The relationship between final year medical students' attachment style and their responses to patient emotion in clinical consultation

Background: Doctor-patient communication influences patients’ health through direct and/or mediated routes, with clinical communication integrated into the teaching and assessment of medical students. Despite this, the field lacks a strong theoretical framework. Attachment theory is psychological theory that offers insight into why some students struggle with clinical communication in patient consultations.
Aim: To explore the relationship between final year medical students’ attachment-orientation (attachment-avoidance and attachment anxiety) and their clinical communication skills (proportion of facilitative responses to patient emotion) in the clinical setting (primary care).
Procedures: The study provided an analysis of the influence of attachment-orientation on clinical communication with a sample of final year medical students (n = 37) in the clinical setting (primary care). Each medical student was videoed in several patient consultations (n =138) in primary care. The purpose of this videoing was to code patients’ expressions of emotion and medical students’ associated responses to that emotion using the Verona Coding Definition of Emotional Sequences. Medical student attachment-orientation was assessed using the Relationship Styles Questionnaire.
Results Attachment-orientation (attachment-avoidance and attachment anxiety) influenced final year medical students’ clinical communication. That is, attachment-avoidance (r = -0.50, p =.002) and attachment-anxiety (r = -0.41, p =.012) were significantly and negatively related to the proportion of facilitative responses to patient emotion in clinical consultations (primary care). The r² value was 0.25 for attachment-avoidance, indicating that attachment-avoidance accounted for 25% of the variance in their responses to patient emotion. The r² value of 0.168 for attachment-anxiety indicated that attachment-anxiety accounted for 16.8% of the variance in their responses to patient emotion.

Conclusions/Implications: Attachment-orientation was influential and activated in authentic clinical environments such as primary care. It is important that medical students develop an understanding of attachment theory to explain individual differences in patient expression of emotion and their associated responses in clinical consultations.