Development and Pilot Implementation of an Assessment-Based Communication Skills Curriculum for Medical Interns to Emphasize Doctor Patient Relationship
Development and Pilot Implementation of an Assessment-Based Communication Skills Curriculum
Keywords:
Communication Skills, Assessment, Interns, Three function approach, Curriculum, Doctor-patient relationshipAbstract
Background & Objectives: The relationship between good doctor-patient communication and improved health outcomes is well established. Communication skills cannot be adequately learnt by mere observation of the experienced physician. Methods: A curriculum was developed and piloted in a workshop to teach aspects of doctor-patient communication to medical interns. Key features of the curriculum were use of Cohen-Cole and Bird’s three function approach, with emphasis on the understanding and responding to the patients’ emotions using verbal and non verbal communication, listening and empathy. A pre- and post training assessment using scenarios based on common clinical situations was conducted before and after an interactive workshop. Fifteen of sixteen designated interns attended the training. Results: Pre- and post workshop assessment scores were recorded and analysed. These were highest for the history taking skills station and lowest for the lifestyle change station. Feedback was taken from the interns and faculty who assessed the students. Students appreciated the chance to participate in the workshop and could recognise what aspects of their communication needed to be improved. Faculty could appreciate the detailed planning required. Conclusion: Communication with patients is the most powerful diagnostic tool of a clinician. The three function approach is an effective model because of its focus on the emotional aspect of patient interaction. This training can serve as a reasonable foundation for interns before their graduation.
References
2. Cole, S. A., & Bird, J. (2000). The Medical Interview: The Three Function Approach . St. Louis, MO: Mosby.
3. Street RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009;74:295-301.
4. Ramirez AJ, Graham J, Richards MA, Gregory WM, Cull A. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996; 347:724-8.
5. Makoul G. The SEGUE Framework for teaching and assessing communication skills. Patient Educ Couns. 2001;45:23-34.
6. Kurtz SM, Silverman JD. The Calgary-Cambridge referenced observation guides: An aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ. 1996;30:83-9.
7. Participants in the Bayer-Fetzer Conference on Physician-patient Communication in Medical Education. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med.2001;76 :390–3
8. Modi JN, Anshu, Chhatwal J, Gupta P, Singh T. Teaching and assessing communication skills in medical undergraduate training. Indian Pediatr. 2016 Jun 1;53:497-504.
9. Shukla AK, Yadav VS, Kastury N. Doctor-Patient Communication: An important but often ignored aspect in clinical medicine. Journal, Indian Academy of Clinical Medicine. 2010;11:208-11.
10. Chatterjee S, Choudhury N. Medical communication skills training in the Indian setting: Need of the hour. Asian J Transfus Sci. 2011;5:8-10.
11. Ranjan P, Kumari A, Chakrawarty A. How can doctors improve their communication skills?. J Clin Diagn Res. 2015 Mar;9(3):JE01–JE04.
12. KEM holds workshop on communication skills for docs. DNA [newspaper on the internet ] 2016 Aug 19 [cited 1st December 2017] Available from: http://www.dnaindia.com/mumbai/report-kem-holds-workshop-on-communication-skills-for-docs-2246675
13. Medical Council of India. Vision 2015 [Internet].2011. Medical Council of India. [cited 1st December 2017] :New Delhi Available from:https://old.mciindia.org/tools/announcement/MCI_booklet.pdf Medical Council of India: Vision 2015, [Published in March 2011]. Available from: http://www.mciindia.org/tools/announcement/ MCI_booklet.pdf
14. Medical Council of India.Revised-GME-2012[cited 1st December 2017] Available from: http://iafmonline.in/data/circular-notifications/Revised-GME-2012.pdf
15. Medical Council of India. National Faculty Development Programme[Internet]2015.One-day Sensitization programme on Attitude and Communication (AT-COM) module for Resource Faculty of Nodal & Regional Centres, MEU coordinators/Co-coordinators, MEU faculty, Faculty Curriculum Committee members. [cited 1st December] Available from: https://old.mciindia.org/fdp/8.%20Three%20day%20revised%20BCW%20programme.pdf
16. Lipkin M.Jr (1991). [Foreword]. In Cohen-Cole S.A., The Medical Interview: The Three Function Approach. 1st ed. St. Louis, MO: Mosby-Year Book, 1991. P. xiii-xv
17. Constitution of the world health organization [Internet]. World Health Organization. [cited 1st December 2017] Available from: http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
18. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196 :129-36.
19. Kurtz SM, Silverman JD. The Calgary—Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ.1996;30:83-9.
20. Lukman H, Beevi Z, Mohamadou G, Yeap R. Implementing an assessment-basedcommunication skills training in pre-clinical phase: an IMU experience. Med J Malaysia. 2006; 61:214.
21. Dick, W., Carey, L., & Carey, J.O. (2001). Introduction to instructional design. In The systematic design of instruction (5th edition) (pp. 2-15). New York: Addison-Wesley Educational Publishers.
22. Trigwell K, Prosser M, Waterhouse F. Relations between teachers' approaches to teaching and students' approaches to learning. High. Educ. 1999;37:57-70.
23. Gibbs G, Coffey M. The impact of training of university teachers on their teaching skills, their approach to teaching and the approach to learning of their students. Activ. Learn. High. Educ. 2004 Mar; 5:87-100.
24. Sukhlecha A, Dass R, Tiwari DS, Anand NI, Dholakia HJ. Structured communicative skills training for medical interns improves history taking skills on sensitive issues: An interventional study. Med J DY Patil Univ. 2016;9:579-84.
25. Choudhary A, Gupta V. Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J App Basic Med Res. 2015;5(Suppl 1):S41 – S44.
