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BRIEF COMMUNICATION
Year : 2022  |  Volume : 15  |  Issue : 5  |  Page : 800-803  

Positive outcomes of communication skill training to medical resident doctors


1 Department of Medicine, Dr. D. Y Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
2 Department of Medicine; Department of Community Medicine, Dr. D. Y Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India

Date of Submission21-Oct-2021
Date of Decision18-Nov-2021
Date of Acceptance19-Nov-2021
Date of Web Publication06-Oct-2022

Correspondence Address:
Dr. Shubhangi Kanitkar
Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Sant Tukaram Nagar, Pimpri, Pune - 411 018, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_836_21

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  Abstract 


Introduction: Communication skills are an important component in building a good doctor − patient relationship. Imparting knowledge on it to medical students, during their formative years of training, help to overcome issues that arise due to communication gaps with patients. Materials and Methods: Twenty-four 1st-year postgraduate resident doctors in the department of medicine in a tertiary care teaching hospital were evaluated regarding their communication skills. Residents were taught how to communicate properly with patients when taking their informed consent prior to a procedure. Results: Competency of residents and patient satisfaction, evaluated using the Kalamazoo Essential Elements Communication Checklist and Interview Satisfaction Questionnaire, respectively, showed improvements following such training. Conclusion: Formal assessments and training in communication skills for medical residents aid significantly to improve physician competence and patient satisfaction.

Keywords: Communication training, patient satisfaction, soft skills


How to cite this article:
Kanitkar S, Thomson BG, Rathod H. Positive outcomes of communication skill training to medical resident doctors. Med J DY Patil Vidyapeeth 2022;15:800-3

How to cite this URL:
Kanitkar S, Thomson BG, Rathod H. Positive outcomes of communication skill training to medical resident doctors. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Dec 10];15:800-3. Available from: https://www.mjdrdypv.org/text.asp?2022/15/5/0/357777




  Introduction Top


Communication skills are core competency that plays a major role in day-to-day clinical practice. Many areas of patient care such as primary contact patient interviews; explaining diagnosis and treatment options, follow-up care and special scenarios such as explaining risks, benefits and complications of interventions to patients and relatives; breaking bad news; counseling, in cases of bereavement or mishap and when taking informed consents, necessitate the need for good and effective communication. This helps both gain the confidence of patients and also encourages further compliance toward their medical care.[1]

Communication skills, such as required to take an informed consent from a patient before a procedure, are very important for medical residents, who are one of the first points of contact, during hospitalization. Patient unawareness, due to the lack of information provided by the doctor, compounded by a low health literacy, causes a high level of dissatisfaction. This can be prevented by means of proper communication skills. However, few programs evaluate the transfer of these skills into patient care settings during core clinical clerkships. Sometimes, the students learn these skills by observing seniors communicating with the patient (as hidden curriculum), but this is not always possible. Besides, such methods of learning are not consistent and may not be complete. A patient-centered communication curriculum can improve student knowledge and skills.[2]

The objective of the study was to assess the communication skills of 1st-year resident doctors for taking informed consents before common medical procedures, before and after attending an instructional role play session on the correct method of obtaining such consents. The study also looked to assess and compare patient satisfaction scores during patient interactions, before and after the role play intervention.


  Materials and Methods Top


The study was carried out after appropriate approval from the Institutional Ethics Committee (Ref No.: I. E. S. C/C-112/2019, dated 06/09/2019). A total number of 24 1st-year resident doctors in the department of medicine were included in the study. The communication skills of the resident doctors were assessed when taking informed consent from patients in the medical ward for common medical procedures such as thoracocentesis, paracentesis, bone marrow aspiration, and lumbar puncture. An objective and structured assessment and evaluation was done by a faculty member using a checklist based on the Kalamazoo Essential Elements Communication Checklist.[3] The Kalamazoo Essential Elements Communication Checklist comprises of seven major elements which represent the protocol to be followed while communicating with patients and their relatives. The assessment required that the communicator cover all the aspects of the checklist. These included how the communicator built a relationship; how they opened the discussion; gathered information; how well they understood the patient's perspective; how they shared information; reached agreements and provided closures to the patient and/or their kin. The communicator was then marked for each of these elements under three headings-Done well, Needs improvement and not done. The residents then underwent a training program on how to communicate with a patient when obtaining an informed consent for a medical procedure. The training program was conducted using the role play method in which Senior Resident doctors took informed consent from a patient for a procedure by the correct method, covering all points mentioned in the Kalamazoo Essential Elements Communication Checklist. Posttraining, the 1st-year residents were reassessed by faculty for communication skills while taking informed consent, using the same checklist as used before training. Patient feedback to evaluate the satisfaction levels was done using the Interview Satisfaction Questionnaire (ISQ) both pre- and postintervention. The ISQ is a patient-centered method which measures satisfaction of the patient–physician interaction in four key components.[4] Patient satisfaction response was measured on a five-point Likert scale, ranging from very poor (one) to excellent (five), allowing for degrees of opinion on which quantitative data was obtained. All the data obtained were entered in Microsoft Excel and were then analyzed.


  Results Top


The overall postintervention average score on Kalamazoo Essential Elements Communication Checklist was 77.17% as compared to 48.61% preintervention [Figure 1]. Among male participants, the postintervention and preintervention scores were 76.59% and 48.28%, whereas among female participants, the postintervention and preintervention scores were 77.96% and 49.07%.
Figure 1: Mean percentages of pre and postintervention on Kalamazoo essential elements communication checklist

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The female participants scored better in the first key element of the Kalamazoo Essential Elements Communication Checklist-Build a Relationship (preintervention 65.56% and post intervention 87.72%) as compared to male participants (preintervention 38.89% and post intervention 73.0%).

The male participants scored better in the fourth key element of the Kalamazoo Essential Elements Communication Checklist–Sharing Information (preintervention 64.73% and post intervention 86.20%) as compared to female participants (preintervention 47.33% and post intervention 77.33%).

Patient satisfaction index-66.66% patients reported as good or excellent (postintervention) as compared to 21.85% (preintervention). 3.11% patients reported as poor (postintervention) as compared to 26.03% who reported as poor (preintervention). No patient reported very poor postintervention [Figure 2].
Figure 2: Percentages pre and postintervention on patient satisfaction index components

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  Discussion Top


Effective communication helps build a good doctor − patient relationship. It boosts patient safety, patient experience, improves their treatment adherence and also is beneficial to the physician as it reduces the number of malpractice suits and decreases physician burnout. While many of these skills are learned and mastered with time, teaching of the same, adhering to the principles of evidenced based and patient-centered medicine is the need of the hour, with the changing landscape of medical practice.[5],[6]

A study by Allenbaugh et al. demonstrated notable improvements in knowledge, attitudes, and communication skills of medicine residents, as well as better patient satisfaction scores after implementing a brief training session focused on clear bedside communication skills.[7] Deveugele et al. too observed a positive effect in the communication skills of medical students when trained using methods which included small group discussions, role playing with colleagues, and showing videotapes of real consultations.[8] Simmenroth-Nayda et al. in their study showed similar improvement in communication skills, when taught as a part of a basic clinical skills course.[9] It is likely that many of these results may be a consequence of short-term memory effects, due to relatively shorter time periods between assessments. Communication skills are found to degrade, especially when transitioning from the preclinical medical student years to clinical residency years and so it is essential that such evaluations and tutoring be done at all levels of medical training.[10]

Communication skill training also becomes essential in the context of intercultural, psychosocial, and language barriers which exist among residents who are not locals to the place of the academic institution. Studies evaluating the same in our country are scarce but a similar study by Nagy et al. evaluating the benefit of teaching patient-centered communication skills to nonlocal students showed significant improvement of communication skills accompanying clinical procedural skills.[11]


  Conclusion Top


Our study shows that formal training in communication skills enhances the communication abilities of residents and has a beneficial impact on immediate patient satisfaction which eventually helps further patient management. Learning good and effective communication skills during residency not only benefits doctors but society at large.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Choudhary A, Gupta V. Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J Appl Basic Med Res 2015;5:S41-4.  Back to cited text no. 1
    
2.
Saba GW, Chou CL, Satterfield J, Teherani A, Hauer K, Poncelet A, et al. Teaching patient-centered communication skills: A telephone follow-up curriculum for medical students. Med Educ Online 2014;19:22522.  Back to cited text no. 2
    
3.
Makoul G. Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Acad Med 2001;76:390-3.  Back to cited text no. 3
    
4.
Grayson-Sneed KA, Dwamena FC, Smith S, Laird-Fick HS, Freilich L, Smith RC. A questionnaire identifying four key components of patient satisfaction with physician communication. Patient Educ Couns 2016;99:1054-61.  Back to cited text no. 4
    
5.
Ferreira-Padilla G, Ferrández-Antón T, Baleriola-Júlvez J, Braš M, Đorđević V. Communication skills in medicine: Where do we come from and where are we going? Croat Med J 2015;56:311-4.  Back to cited text no. 5
    
6.
Tan XH, Foo MA, Lim SL, Lim MB, Chin AM, Zhou J, et al. Teaching and assessing communication skills in the postgraduate medical setting: A systematic scoping review. BMC Med Educ 2021;21:483.  Back to cited text no. 6
    
7.
Allenbaugh J, Corbelli J, Rack L, Rubio D, Spagnoletti C. A brief communication curriculum improves resident and nurse communication skills and patient satisfaction. J Gen Intern Med 2019;34:1167-73.  Back to cited text no. 7
    
8.
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. 8
    
9.
Simmenroth-Nayda A, Weiss C, Fischer T, Himmel W. Do communication training programs improve students' communication skills? – A follow-up study. BMC Res Notes 2012;5:486.  Back to cited text no. 9
    
10.
Levinson W, Pizzo PA. Patient-physican communication: It's about time. JAMA 2011;305:1802-3.  Back to cited text no. 10
    
11.
Nagy E, Luta GM, Huhn D, Cranz A, Schultz JH, Herrmann-Werner A, et al. Teaching patient-centred communication skills during clinical procedural skill training – A preliminary pre-post study comparing international and local medical students. BMC Med Educ 2021;21:469.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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