Open Access Open Badges Research article

Writing letters to patients as an educational tool for medical students

Nataša Mrduljaš Đujić1, Edi Žitnik2, Ljubica Pavelin1, Dubravka Bačić1, Mia Boljat1, Davorka Vrdoljak1, Ivančica Pavličević1, Ana Radica Dvornik3, Ana Marušić4* and Matko Marušić4

Author affiliations

1 Department of Family Medicine, University of Split School of Medicine, Šoltanska 2, Split 21000, Croatia

2 ‘Mi’ Association and ‘Kajo Dadic’ Foundation Split, Split, Croatia

3 Croatian Institute for Pension Insurance, Split, Croatia

4 Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia

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Citation and License

BMC Medical Education 2013, 13:114  doi:10.1186/1472-6920-13-114

Published: 23 August 2013



Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine.


The study included all 6th year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 – poor, 1 – medium, 2 – good) for 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis.


Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category “Technical terms unclear to a lay reader”.


Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care.

Doctor-patient communication; Student-patient relationship; Letter to patient; Family medicine