This cross-sectional study was carried out over a period of four months, from 1st March 2015 to 30th June 2015 in CSL of Department of General Surgery at Index Medical College Hospital and Research Centre, Indore [Table/Fig-1a] after getting approval from Institutional Ethics Committee.

[Table/Fig-1]:

Composite picture of Communication Skills Lab including; a) Entrance of Communication Skills Lab; b) Recording of conversation of student with simulated patient in the recording room; c) Demonstration of video of the mentor while communicating with the simulated patient, in demonstration room; d) Feedback being given to the students individually in counselling room.

During the study period, 60 students (37 girls and 23 boys, within age range of 18 years to 21 years) were posted in CSL. Out of these, feedback was obtained from 56 students, as four students could not complete the major part of the course due to unavoidable reasons.

A special basic communication skills training course was conducted for MBBS second year students in systematically designed CSL. This batch was specifically selected because an early training of basic communication skills will help the students while interacting with various types of patients during the subsequent years of their undergraduation. Three batches of 20 students each were trained in the months of March, April and June 2015, respectively. Total duration of course was of eight days and average teaching time was about two hours per day.

The first four days of the course were spent in theoretical teaching of the students. On first day, they were taught about the importance of proper communication with patients, role of investigations, difference between communication during student life and practicing life etc. Second day was focused on ‘student-patient interaction’, in which the students were taught about proper method of communication with indoor patients during their clinical posting. Major emphasis was given on their appearance, dressing, language, non verbal communication, proper way to start and conclude the conversation etc.

Next to it, a detailed description of each and every question of standard format of medical history (e.g., presenting complaints, past history, personal history etc.,) was made on day 3 and day 4, with special emphasis on ‘how’ to ask various questions to different types of patients. This was supported by demonstration of video clips of various types of patients (like silent, talkative, co-operative etc.,) of different types of diseases. Also, some audio clips of conversation of physician with real and simulated patients were played to teach the students about the proper method of communication with various types of patients.

Theoretical teaching was followed by practical session of four days, which commenced with the communication of individual student with a simulated patient [Table/Fig-1b]. Video recording of conversation was done and assessment was made keeping both verbal and non verbal communication of students in mind. Feedback was given in the group as well as individually, focusing upon both strength and weakness of each student during communication with the patient. Major emphasis was given on verbal (language), paraverbal (tone, volume, speed etc.,) and non-verbal (facial expressions, eye contact, gestures etc.,) communication of the students. This was followed by demonstration of video clip of the mentor communicating with the same simulated patient [Table/Fig-1c]. This helped the students to understand about the appropriate use of non verbal communication during conversation with the patients. Following this, the recorded video clip of each student was viewed and analysed by the mentor and an assessment was done for the strengths and weakness of the individual student as a communicator. This feedback was then passed on to the individual student along with the video clip in his/ her cellphone or pen drive for self assessment [Table/Fig-1d].

This was followed by the communication of individual student with a real patient and his relatives. Suitable patients were selected from the wards and one patient was allotted to one student, randomly.

Later on, an open interrogation of every student was done when he/she presented his/her experience of conversation with his/ her patient and his/her relatives. This discussion benefited all the students as they also came to know about the common problems faced during communication with various types of patients and about the proper way to interact with them. Towards its end, the course also included a multiple choice question type of test of the students, which included questions from various topics covered during the course.

The course was concluded with collection of feedback from the students. Seven closed questions formulated by the chief investigator were asked, which were focused on their experience of the course and about the importance of ‘communication skills’ in medical field, as perceived by them. The students were asked to score on the basis of five point Likert scale (5: Strongly agree, 4: Agree, 3: Neutral, 2: Disagree, 1: Strongly disagree). Additionally, students were also asked to share their feedback and suggestions for improvement of the module (as open ended question).

In feedback questionnaire, 92.86% of the students opined that communication skills training should be made compulsory in MBBS curriculum. Out of these, 67.86% students strongly agreed and 25% students agreed with this proposal.

89.29% students agreed that the communication skills lab was well equipped. A total of 98.21% students agreed that the use of audio-visual demonstrations had made the course more interesting and understandable (83.93% strongly agreed, 14.29% agreed).

Out of 56 students, 40 students (71.43%) were comfortable in front of the camera and simulated patient (28.57% strongly agreed, 42.86% agreed). On this question, 13 students (23.21%) were neutral, and three students (5.36%) accepted that they were not comfortable. This feedback was essential as it will help us in selecting various types of teaching modalities (like role playing etc.,) for the course in future.

A total of 85.71% students felt that the duration of course (eight days) was adequate to teach them the basic course of communication skills. A 96.43% of the students accepted that the course had improved their communication with the patients (67.86% strongly agreed, 28.57% agreed; Average score on Likert scale: 4.64). A total of 98.21% students agreed that they would like to be a part of such course in future [Table/Fig-2].

In open-ended feedback, majority of students wished that such course should be conducted more frequently in our institute. They found this course as very easy, informative and interesting. Also, many students suggested introducing the new teaching modalities (like role playing, skits etc.,) to the course.

The results of our study are comparable to the results of other studies on communication skills training in medical students. An 89.29% of our students felt that the lab was well equipped, which matched with the observation (78.46%) of the study of Jagzape TB et al., [9].

A total of 98.21% students agreed that the audio-visual demonstration was helpful in understanding the message more clearly. This result has encouraged us to expand our audio-video bank in future.

Although it was the very first experience of the students, still majority of the students (71.43%) accepted that they were comfortable in front of the camera and simulated patients. Still, we would like to find some measures to improve the comfort level of students in our future courses.

A total of 96.43% of the students agreed that the course had improved their communication skills with the patients. Similar finding were observed by Jagzape TB et al., Towle A and Hoffman J; and Wagner PJ et al., [9-11]. Jagzape TB et al., in their observational study found a 78.46% improvement in communication skills experienced by the students [9]. Similarly, in their five-module advanced communication skills course; Towle et al., obtained a high rating both by students and tutors alike [10]. Students ratings on a five-point scale were as follows: relevance of the weekly themes: 4.21; the effectiveness of the Simulated Patient (SP) interviews: 4.10; the effectiveness of the group discussion and feedback: 4.18; and overall course effectiveness in enhancing communication skills: 3.91. In a study by Wagner PJ et al., four interactive lab sessions were designed and assessed on several parameters [11]. They reported a significant overall improvement in students-patients communication following this structured learning programme.

A total of 92.86% of the students opined that communication skills training should be compulsorily included in MBBS curriculum. This matched with the observation of Jagzape TB et al., (78.46%) in their study [9].

In last few years, several studies have been conducted at different medical and dental colleges of our country in relation to early teaching of communication skills to the students during undergraduation period [12-17]. Each study is based on different methods of teaching and assessment of communication skills of medical students, but all of them concluded that the introduction of such teaching courses improves communication skills of the students.

It was encouraging for us to know that almost all of our students (98.21%) liked to be a part of such courses in future also.

Some minor practical difficulties were encountered during conduction of this course. Since such training is still not compulsory in medical curriculum of our country, it was essential to encourage maximum number of students to be a part of this optional course. Besides, as no special time period has been provided for its training, this course was conducted during routine clinical posting of the students in the Department of General Surgery only.

There is lack of any established protocol of teaching communication skills in the curriculum of medical sciences. Hence, comparison of results obtained with such a teaching curriculum cannot be specifically compared with the previous studies. However, it is beyond doubt that communication skills have a major positive impact on patient doctor relationship and papers like this do provide a basis for inclusion of such a course in the curriculum.

The students of our institute found that the training module in communication skills lab was very useful in improving their communication skills. Majority of students strongly felt that its training should be included compulsorily in MBBS curriculum. The training programme of medical students can be implemented at an early stage of their undergraduation. This module can be used as an effective, economic, interesting and acceptable tool for early training of communication skills to the undergraduate medical students.