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Developing therapeutic rapport: a training validation study

Tim Norfolk, Kamaljit Birdi, Fiona Patterson

BackgroundPatient-centred consulting is at the heart of modern medicine, and training programmes now routinely highlight a range of communication skills that enhance the doctor–patient relationship. The present pilot study focuses on the central role played by empathic skills in developing rapport and shared understanding, as captured in a new model developed by the authors. The specific aim of the study was to evaluate the potential of a short-term training programme using this model to improve rapport-related behaviour in general practitioner (GP) trainees. MethodsIn a quasi-experimental study, 37 GP trainees from schemes in central England (the training group) participated in a training programme based around a new model of therapeutic rapport, with pre- and post-training analysis of relevant knowledge-based, affective and behavioural outcomes. A control group of ten GP trainees, from schemes in a comparable UK medical deanery, took no part in the training programme but were involved in all pre- and post-training analyses. ResultsThe training group demonstrated significant increases in rapport-related knowledge and all three affective dimensions (attitudes, confidence and motivation); there was a similar finding in terms of ‘positive engagement’ and all expert-rated aspects of rapport-related behaviours. The control group showed no comparable improvement in any area, and recorded a significant drop in demonstration of positive engagement behaviours. ConclusionsThe significant improvement in rapport-related knowledge, attitudes and behaviour after training, and the lack of any comparable change in the control group, gives some support to the suggestion that the module (and the model that underpinned it) may have triggered such an impact independent of ongoing experience or other educational activities.