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Table of Contents
LETTER TO EDITOR
Year : 2022  |  Volume : 13  |  Issue : 3  |  Page : 205-207

Attitude, ethics, and communication skills (AETCOM) training of young doctors for COVID-19: An Indian perspective


1 Department of Pulmonary Medicine, Lady Hardinge Medical College, New Delhi, India
2 Department of General Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
3 Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
4 Department of Neonatology, Seth GSMC and KEMH, Mumbai, Maharashtra, India
5 Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Submission11-Mar-2022
Date of Decision11-Mar-2022
Date of Acceptance11-Mar-2022
Date of Web Publication13-Jul-2022

Correspondence Address:
Dr. Pranav Ish
Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_32_22

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How to cite this article:
Talukdar T, Verma N, Kishore J, Goyal M, Ish P. Attitude, ethics, and communication skills (AETCOM) training of young doctors for COVID-19: An Indian perspective. Indian J Med Spec 2022;13:205-7

How to cite this URL:
Talukdar T, Verma N, Kishore J, Goyal M, Ish P. Attitude, ethics, and communication skills (AETCOM) training of young doctors for COVID-19: An Indian perspective. Indian J Med Spec [serial online] 2022 [cited 2022 Aug 15];13:205-7. Available from: http://www.ijms.in/text.asp?2022/13/3/205/350776



Dear Editor,

The National Medical Commission (NMC) has endorsed and introduced a novel competency-based medical education curriculum in India to train doctors from the academic year 2019 to 20 onward.[1] The NMC has made attitude, ethics, and communication skills (AETCOM) modules a mandatory part of undergraduate learning.[2]

The COVID-19 pandemic has necessitated the need to deliver medical training in innovative ways and to diagnose, monitor, and treat medical conditions during the SARS-CoV-2 outbreak to reduce viral transmission. It has resulted in the emergence of home care-based treatment protocols, particularly for milder cases of COVID-19.[3] However, it is imperative to monitor and follow up these patients to provide a continuity of care. Regular monitoring of patients for signs of worsening clinical conditions and mental health support to alleviate fear and anxiety is crucial. Junior doctors including interns and undergraduate students have been redeployed to deliver service at the coronavirus frontline in response to stretched health-care settings such as that found in India. Training of such students in diagnosis and management of COVID-19, mainly through telemedicine routes, has been carried out. The ensuing strategy was to allow senior residents and specialists to be available to manage severe COVID-19 patients in secondary and tertiary care hospitals. It has been observed that training in appropriate attitude, interpersonal communication skills, and maintenance of ethical principles whilst delivering holistic care to patients is often lacking.

The benefits of inculcating such AETCOM modules in internship training in India are immense. Utilizing interns and undergraduate residents for managing mild and home isolation patients can lessen the burden on senior doctors and allow them to deal with unwell patients with complex clinical needs at hospitals. It will ensure triage and evaluation of patients with mild symptoms, for signs of worsening, allay patient anxiety, improve judicious utilization of drugs, and monitor recovery. As the internees undergo training in many specialties, they learn to be flexible when dealing with potentially stressful situations. They can assess patient's well-being through teleconsultation, become confident in the remote evaluation of the danger signs of clinical deterioration and guide the patient including their families in organizing prompt referral to a specialist care when the need arises.[4]

While we keep hearing that mere theoretical and/or clinical knowledge is not sufficient for managing patients, the utility of attitude, ethics, and communication skills has never been more acutely felt than during the current unforeseen pandemic situation. Such training benefits both the patient and the interns as patients can be managed at home and interns learn essential skills that will help them during their lifetime.[5] With all the paranoia around morbidity due to COVID-19, there has been a growing concern that an increased number of people are self-medicating or getting admitted when it is too late. Using the intern to help guide patients can reduce such outcomes by employing their services in counseling affected people in populous and overstretched health-care systems in India. Counseling and educating the patients against unnecessary usage of certain drugs such as steroids and antibiotics help reduce panic and fatal outcomes such as antibiotic resistance and diseases such as Mucormycosis, which have been seen with steroid misuse.[6] Apart from the enormous scare, the COVID-19 pandemic has taken a huge toll on human lives, and many individuals require specialized psychiatric counseling for dealing with the tragic loss of friends and family members. Similarly, COVID-19 patients with comorbidities may require specialist opinions from physicians. While adequate training of the interns on dealing with common complaints and providing psychological counseling is essential, it is also necessary to train the junior doctors when to seek expert opinion and guidance. These factors emphasize the importance of an empathetic attitude when dealing with patients and their relatives, practicing ethical medicine, and maintaining effective communication between patients and interns and specialist doctors. Suitable training modules, guidelines, and standard operating procedures will have to be developed and an effective referral mechanism will have to be ensured. All communications between the patient and the caregiver will need to be documented for regular review and feedback.

Designing and implementing novel training modules in attitude, medical ethics, and communication skills, particularly during the COVID-19 pandemic, is pivotal. While the necessary interventions can be started from the 1st year of medical education, regular reinforcements, especially during the clinical postings and during internship, are essential for improved and effective patient care. Boot camps for short-duration intensive training of interns have been shown to be well received by faculty and students alike and can be an effective method to introduce AETCOM training during internship.[7] Simulation-based teaching (SBT) is the future of medical education, and SBT modules on communication skills can be easily adapted for delivery over virtual teaching–learning platforms.[8] Skills laboratories are an essential requirement in all medical colleges under the new NMC guidelines, and the clinical teaching departments can collaborate with the medical education units to implement AETCOM modules in these laboratories. There is therefore an urgent need for sensitizing, involving, and training faculty and postgraduate residents for designing and successful implementation of such modules. Perhaps, we can also think of developing similar modules for the postgraduate residents especially considering that postgraduate teaching in our country is also in the process of transitioning to a competency-based curriculum in which AETCOM will receive a major emphasis. In the near future, once these trained young doctors become postgraduate residents or join the teaching workforce, the modules will become self-sustaining. The proposed AETCOM training modules are summarized in [Table 1].
Table 1: Aspects to be covered and possible training methods to reinforce attitude, ethics, and communication skills in the proposed attitude, ethics, and communication skills module for interns and junior doctors

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Conflicts of interest

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  References Top

1.
Iyengar KP, Jain VK, Sakthivel P, Malhotra N, Ish P. Competency-based novel medical curriculum in India. Postgrad Med J 2021;j-139690. [doi: 10.1136/postgradmedj-2020-139690].  Back to cited text no. 1
    
2.
National Medical Commission. Competency Based Undergraduate Curriculum. Available from: https://www.nmc.org.in/information-desk/for-colleges/ug-curriculum/. [Last accessed on 2021 Oct 17].  Back to cited text no. 2
    
3.
Ish P, Sakthivel P, Gupta N, Malhotra N, Rajeshwari M. ABC triage and protect phase strategy in COVID-19 management: Lessons from the past. Postgrad Med J 2020;j-139114. [doi: 10.1136/postgradmedj-2020-139114].  Back to cited text no. 3
    
4.
Malhotra N, Sakthivel P, Gupta N, Nischal N, Ish P. Telemedicine: A new normal in COVID era; perspective from a developing nation. Postgrad Med J 2020;j-138742. [doi: 10.1136/postgradmedj-2020-138742].  Back to cited text no. 4
    
5.
Ish P, Sakthivel P, Gupta N, Malhotra N, Rajeshwari M. E-learning of medical residents during COVID-19: Perspective from a developing nation. Postgrad Med J 2020;j-139022. [doi: 10.1136/postgradmedj-2020-139022].  Back to cited text no. 5
    
6.
Ish P, Ish S. Prevention of mucormycosis in COVID-19 – The need of the hour. Indian J Ophthalmol 2021;69:1969.  Back to cited text no. 6
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7.
Kumar Mahesh N, Verma N, Mohan C, Mahesh A, Verma P, Mannan R. Introduction of a skills boot camp for final year undergraduate medical students entering internship in general medicine in a North Indian medical college: A pilot study. J Educ Technol Health Sci 2018;5:110-7.  Back to cited text no. 7
    
8.
Verma N. Simulation based teaching – The future of medical education. J Educ Technol Health Sci 2021;8:38-9.  Back to cited text no. 8
    



 
 
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