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Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 117-119

Communications Skills Training – A Missing Link in Medical Education Curriculum

1 Indian Institute of Healthcare Communication, New Delhi, India
2 Editor in Chief, MAMCJMS; Director Professor of Surgery, Head of Clinical Skills Centre, Maulana Azad Medical College, New Delhi, India

Date of Web Publication24-Oct-2017

Correspondence Address:
Indu Arneja
Indian Institute of Healthcare Communication, New Delhi, Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mamcjms.mamcjms_70_17

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How to cite this article:
Arneja I, Lal P. Communications Skills Training – A Missing Link in Medical Education Curriculum. MAMC J Med Sci 2017;3:117-9

How to cite this URL:
Arneja I, Lal P. Communications Skills Training – A Missing Link in Medical Education Curriculum. MAMC J Med Sci [serial online] 2017 [cited 2021 Sep 16];3:117-9. Available from: https://www.mamcjms.in/text.asp?2017/3/3/117/217130

The practice of Medicine was much simpler and easier earlier, because patients had a lot of faith in this profession, to the extent that they compared doctors with God. With the changing times, the relationship, which was based on empathy and trust, has undergone a drastic change that has led to mistrust, dissatisfaction and aggressive reactions. Good doctor–patient communication is central to therapeutic relationship and patient satisfaction. Institute of Medicine in its report on ‘education in healthcare profession’ identified that clinicians and other healthcare professionals lack adequate soft skills training.[1]

Effective communication is the heart and soul of treatment accuracy and patient safety. It is an important determinant of quality health outcome. Communication failure is the main cause of medical errors leading to life-threatening consequences. According to Joint Commission International, medical errors are the fifth most common cause of deaths in US.[2] Another report by Joint Commission International reveals that 80% of the serious medical errors are due to communication failure.[3] Medical errors, inaccurate diagnosis, inaccurate treatment, compromised patient safety and patient non-compliance are some of the immediate results of poor communication. Patients and their family have queries, ideas, expectations and concerns that need to be addressed by the treating team. When the attending doctor is not able to address these issues, it leads to dissatisfaction and resentment. The impact of inaccurate and insufficient communication is clearly visible in the recent increase in the number of aggressive reactions and assaults on the doctors all across the country.

Various studies all across the world indicate that patients have different psycho-social needs, and tailoring the communication to the patients’ requirements is essential.[4],[5] Communicating the key points during each step of the patient’s treatment is now considered to be an essential criterion for good medical practice and improves the job satisfaction of doctors.[6] The benefits of communicating appropriately in the setting of clinical oncology have reported improved treatment adherence and better psychological performance by patients.[7]

Communication skills are the basic skills needed not only for patient care but also for the medical education and training. Communication ability is one of the essential skills required to be a physician besides other skills such as intellectual, conceptual and observation skills. The students desirous of getting admission in medical colleges in Western world are assessed for their communication skills. The teaching and assessment of clinical communication is the central component of undergraduate medical education in the United Kingdom.[8],[9],[10],[11],[12] Currently in the US, the communication and interpersonal skills of the physician-in-training are no longer viewed as personal styles that emerge during residency but, instead, as a set of measurable and modifiable behaviours that can evolve. On the basis of emerging literature on the value of effective communication, medical students and postgraduates are increasingly given instruction on techniques for listening, explaining, questioning, counseling and motivating. As such, techniques are central to delivering a full and tailored health prescription and as many as 65% of the medical schools now teach communications skills as a subject.[13] Training in patient–physician communication is also nowadays objectively evaluated as a core competency in various accreditation settings, including the Comprehensive Osteopathic Medical Licensing Examination – USA, the United States Medical Licensing Examination and the American Board of Medical Specialties’ certification.[14],[15],[16]

Incidentally, medical education curriculum in India is tubular in approach, because it focuses majorly on the clinical skills of the medical students, whereas to deal with patients and to work as a team, one requires a different set of skills – communication skills, interpersonal skills and management skills, usually referred to as non-technical skills. Most of the medical education programs do not address these skills. The course curriculum of premier institutes in India or the medical colleges under the Medical Council of India (MCI) do not explicitly incorporate communication skills training as a part of the medical education or assessment criterion. The lack of communication skills training and the inability of people to communicate effectively cause a large amount of stress, frustration, anger, resentment, misunderstanding and disappointment.[17] This is what has led to increased conflict in healthcare. It is heartening to see that Clinical Skills Centre at Maulana Azad Medical College (MAMC) has introduced communication skills courses for the final year medical students and for the first year postgraduates at the level of the institution itself for the past 2 years and plan to start these at the beginning of the clinical posting in the third and fourth semester of MBBS.

In view of the changing needs of the healthcare scenario, it is important to work on the communication skills of the medical practitioners. Doctors and other healthcare providers need to proactively meet the communication needs of the patient and their family. This will not only ensure accuracy of diagnosis, treatment, patient safety and continuity of care but will also create greater patient satisfactions.

It is time that we seriously include communication skills training in the medical teaching curriculum and have the assessment of communication ability as part and parcel of examination system. Medical graduates need to be prepared for various communication skills such as conducting patient interview, information sharing with the patient, documentation, practicing informed decision making, handing over protocols, updating the family of critically ill patients, breaking bad news, practicing empathy, gratitude towards patient for allowing to practice, positive attitude towards patient and their family, respecting patient’s right to be treated with respect and care, valuing patient’s time, examining the patient with respect and care, respecting patient’s right to privacy, responding to patient’s emotions appropriately, understanding patient’s perspective and demonstrating sensitivity to patient’s preferences and concerns and many more.

Fortunately, these skills can be inculcated and learnt. There are certain protocols such as updating the family of critically ill, breaking bad news and handing over that can be learnt and put in practice to prevent errors and improve health outcome.

MCI has taken an initiative to include communication training for the medical students in the form of attitude and communication module (ATCOM, July 2015) that was introduced in medical colleges all across the country. This module has received a mixed response as the responsibility of delivering the content has been given to the existing faculty and there is no evaluation linking it to successful completion of the module for onward progression in the semesters. The mere introduction of ATCOM will not serve the purpose; we have a long road ahead towards implementing competency based medical education (CBME) and ensuring sustainability, the principal responsibility of which lies on the shoulders of medical school leaders.[18] Because the competency-based training program and assessment methods differ in many ways from the traditional curriculum, it is crucial to sensitize and prepare the faculty for this change. Though faculty development is gaining momentum in India through Medical Education Units in some colleges, but this is yet to be materialized in most of the institutions.[19] The next important challenge is to change the student’s attitude towards medical education from the mere internalization of knowledge and score marks to adopting finer ATCOM skills to deliver quality medical care. This is also a tremendous task to change the behaviour of medical students in the four and half year tenure of medical course. Assigning marks or grades with equal weightage for the assessment of competence acquisition in all the domains of CBME can play a key role in shaping the outcomes and success of the curriculum and hence assessment tools must be carefully planned.[18]

ATCOM is a long-term intervention, but the situation needs to be dealt at war footing and therefore we need to come up with short courses on communication skills enhancement for the students passing out in the next few years in the pattern of MAMC and also for the postgraduates and senior residents where we can inculcate some basic and some advance level communication skills among the existing medical professionals. Senior medical professionals need to respond to the changing scenario and proactively inculcate communication and interpersonal skills among their juniors and students.

  References Top

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James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Safety 2013;9:122-8.  Back to cited text no. 2
Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. JCI Resource; 2012.  Back to cited text no. 3
Parker PA, Baile WF, de Moor C, Lenzi R, Kudelka AP, Cohen L. Breaking bad news about cancer: Patients’ preferences for communication. J Clin Oncol 2001;19:2049-56.  Back to cited text no. 4
Hack TF, Degner LF, Parker PA. The communication goals and needs of cancer patients: A review. Psychooncology 2005;14:831-45.  Back to cited text no. 5
Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002;325:687-700.  Back to cited text no. 6
Arora NK. Interacting with cancer patients: The significance of physicians’ communication behavior. Soc Sci Med 2003;57:791-806.  Back to cited text no. 7
General Medical Council. Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education. London: GMC; 2003. p. 1-40.  Back to cited text no. 8
Simpson JG, Furnace J, Crosby J, Cumming AD, Evans PA, Friedman Ben David M et al. The Scottish doctor – Learning outcomes for the medical undergraduate in Scotland: A foundation for competent and reflective practitioners. Med Teach 2002;24:136-43.  Back to cited text no. 9
British Medical Association. Communication Skills Education for Doctors: A Discussion Document. London: BMJ; 2003.  Back to cited text no. 10
Department of Health. Statement of Guiding Principles Relating to the Commissioning and Provision of Communication Skills Training in Pre-Registration and Undergraduate Education for Healthcare Professionals. London: DoH; 2003. p. 1-15.  Back to cited text no. 11
Department of Health. Medical Schools: Delivering the Doctors of the Future. London: DoH; 2004. p. 1–32.  Back to cited text no. 12
Kalet A, Pugnaire MP, Cole-Kelly K, Janicik R, Ferrara E, Schwartz MD et al. Teaching communication in clinical clerkships: Models from the Macy Initiative in Health Communications. Acad Med 2004;79:511-20.  Back to cited text no. 13
Duffy FD, Gordon GH, Whelan G, Cole-Kelly K, Frankel R, Buffone N et al. Assessing competence in communication and interpersonal skills: The Kalamazoo II report. Acad Med 2004;79:495-507.  Back to cited text no. 14
Gimpel JR, Boulet DO, Errichetti AM. Evaluating the clinical skills of osteopathic medical students. J Am Osteopath Assoc 2003;103:267-79.  Back to cited text no. 15
Makoul G. MSJAMA. Communication skills education in medical school and beyond. JAMA 2003;289:93.  Back to cited text no. 16
Richard D. Communicate to Win. 2nd ed. Kogan Page India Private Ltd.; 2006. ISBN: 0749444355.  Back to cited text no. 17
Mitra J, Saha I. Attitude and communication module in medical curriculum: Rationality and challenges. Indian J Public Health 2016;60:95-8.  Back to cited text no. 18
[PUBMED]  [Full text]  
Vinod Kumar CS, Kalasuramath S, Kumar CS, Jayasimha VL, Shashikala P. The need of attitude and communication competencies in medical education in India. J Educ Res Med Teach 2015;3:1-4.  Back to cited text no. 19

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