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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 108-113

Effect of teaching communication skills to medical undergraduate students: An exploratory study


1 Department of Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
2 Department of Community Medicine, J. N. Medical College, KAHER, Belagavi, Karnataka, India

Date of Submission05-Aug-2019
Date of Decision03-Oct-2019
Date of Acceptance16-Oct-2019
Date of Web Publication19-Dec-2019

Correspondence Address:
Rakesh K Nayak
Department of Community Medicine, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCFM.IJCFM_66_19

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  Abstract 

Introduction: Good communication skills are an essential component of physician training. Effective communication between the doctor and the patient leads to better compliance, better health outcomes, decreased litigation, and higher satisfaction both for doctors and patients. Traditional medical teaching imparts students with theoretical and practical knowledge of diseases process, diagnostic and treatment modalities but does not address communication skills, which are most essential in dealing with patients.
Material and Methods: The present randomized control study was conducted in a Medical College of North Karnataka. A total of 60 students participated who were randomly assigned into two groups. Attitude toward learning communication skill was assessed using the Communication Skills Attitude Scale (CSAS). Pre- and post-assessment of communication skill was done using the Kalamazoo Essential Elements Communication Checklist.
Results: All the study participants (n = 60) were 3rd-year MBBS students with the mean age of 21 ± 1.8 years. The CSAS median score for positive attitude was 57.5 and for negative attitude was 25 (minimum score = 13 and maximum score = 65). Significant difference was noted in the study group after training in communication skills (P < 0.01) compared to the control.
Conclusion: Adequate training in communication does improve the skills of medical students and help in better relationship with patients.

Keywords: Communication skills, communication skills attitude scale, Kalamazoo Essential Element Communication Checklist, medical students


How to cite this article:
Nayak RK, Kadeangadi DM. Effect of teaching communication skills to medical undergraduate students: An exploratory study. Indian J Community Fam Med 2019;5:108-13

How to cite this URL:
Nayak RK, Kadeangadi DM. Effect of teaching communication skills to medical undergraduate students: An exploratory study. Indian J Community Fam Med [serial online] 2019 [cited 2020 Apr 2];5:108-13. Available from: http://www.ijcfm.org/text.asp?2019/5/2/108/273531


  Introduction Top


Good communication skills are one of the essential components of physician training. Effective communication between the doctor and the patient is necessary for better treatment compliance, better health outcomes, and higher satisfaction both for doctors and patients. It is crucial for doctors to have active listening skills so as to gather information effectively and also to handle emotions of patients actively. At the same time, it is important to demonstrate empathy, rapport, ethical awareness, and professionalism. Teaching good communication skills can also improve diagnostic efficiency and decision-making ability resulting in lower rates of complaints and malpractice claims.[1]

In the past, many litigations against doctors have been reported because of lack of communication skills. Patients appreciate physicians who listen actively, encourage them to ask clarifying questions, understand and value their privacy and comfort. Proper body language, facial expression, touch, gestures, and interpersonal distance are some of the nonverbal aspects which are of extreme importance in building rapport between the doctor and the patient.

Many students do not realize the importance or understand the need for learning and developing communication skills as a part of their course. Teachers have now realized the importance of teaching and imparting communication skills.[2] Medical trainees imbibe basic communication skills consciously or subconsciously during their internship by observing their peers and senior colleagues, but these skills may not be adequate to exhibit good communication in their professional careers.[3] The Medical Council of India Vision statement 2015 also stresses the need to include communication skills in the 1st year MBBS along with other basic clinical skills and professionalism.[4] Traditional medical teaching imparts medical students with theoretical and practical knowledge of diseases processes and gives them education about diagnostic and treatment modalities but does not address communication skills, which are most essential in dealing with patients.[5]

Studies on teaching and learning communication skills in medical students are very few. It is hence very important to explore the needs of students, outline the objectives and the modalities of communication skill training. Hence, the present study was conducted to assess the attitude of medical students towards learning communication skills and to assess the effect of inclusion of an appropriate communication skills course in the undergraduate medical curriculum.


  Material and Methods Top


The present randomized control study was conducted in a Medical College of North Karnataka. Undergraduate students belonging to 3rd year MBBS course were included in the study. The reason for selecting the 3rd year MBBS students was that these students would have just started with their clinical postings and this type of training would benefit them in performing better in clinical case taking. Of the total 97 students studying in 3rd year, only 62 students gave consent to participate in the study. Of these, 2 students were absent during the main study giving a total sample of 60. The sample included both boys and girls. It was ensured that all 60 students were present till the end of the training. The training sessions were clubbed with medicosocial case discussion classes in community medicine and care was taken that the regular classes were not hampered. No extra classes were conducted. The study was conducted over a period of 3 months from July to September 2018. Attitude toward learning communication skill was assessed using Communication Skills Attitude Scale (CSAS) developed by Rees et al.[6] CSAS consists of 26 items, of which 13 are positive attitude statements (PASs) and 13 negative attitude statement (NAS) which are inter mingled. Each item is scored on Likert's scale with 5 responses (1 - strongly disagree and 5 - strongly agree). Minimum and maximum possible scores thus were 13–65 for both positive and negative questions. Higher scores in both indicate strong attitude either positive or negative towards learning communication skills. The CSAS is a validated tool and has a Cronbach's alpha value of 0.862 for the PAS and 0.565 for the NAS.[7] The CSAS scale was distributed after the medico-social case discussion classes after taking written informed consent from all the students. The students were then randomly assigned into two groups of thirty students each. Randomization was done by the authors using the random number table. Single blinding technique was followed and the participants were unaware about which group they belonged to. For the control group, a lecture of 1 h duration was delivered regarding the importance of communication skills in doctor patient relationship. The study group was exposed to a short communication skill course of 5 days (1 h each day) duration consisting of lecture, role play, and feedback [Table 1]. The role play was performed by the students with preliminary training. The content of the role play included patient history taking and counseling skills. Feedback was given by other students in the group. Pre- and post-assessment of communication skills was done in both the study and control groups using Kalamazoo Essential Elements Communication Checklist (KEECC). The KEECC has a Cronbach's alpha value of 0.89, signaling high internal consistency and reliability across items.[8] The KEECC is a seven-item rating scale with each item corresponding to the essential elements of physician communication. The ratings are made on a 3-point Likert scale (2-well done, 1-needs improvement, 0-not done). Responses to the seven items were summed up to provide a total communication score, the higher scores representing good communication skill and lower scores poor communication skill. Pre- and post-scores were also compared in the control group, and the difference in the study and control groups was noted. Ethical Clearance was obtained from the Institutional Ethics Committee for human research before data collection.
Table 1: Schedule for communication training program for UG medical students

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Statistical analysis

The data obtained were entered and analyzed in SPSS statistical software 22 developed by IBM Corporation, India trial version. P < 0.05 was considered as statistically significant. The median scores of CSAS subscales were compared, and t-test was done to determine statistically significant differences between both the groups.


  Results Top


All the study participants (n = 60) were 3rd-year MBBS undergraduate students with the mean age of 21 ± 1.8 years. Among the 60 students, the median score for positive attitude was 57.5 and the median score for negative attitude was 25 [Table 2]. The higher positive score indicates that all students have positive attitude toward learning communication skills. Positive and negative questions are shown separately in [Figure 1] and [Figure 2].[9] Among the positive scores, the lowest positive attitudes were expressed in item 22 (My ability to pass exams will get me through medical school rather than my ability to communicate).
Table 2: List of questions in the Communication Skills Attitude Scale

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Figure 1: Bar chart showing only the positive questions in the Communication Skills Attitude Scale with the corresponding Likert score (n = 60)

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Figure 2: Bar chart showing only the negative questions in the Communication Skills Attitude Scale and the corresponding Likert score (n = 60)

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[Table 3] shows the pre- and post-assessment scores by Kalamazoo Essential Elements Checklist. The study group performed extremely well after the short course in communication skill training. The students performed better in building a relationship and opening the discussion with the patient. Gathering information and understanding the patient's perspective also improved in the posttest assessment. Significant difference was noted in the pre- and post-scores for sharing information with the patient and providing an appropriate closure to the discussion. None of the students in both groups were aware about the closure component in communication. No much change was noticed in the control group for each of these components. The total median score in the study group before the intervention was 9 which was improved to 40 after the communication skills training was imparted. This difference was statistically significant (P < 0.05). The t-test showed no difference in score for the control group (P = 0.328).
Table 3: Comparison between pre- and post-scores by Kalamazoo Essential Elements Checklist in both groups (n=30)

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  Discussion Top


The present study showed an increased positive attitude and decreased negative attitude towards learning communication skills which was similar to a study done in Saudi Arabia (PAS – 52 vs. NAS – 34.5).[10],[11]

A study done by Wright et al., which compared the attitudes in 1st -and 4th-year students, found that that 4th-year medical students did not differ much from 1st-year medical students in terms of attitudes toward communication skills training, but they had significantly higher confidence scores about communicating with patients.[12] This study indicates that the positive attitude increased by perceived relevance of the skills by the students.[9] In the present study, the subjects were 3rd-year students, and we found that a significantly higher number of students had a positive attitude toward learning communication skills. This may be due to the fact that these students were in contact with the patients during clinical posting and began to understand the importance of effective communication skills in patient care.

Haq et al. describe the content and methods used to teach communication skills to medical students. Suggested curriculum projects should be designed to improve medical students' communication skills during the undergraduate years, which they can refine and practice throughout the MBBS course and later.[13] The present study was designed to understand the utility of teaching communication skills to medical students. The most effective point in time to learn these at medical school is probably during the clinical posting. After a short training, doctors can be as effective as teachers.[14] We tried to focus our training courses for the 3rd-year medical students and found that these skills can be taught and learned and practiced to improve clinical competence. The training in our teaching module was done by faculty doctors. Medical students' interpersonal and communication skills are a fundamental dimension of their clinical competence.[15]

In this study, we found that students' skills and confidence in communicating with patients increased after training. Yedidia et al. studied the effect of communications training on medical students' performance and concluded that communications curricula using an established educational model not only improved the 3rdyear medical students' overall communications competence, but also their skills in relationship building, organization, time management, patient assessment and clinical competence.[16] These findings were similar to our observations. In a study done by Joekes et al., where students received a curriculum that included communication skills training integrated into a “professional development” vertical module, noticed that students receiving the professional development training showed significant improvements in certain communication skills and achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant, compared to students receiving the traditional curriculum.[17] We observed a similar increase in the use of verbal and nonverbal communication skills by our students after the training.

Deveugele et al. in their efforts to teach communication skills to medical students used various methods like group discussions in small groups (10–15 students), with focus on role playing with colleagues and simulated patients and showing videotapes of real consultations etc., observed a positive effect in the communication skills of students.[18] Karlberg and Lindgren incorporated a continuous and structured training in communication skills during the early phase of medical studies. As a result of these programs, they noticed significantly higher satisfaction in medical encounters among patients. These results agree with our findings in which lectures, role plays and feedback were used as teaching methods.[19] Based on our observations, it was found that there is a utility of communications skills training in the formative years. These soft skills can be imparted to medical students by the faculty, practiced to increase competency, used to build doctor–patient relationships and enhance health outcomes.[20]


  Conclusion Top


Undergraduate medical students had a strong positive attitude toward learning communication skills in our study. Levels of knowledge and confidence among medical students were found low in communicating with patients as assessed by the pretest questionnaire. Intervention done in the form of teaching communication skills had helped medical students understand the importance of communication and complexity of communication issues in health care as assessed by the posttest questionnaire.

It is recommended that communication skills training programs be designed and incorporated into the curriculum of MBBS program so that medical students learn as well as pay more attention to communication skills. Inculcating habits of good communication skills during formative years will help the medical students and future practitioners. Communication skills' training during formative years is a positive investment for the better future health of the society. Regular courses on effective communication should be included in the medical school curriculum.

Acknowledgment

Authors would like to thank the Medical Director, the Principal and the Head of Department, Community Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka for providing permission and administrative assistance to conduct the study. Special thanks to all the 7th term medical students for their participation in the study and the faculty of the Department of Community Medicine for the cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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4.
Medical Council of India. Vision 2015. Medical Council of India; 2011. Available from: https://https://old.mciindia.org/tools/announcement/MCI_booklet.pdf. [Last accessed on 2018 Apr 17].  Back to cited text no. 4
    
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Rees C, Sheard C, Davies S. The development of a scale to measure medical students' attitudes towards communication skills learning: The Communication Skills Attitude Scale (CSAS). Med Educ 2002;36:141-7.  Back to cited text no. 6
    
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Baharudin N, Mohamed-Yassin M, Badlishah-Sham SF, Yusaf ZY, Ramli AS. Validation of the communication skills attitude scale (CSAS) questionnaire in a cohort of Malaysian medical students. J Clin Health Sci 2017;2:46-53.  Back to cited text no. 7
    
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Shetty AC, Rasheed NM. Attitudes of dental interns towards learning communication skills. J Appl Dent Med Sci 2017;69:338-45.  Back to cited text no. 11
    
12.
Wright KB, Bylund C, Ware J, Parker P, Query JL, Baile W. Medical student attitudes toward communication skills training and knowledge of appropriate provider-patient communication: A comparison of first-year and fourth-year medical students. Med Educ Online 2006;11:4594.  Back to cited text no. 12
    
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Haq C, Steele DJ, Marchand L, Seibert C, Brody D. Integrating the art and science of medical practice: Innovations in teaching medical communication skills. Fam Med 2004;36 Suppl: S43-50.  Back to cited text no. 13
    
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Aspegren K. BEME Guide No. 2: Teaching and learning communication skills in medicine-a review with quality grading of articles. Med Teach 1999;21:563-70.  Back to cited text no. 14
    
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Chessman AW, Blue AV, Gilbert GE, Carey M, Mainous AG 3rd. Assessing students' communication and interpersonal skills across evaluation settings. Fam Med 2003;35:643-8.  Back to cited text no. 15
    
16.
Yedidia MJ, Gillespie CC, Kachur E, Schwartz MD, Ockene J, Chepaitis AE, et al. Effect of communications training on medical student performance. JAMA 2003;290:1157-65.  Back to cited text no. 16
    
17.
Joekes K, Noble LM, Kubacki AM, Potts HW, Lloyd M. Does the inclusion of 'professional development' teaching improve medical students' communication skills? BMC Med Educ 2011;11:41.  Back to cited text no. 17
    
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Deveugele M, Derese A, De Maesschalck S, Willems S, Van Driel M, De Maeseneer J. Teaching communication skills to medical students, a challenge in the curriculum? Patient Educ Couns 2005;58:265-70.  Back to cited text no. 18
    
19.
Karlberg L, Lindgren C. Communication skills in the encounter with patients-current examination subject for medical students. Beneficial educational investment. Lakartidningen 2004;101:3072-4, 3076.  Back to cited text no. 19
    
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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