|Year : 2019 | Volume
| Issue : 1 | Page : 22-25
Public forum by undergraduate medical students during clinical postings: A way to improve the communication skill
Sumedha Sharma, Aruna Nigam
Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
|Date of Submission||20-Dec-2018|
|Date of Acceptance||30-Dec-2018|
|Date of Web Publication||18-Feb-2019|
Dr. Aruna Nigam
Flat No. 6, Type 4 Quarters, Lady Hardinge Medical College Campus, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
Introduction: Excellent communication skills are essential to the practice of medicine as good doctor–patient communication is necessary to elicit information from the patient to arrive at an accurate diagnosis. Aim: The aim of this study was to assess the improvement in the communication skills of undergraduate medical students using public forum as a tool. Methodology: A total of 80 students of 5th-semester MBBS were invited to participate in public forum on the topic of “contraception.” Their communication skills were assessed using the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) assessment of communication skills tool. Each student performed four public forums over 2 months, one every fortnight. Each student delivered 15 min talk once in 2 weeks in front of a group of patients regarding the different contraceptive methods. The assessment of communication skill was done twice, i.e., they were assessed at the first and after the fourth public forum. Paired t-test was applied to assess the improvement in communication skill. Results: The mean score on RANZCOG assessment at the first public forum was 11.92 ± 3.89 and after the fourth public forum was 19.75 ± 6.13 (P < 0.00). An overall improvement in scores was 22.3%. There was a statistically significant improvement in the scores for all the points on the RANZCOG checklist. All the students felt more confident after the public forums. Conclusion: Involving students in small public forums (or patient education programs) helps in improving communication skills and can, in turn, be of great help improving the personality of the future medical professionals as well as in the development of better health-care providers.
Keywords: Communication, medical education, public forum
|How to cite this article:|
Sharma S, Nigam A. Public forum by undergraduate medical students during clinical postings: A way to improve the communication skill. Indian J Med Spec 2019;10:22-5
|How to cite this URL:|
Sharma S, Nigam A. Public forum by undergraduate medical students during clinical postings: A way to improve the communication skill. Indian J Med Spec [serial online] 2019 [cited 2019 Mar 20];10:22-5. Available from: http://www.ijms.in/text.asp?2019/10/1/22/252475
| Introduction|| |
Communication plays an important role in the field of medical sciences. Good doctor–patient communication is essential to elicit necessary information from the patient to arrive at an accurate diagnosis. Moreover, it also helps in ensuring better compliance with the treatment, provides better health outcomes, gives greater patient satisfaction, and decreases litigations.
The common barriers encountered by the medical students in establishing a good rapport with their patients include the inability to use simple language, inability to understand patient's native language, and excessive use of medical jargons/terminologies. Nonverbal communication is another aspect which plays an important role in establishing good doctor–patient relationship. The nonverbal communication includes eye contact, body language, and facial expressions.
The Western world is already stressing on development of good communication skills in the doctors. Even in India, its ever-increasing need is now being realized. Recently, the Medical Council of India in its “Vision 2015” (reforms for undergraduate and postgraduate training) has stated that clinical training should start early with emphasis on communication skills, and one of the roles that a doctor should fulfill is that of a good communicator with patient, families, colleagues, and community.
Keeping this in mind, the present study was planned as a pilot study, to assess improvement in the communication skills of undergraduate medical students using public forum as a tool.
Public forum is expressing ideas and views in front of a large audience. For public speaking, the speaker should have knowledge of the content or the message that is to be conveyed to the target audience, the best means to convey the message and should be able to make the session interactive. For medical students, this implies, having a good knowledge of the subject material, being able to convey the medical information to the audience in simple, plain language that the patients can comprehend and having the right body language which makes the patients have confidence in the speaker encouraging them to interact and clear their doubts. Public speaking also helps boost confidence in students. These skills would help medical graduates later in their careers.
There are many evaluation methods in medical school programs for the assessment of communication skills such as objective structured clinical examination, translating medical prescription, Kalamazoo consensus (Royal Australian and New Zealand College of Obstetricians and Gynaecologists [RANZCOG]), and the SEGUE framework. However, there is no universally accepted standard for the assessment of communication skills of undergraduate medical students. The RANZCOG assessment of communication skills (Kalamazoo Essential Elements Communication checklist) was initially designed to be used by training supervisors by RANZCOG. It provides an objective assessment of the trainee's communication skills and also helps in providing feedback to the trainee for the improvement of their communication skills.
| Methodology|| |
It was a cross-sectional study conducted over 8 months from January 2016 to August 2016 in the antenatal and postnatal wards of the Department of Obstetrics and Gynaecology of Hamdard Institute of Medical Sciences and Research and associated Hakeem Abdul Hameed Centenary hospital, New Delhi, India. The students of 5th-semester MBBS were invited to participate in public forum on the topic of “contraception” at the beginning of their clinical posting in gynecology. There were a total of 100 students in this semester with 20 students in each batch in a posting of 2 months. All the students of the first four batches (N = 80) consented to participate in the study. Last batch of 20 students was not willing to participate in view of their impending professional examination. The 5th-semester students would be appearing for their second professional examinations at the end of the semester. The students had already done their “family planning” posting and had attended the lectures on the contraception and family planning by this time, so they had a fair idea about the topic of contraception. Besides, during their family planning postings, they had an exposure of public forum which is regularly conducted in the Department of Family Welfare every 15 days by the faculty and residents. Students who expressed willingness to participate were given a formal introduction of what exactly was expected of them and how to go about it. Informed consent was obtained from all the participants. Their communication skills were assessed by the consultant in a set format at their first public forum. The RANZCOG assessment of communication skills (Kalamazoo Essential Elements Communication Checklist) was used for assessment of the students' communication skills. This checklist considers seven points such as introduction with patients, carrying the discussion forward, providing medical information, clearing any doubts, and closing the discussion. Each point was scored as fair to excellent.,,,, The maximum score obtained was 35. Consultants who assessed the students were trained in using the “RANZCOG assessment of communication skills” tool.
Two sessions were conducted on a single day (one each in the antenatal and postnatal wards), each involving 2–3 students. Total eight sessions were conducted every fortnight so that 20 students conducted one public forum over one fortnight. Therefore, each student performed four public forums over 2 months, one every fortnight. Each student delivered 15 min talk once in 2 weeks in front of a group of patients regarding the different contraceptive methods available, their advantages, disadvantages, and side effects. The patients were encouraged to ask questions from the students to clear their doubts. The students were given verbal feedback after every forum to improve their performance.
Reassessment of communication skill was done at the end of the posting in the last public forum, i.e., they were assessed at the first and after the fourth public forum. Thus, the first public forum assessment acted as a pretest for them. Feedback was given after first public forum only. Apart from the pre- and post-assessment of communication skill, feedback was obtained from the students. This feedback focused on their involvement in the public forum, their own performance, and timing. Besides this, they were encouraged to write down their own suggestions anonymously on a paper. A feedback from the patients was also taken about their satisfaction with the information provided by the students during the public forum. The study was approved by the Institutional Ethical Committee of Jamia Hamdard.
Data were entered into Microsoft Excel sheet and the average values and percentages for the various parameters were determined. Paired t-test was applied to the RANZCOG assessment tool for testing the significance of improvement in results. P < 0.05 was considered as statistically significant.
| Results|| |
The mean score on the RANZCOG assessment at the first public forum was 11.92 ± 3.89 and after the fourth public forum was 19.75 ± 6.13(P = 0.00). An improvement in scores was 22.3%. There were 55% boys (N = 44) and 45% girls (N = 36) in the study (male: female = 11:9) and the age ranged from 20 to 23 years (mean age = 21.2 years). The mean scores after the first and last forum for boys and girls did not differ much. For male students, the mean scores after the first and final public forum were 12 and 20.2, respectively, and for female students, these scores were 11.8 and 19.1, respectively. [Table 1] depicts the total RANZCOG scores after the first and fourth public forum. There was a marked improvement in scores of the students. Most of the students initially had a score of fair and good in the first public forum, and with exposure of subsequent forums, they stepped up to good-to-excellent scores after the final forum.
[Table 2] describes the improvement in scores of students based on individual assessment points of the checklist. There was a statistically significant improvement in the scores for all the points on the RANZCOG checklist.
|Table 2: Improvement in the individual Royal Australian and New Zealand College of Obstetricians and Gynecologists checklist assessment points after fourth public forum|
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The patients were also asked about the satisfaction on the information provided by the students on which 62% said they liked it, 26% said it was average, and 12% did not comment on the question. [Table 3] describes the feedback obtained from the students regarding their views on public forum. All the students felt more confident after the public forums.
| Discussion|| |
Updated clinical knowledge and good communication skills are essential for a good clinical practice. In the United Kingdom, all medical schools are required to assess the competence of medical graduates in clinical communication. The first step of clinical teaching is engagement of students by the faculty members. Involvement in the public forum appears good tool for it as evident from the current study. We could not find any study on literature search where the students' involvement in public forum had been used for the improvement in communication skills. However, there are studies where the individual communication skills have been assessed recently in dental institutes. Berkhof et al. analyzed 12 systematic reviews and concluded that the best training strategies for teaching communication skills to physicians are role play, small group discussion, and feedback.
The main aim of the study was to assess the improvement in doctor–patient communication skills of undergraduate students with the help of public forum. We chose the RANZCOG checklist for assessment of students' communication skills as it was found to be self-explanatory, having good interobserver reliability, and is a reasonably efficient way of providing feedback on trainee's communication skills. Based on the results of the pilot study, students had statistically significant improvement in the communication skills. The results demonstrated that most students had average skills in the first forum and improved dramatically by the fourth forum. Since the students were not given any formal training in public speaking, the improved communication skills were most likely by self-reflection, imbibing from peers, and practice in public speaking. Most of the students, who participated in the study, appreciated this exercise and found it useful for their self-development. A study on medical interviewing skill of medical students showed that, after the training on simulated patients, the students had improved score on “greeting, self-introduction, eye contact, nodding, and attitude.” In this study also, the students have scored better in building and maintaining the relationship after the last public forum and the situation in the current study was real patient. The improvement was visible from the start of talk such as opening and building the speech to providing relevant information to closing the talk. This shows that they improved not only in terms of providing medical information to the patients regarding contraception but also in their way of projecting this information in an audience-friendly manner.
Literature presents varied evidence on the communication skills based on gender. In a study on 150 medical students, it has been observed that female students were more willing to undergo training in communication skills as compared to male counterpart. In another study, female student scored higher on positive attitude scale in communication skill learning. In the present study, no difference was found in the communication skills of undergraduate medical students based on gender.
Based on the feedback, we received from the students, most students appreciated the exercise and found it useful. However, 24% of the students found difficulty in communicating in the patient's language. They expressed inability to express medical terminology in the patient's language. This needs to be addressed as this is a common issue which will be faced by medical students even later in their careers. Haldar in their study also showed that presentations by the students helped them in better understanding of topic as well as their peer group has taken more interest in the subject.
The prevalence of public speaking anxiety in general population is found to be 15%–30% as compared to 17% among residents and medical students and is being classified as DSM-5 (Diagnostic and statistical manual of mental disorder; American psychiatric association). The present study showed that 32.5% students felt nervous and anxious while speaking which is almost double of the incidence quoted. This could be due to involvement of only undergraduate students in the study. An indirect advantage of the student's involvement in the public forum was imbibing in-depth knowledge regarding contraception by the student. Besides, the study provided a valuable opportunity to patients to gather information regarding contraceptive methods.
Effective communication during medical encounters has been associated with significant benefits in areas such as patient recall and understanding, adherence to treatment plans, symptom resolution, physiological outcomes, and medical decision-making, as well as the satisfaction of both patients and physicians. Moreover, researches in the clinical trials have shown that effective patient–physician communication can improve a patient's health as quantifiably as many drugs.
The drawbacks of the present study are that the students were not provided with any formal skill training to enhance their communication skills. The other foreseeable lacuna could be the waning of gained abilities in the absence of continued exposure to such public fora. The other limitations of this pilot study include the single-group pretest and posttest design and the absence of control group. The results of the present study may not be generalized on the individual doctor–patient communication skills, for which the study can be extended to further till the internship and with the larger group size.
| Conclusion|| |
Involving students in small public forums (or patient education training programs) helps in improving communication skills and can in turn be of great help in improving the personality of the future medical professionals as well as in the development of better health-care providers. Undergraduate MBBS curriculum should incorporate similar exercises for improving communication skills of students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Robins LS, White CB, Alexander GL, Gruppen LD, Grum CM. Assessing medical students' awareness of and sensitivity to diverse health beliefs using a standardized patient station. Acad Med 2001;76:76-80.
Bittner A, Bittner J, Jonietz A, Dybowski C, Harendza S. Translating medical documents improves students' communication skills in simulated physician-patient encounters. BMC Med Educ 2016;16:72.
Rider EA. Competency!: Interpersonal communication skills. In: Rider EA, Nawotnaik RH, Smith GD, editors. A Practical Guide for Teaching and Assessing the ACGNE Cor Competencies. Marblehead, MA: HC Pro, Inc.; 2007. p. 1-84.
Braverman G, Bereknyei Merrell S, Bruce JS, Makoul G, Schillinger E. Finding the words: Medical students' reflections on communication challenges in clinic. Fam Med 2016;48:775-83.
Sangappa SB, Tekian A. Communication skills course in an Indian undergraduate dental curriculum: A randomized controlled trial. J Dent Educ 2013;77:1092-8.
Berkhof M, van Rijssen HJ, Schellart AJ, Anema JR, van der Beek AJ. Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews. Patient Educ Couns 2011;84:152-62.
Sugawara A, Ishikawa K, Motoya R, Kobayashi G, Moroi Y, Fukushima T, et al.
Characteristics and gender differences in the medical interview skills of Japanese medical students. Intern Med 2017;56:1507-13.
Löffler-Stastka H, Seitz T, Billeth S, Pastner B, Preusche I, Seidman C, et al.
Significance of gender in the attitude towards doctor-patient communication in medical students and physicians. Wien Klin Wochenschr 2016;128:663-8.
Molinuevo B, Aradilla-Herrero A, Nolla M, Clèries X. A comparison of medical students', residents' and tutors' attitudes towards communication skills learning. Educ Health (Abingdon) 2016;29:132-5.
Halder N. Encouraging teaching and presentation skills. Clin Teach 2012;9:253-7.
Pull CB. Current status of knowledge on public-speaking anxiety. Curr Opin Psychiatry 2012;25:32-8.
Tejwani V, Ha D, Isada C. Observations: Public speaking anxiety in graduate medical education – A matter of interpersonal and communication skills? J Grad Med Educ 2016;8:111.
Agarwal A, Agarwal A, Nag K, Chakraborty S, Ali K. Doctor patient communication-a vital yet neglected entity in Indian medical education system. Indian J Surg 2011;73:184-6.
[Table 1], [Table 2], [Table 3]