What Shapes Medical Students' Engagement With Communication Skills Learning in Tabuk- Saudi Arabia: A Cross-Sectional CSAS-Based Study.

Abstract

Purpose: To examine the Communication Skills Attitude Scale (CSAS) framework as a way to identify factors associated with medical students' attitudinal engagement with communication skills training (CST) at the University of Tabuk, Saudi Arabia. To assess positive attitudes (Positive Attitude Scale; PAS) and negative attitudes (Negative Attitude Scale; NAS), and explore their associations with demographic and academic characteristics, compared attitudes across all six Bachelor of Medicine and Bachelor of Surgery (MBBS) years, and tested their associations with an attitudinal Engagement Index (EI).

Methods: A quantitative cross-sectional survey was conducted during the 2023-2024 academic year among undergraduate MBBS students. A convenience sample of 179 students completed the validated 26-item CSAS. The EI was calculated as PAS minus NAS and should be interpreted as an attitudinal proxy for engagement rather than a direct measure of observable learning behaviour. Descriptive statistics, reliability testing, paired and independent-samples t tests, and one-way analysis of variance (ANOVA) with Tukey post-hoc testing were used.

Results: PAS scores (mean 49.23, SD 6.89) were significantly higher than NAS scores (mean 37.42, SD 7.15; p<0.001). Female students had higher PAS and EI scores than male students. Academic-year differences were evident, with a marked decline in the fourth year. Because EI was mathematically derived from PAS and NAS (EI=PAS-NAS), PAS and NAS were not retained as independent predictors of EI in a regression model; EI was interpreted descriptively and through demographic and academic-year comparisons.

Conclusion: Negative attitudes toward CST were strongly associated with lower attitudinal engagement. The transition into clinically intensive learning, particularly the fourth year, appears to be a vulnerable period. Curriculum strategies should therefore address negative stereotypes about communication skills, explicitly connect CST to clinical reasoning and assessment, and provide visible role modelling in the clinical learning environment.