Learning communication before patient encounters: everyday relational reflections as precursors to professional communication judgment

Background Medical schools commonly teach communication through clinical interviews, standardized patients, and assessment rubrics. These approaches make communication teachable and assessable, but may frame it as a set of behaviors to perform rather than as situated judgment about what a given interaction requires. This study examined how first-year medical students interpreted communication in reflections on ordinary, non-clinical relationships, and how these interpretations related to developmental precursors of professional communication judgment before patient encounters. Methods We analyzed 692 written reflections from 173 first-year students in a required course at Hanyang University College of Medicine, South Korea, of which 688 contained analyzable narrative content, using framework-informed thematic analysis. Students responded to four prompts concerning communication in family or friendship relationships, listening and empathy, nonverbal habits, and emotion regulation. Because the prompts structured the domains in which reflection could occur, the analysis focused on the interpretive patterns that appeared within and across those domains rather than on the domains themselves. All coding was conducted in Korean. The Kalamazoo Consensus Statement was used as a sensitizing framework rather than a coding template. Trustworthiness was supported through independent coding, consensus discussion, investigator and analytic triangulation, reflexive memoing, an explicit search for divergent and less interpretively developed responses, and bilingual review of translated quotations. Results Five themes described how students interpreted what a given situation required: recognizing ambiguity and the limits of assumed understanding; validating emotion before giving advice; interpreting nonverbal behavior through the other person's response; regulating emotion to sustain dialogue; and re-engaging after communication breakdown. Several themes appeared beyond the prompts that most directly elicited them. Re-engagement after communication breakdown, for which no dedicated prompt existed, appeared across all four prompts (139 responses from 100 students; P1/P2/P3/P4 = 53/22/10/54). Responses varied considerably in interpretive development: 290 of 688 substantive responses (42.2%) were primarily descriptive, whereas 398 (57.8%) showed interpretive reconstruction. Conclusions The reflections provided evidence of several patterned ways in which students interpreted communication as context dependent. These patterns may represent developmental resources that communication education can further examine and reorganize in clinical contexts, rather than evidence of professional communication judgment itself.