organized by the Centre of Postgraduate Medical Education in Poland. This specific group may have different attitudes toward communication skills than do physicians not engaged in these courses. Additionally, since the survey was offered as an optional component, there may have been self-selection bias, with only those particularly interested in communication skills choosing to respond. This could lead to an overrepresentation of participants with positive attitudes toward communication training. Furthermore, the reliance on self-reported data could introduce response bias, as participants might provide socially desirable answers rather than their true opinions. These factors should be considered when interpreting the findings, as they can influence the generalizability of the results to the broader population of physicians.
Conclusions
The conducted study highlights the diverse attitudes of Polish doctors toward learning communication skills and emphasizes the influence of sociodemographic factors on these attitudes. The findings suggest the need for a tailored and differentiated approach to communication education among physicians, addressing variations in sex, marital status, and professional experience.
To increase the effectiveness of communication training programs, special attention should be directed toward groups that may face barriers to engagement, such as men and physicians with longer professional experience, who were identified as less open to formal communication training. These programs should be customized to meet the unique challenges and needs of each group, fostering greater participation and acceptance.
Further research should explore the underlying reasons for differences in attitudes across medical specialties and investigate interventions that can address negative perceptions of communication training. Additionally, evaluating the long-term impact of tailored communication programs on clinical practice and patient outcomes will provide valuable insights for improving medical education.
By addressing the specific needs of diverse physician groups, communication training can become a more effective tool for enhancing doctor-patient relationships and improving the quality of healthcare delivery.
Tables
Table 1. Positive Attitude Scale score according to sociodemographic and professional variables.
Table 2. Negative Attitude Scale score according to sociodemographic and professional variables.
Table 3. Communication Skills Attitude Scale score acording to sociodemographic and professional variables.
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