This cross-sectional observational study was carried out over a period of 6 months, from 1st January 2014 to 30th June 2014 in Communication Skills Lab (CSL) at Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, (DU), Sawangi (M), Wardha after approval from the Institutional Ethical Committee.
In our University, the MBBS students are posted in the CSL for two days during their first year and five days during their second year and third professional years. The first year module is labeled as ’sensitization module’ as students are in a transition phase from non professional (high school and junior colleges) to professional course. The module from second year onwards is labeled as ’consolidation module’. The students are posted in a batch of 25 each.
Materials and Methods
The III-I MBBS students who were posted in communication skills lab were taught with a communication skills module during their posting of 5 days for 2 hours each day. Each day a different faculty member, trained in communication skills, engages the students. These faculties are members of Medical Education Unit (MEU) and were trained in communications skills in a workshop conducted by School for Health Professions Education (SHPER) for this purpose.
Module of Communication Skill Lab for III- I MBBS: The module deals with various aspects of communication and professionalism including rapport building with the patient, history taking, consent, examination of patient and grief announcement. The teaching methods used are didactic lectures, debates, role plays, group activities and videos. The students are also sensitized about time management, stress management and conflict management skills. On the last day of posting the students are taught about common vernacular terminologies regarding the symptoms [Table/Fig-1].
Details of the module are as follows:
Day | Topic |
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1 | Get acquainted Power point presentations on communication skills Discussion on the power points Planning /practice for role play
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2 | Role plays
Importance of History talking – Deviant, Ideal Rapport Building – Deviant, Ideal Examination of patient - Deviant, Ideal Ward & Bedside manners - Deviant, Ideal Behaviour in the clinical postings – Deviant, Ideal
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3 | Debate: Topics:
Good communicators are born as good communicators Language is an important barrier for communication Communication gap and generation gap are inter-related Health professional students should be posted in the communication skill lab. The generation of family physicians was the generation of excellent communicators.
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4 | Powerpoint presentations on:
Conflict Management Time Management Stress Management Team Performance Sympathy and Empathy Leadership skills
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5 | English to Marathi Dictionary
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Feedback: In the present study at the end of the posting, feedback from the students were collected. The feedback was based on a pre-designed and pre-validated questionnaire. This questionnaire included:
Nine close ended (quantitative) questions and
Three open ended (qualitative) questions.
The close ended questions were to be answered on a five point Likert scale where 1=strongly disagree and 5=strongly agree. These questions focused on the reactions and feelings about the communication skills lab.
Open ended questions dealt with factors which facilitated learning, the factors that hindered learning. Students were also asked their suggestions about improvement in the module. The feedback was analysed.
Statistical Analysis
For close ended questions, various percentages were calculated and also average score on a scale of five was estimated. Open ended responses were qualitatively analysed using coding and categorization.
Results
During the study period 85 students of final MBBS were posted in communication skills lab. Out of these 65 met the inclusion criteria and feedback forms were obtained from them. Before posting in the communication skills lab (CSL) 12 out of 65(18.46%), students were unaware about communication skills lab. A total of 30 (46.15%) students were slightly aware and remaining 23 (35.38%) were well aware of CSL as they are posted during the 1st and 2nd MBBS as well (But attendance is not compulsory) [Table/Fig-2].
Student’s awareness about communication skills lab before posting
Awareness | Unaware (%) | Slightly aware (%) | Well aware (%) |
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No of students (N)- 65 | 12 (18.46) | 30 (46.15) | 23(35.38) |
In the feedback questionnaire, among the closed ended questions, 78.46% students opined that CSL posting should be compulsory to the medical students. Out of these 40% students strongly agreed and 38.46% agreed. Only two students (3.07%) strongly disagreed and five (7.69%) disagreed and 10.76% were neutral on this question. Average score on 5 point scale was 4.04. The students who strongly disagreed were probably concerned with the timing of the posting i.e. last semester. They thought that they should get more time to study.
A total of 56 (86.15%) students felt that the CSL is well equipped, in terms of availability of audio-video aids, small group discussion rooms, reading material, computers. Out of the 56 students 26 (40%) agreed and 30 (46.15%) agreed strongly. Almost 94% students (61) agreed that the module taught in CSL was useful and 21 (32.30%) of these students agreed strongly. Not a single student had commented that the module was not of any help. Average score on a 5 point scale was 4.26.
Four students said that the posting duration is inadequate. Whereas 53 (81.53%) students felt that the posting duration was adequate. Out of this 43.07% (28) strongly agreed to adequacy of duration of posting. Only four (6.14%) students felt that, there was no improvement in their communication skills after the posting in CSL (Two strongly disagreed and two disagreed). These were the students who also thought that the duration of posting was inadequate and the timing of posting was not correct. On the other hand 51 (78.46%) students felt that, their communication skills improved after the posting in CSL. This includes 38.4% students who agreed strongly and 40% who agreed. Average score was 4.07 [Table/Fig-3].
Student’s reaction to communication skills lab posting using a 5 point Likert scale
Parameter | SDNo (%) | DNo (%) | SD+D(%) | NNo (%) | ANo (%) | SANo (%) | A+SA(%) | Average score |
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CSL posting should be compulsory | 2(3.07) | 5(7.69) | 7(10.76) | 7(10.76) | 25(38.46) | 26(40) | 51(78.46) | 4.04 |
CSL is well equipped | 0 | 4(6.15) | 4(6.15) | 5(7.69) | 26(40) | 30(46.15) | 56(86.15) | 4.26 |
Modules taught are helpful | 0 | 0 | 0 | 4(6.15) | 40(61.53) | 21(32.30) | 61(93.83) | 4.26 |
Faculties are competent | 0 | 3(4.61) | 3(4.61) | 11(16.92) | 25(38.46) | 26(40) | 51(78.46) | 4.13 |
Faculties are approachable | 1(1.53) | 3(4.61) | 4(6.14) | 8(12.30) | 26(40) | 27(41.53) | 53(81.53) | 4.15 |
Duration of posting is adequate | 4(6.15) | 0 | 4(6.15) | 8(12.30) | 25(38.4) | 28(43.07) | 53(81.47) | 4.12 |
Posting has improved your communication skills | 2(3.07) | 2(3.07) | 4(6.14) | 10(15.38) | 26(40) | 25(38.4) | 51(78.46) | 4.07 |
Five point Likert scale – SD (Strongly disagree) – 1, D (Disagree) - 2, N (Neutral) -3, A (Agree) – 4, SA (Strongly agree) – 5
Maximum students (61.53%) wanted to learn about communication between doctor and patient. Thirty five percent (35.38%) i.e. 23 students opined that communication between student and teacher should be taught in the module of CSL. Surprisingly almost 18.46% students preferred modules on student-student communication, indicating the communication gap between peers. Only one student (1.53%) wanted to learn about communication between student and non teaching staff. This aspect of communication is important in the clinical settings but mostly overlooked [Table/Fig-4].
Student’s preference about communication skill module
Module for communication between | No of students (%) |
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a. Student – teacher | 23 (35.38) |
b. Student- student | 12 (18.46) |
c. Student- non teaching staff | 01 (1.53) |
d. Doctor- patient | 40 (61.53) |
e. Any other | Nil |
Analysis of the open ended questions suggested that, the students found group discussions (33%) and interactive sessions (20%) very helpful for learning in CSL, followed by role play (18.46%), games (16.92%). The students were of the opinion that, power point presentations (7.69%) were not very helpful in learning. In fact it was stated as the top most factor (9.23%) causing hindrance to learning and 4.61% students found the infrastructure and ambience of CSL as one of the factors facilitating learning [Table/Fig-5].
Factors facilitating learning in communication skills lab*
Factor | No of students (%) |
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1. Group discussion | 22(33) |
2. Interactive sessions | 13 (20) |
3. Role play | 12 (18.46) |
4. Games | 11 (16.92) |
5. Power point presentations | 5 (7.69) |
6. Infrastructure and ambience | 3 (4.61) |
*Open ended question. All students did not respond to these questions. |
Top five factors causing hindrance to learning, as stated by students were power point presentations (9.23%), less interactivity, small duration of posting, communication gap between teacher and students (6.15% each) and interruption in power supply (4.61%). The reason for felt or perceived communication gap between teacher and student could be due to more use of power point presentations by the teachers, which sometimes become monotonous [Table/Fig-6].
Factors causing hindrance to learning*
Factors | No of students (%) |
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1. Power point presentations | 6 (9.23) |
2. Less time | 4 (6.15) |
3. Less interactivity | 4 (6.15) |
4. Communication gap between teacher and student | 4 (6.15) |
5. Interruption in power supply | 3 (4.61) |
*Open ended question. All students did not respond to these questions
The most common suggestion given by students for improvement in the module of CSL was regarding increasing the interactivity. The students also wanted more role plays with various themes, some video demonstrations about real patient encounter and increase in duration of the posting [Table/Fig-7].
Suggestions for improvement from the students*
Areas of improvement | Suggestions |
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Teaching – learning methodology | The teaching methodology should be more interactive There should be more role plays Video demonstrations should be more
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Timing – duration | –Duration should be more –Should be during VI or VII semester
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Note - *Open ended question. All students did not respond to these questions
Discussion
Our results are comparable to other studies done on communication skills in medical students. Neupane MS et al., in their study of, “Attitude towards learning communication skills in medical students of Chitwan Medical College, Nepal” also found similar results, where in the students in lower terms had a stronger tendency to learning communication skills than the ones in higher terms [15]. One of the important observations in this study was that along with positive attitudes about communication skills, negative attitudes should also be taken into consideration and steps should be planned and executed to modify or eliminate them. In their study some of the most important constituents of negative attitudes were: “My ability to pass exams will get me through medical school rather than my ability to communicate”, “Nobody is going to fail their medical degree for having poor communication skills”, “learning communication skills is too easy” and “I haven’t got time to learn communication skills”. Such negative attitudes if not channelized and controlled might have negative effect on positive attitudes as well. Not only is it recommended to place more importance on communication skills but also to provide greater opportunities for students to learn the communication skills [15].
In the present study, 93.83% students opined that the modules taught in the CLS were helpful with a average score on 5 point Likert scale of 4.26. A study by Towle A and Hoffman J also had similar results with average score of 4.21 of the relevance of modules taught in communication skill lab [16]. In the study by Ghodke et al., all the students strongly agreed with the importance of effective communication [17]. Billngs JA and Block S in their study of palliative care in undergraduate medical education has suggested that offering undergraduate and graduate training about death and dying care, breaking bad news and communication with dying patient and their families can prove useful [18].
Majority of the students felt that faculties in CSL are competent as well as approachable. The findings are in concordance with those of Towle A et al., [16].
Overall 51 students (78.46%) agreed to the point that CSL posting had helped them in improving their communication skills. Similar were the findings of Towle A et al., and also Wagner PJ et al., [16,19]. There is some evidence that taking courses that emphasized communication skills training also influenced the medical students’ attitudes towards them [20,21]. In the study by Rees C et al., which examined the attitudes before and after the course for communication skills, the students rated their communication skills significantly lower at the end than before the start of the course. By the end of the course even positive attitudes towards learning communication skills become significantly lower as compared with the start. In this study as per the researchers, the reason might have been the overconfidence of students about their abilities to communicate with patients, which was brought down to more realistic levels after learning the communication issues during their training [20,21].
A 61.53% (40) students wanted that communication between doctor and patient should be focused more. Wagner PJ et al., had similar observation in their study [21]. Ghodke BV et al., in their study concluded that the perception of students on death related issues like breaking the bad news to the relatives and communication with dying and relatives of dying patients need to be improved [17]. The literature review suggest that medical students perception of the importance of communication skills is determined by their attitude towards communication skills training and attitude may eventually influence the learning and adoption of communication skills in the clinical setting. The students self assessment of their ability to communicate effectively with the patient is responsible for the development of attitude towards communication skills training [21].
Limitation
There are chances of bias on part of the responders. Very few responders answered the open ended questions. Focus grouped discussion in addition to the feedback form might have helped in getting a better perception.
Conclusion
The students found communication skills lab very useful in improving their communication skills. They desired more emphasis on communication between doctor and patient. They sought more interactivity and video demonstration to be part of the modules.
The methodology used to teach the modules should be more interactive. Apart from doctor patient communication, communication between students and teacher and between students themselves also needs to be taught. Video demonstrations should be added in teaching methodology. Power back up should be provided to the communication skills lab.
Five point Likert scale – SD (Strongly disagree) – 1, D (Disagree) - 2, N (Neutral) -3, A (Agree) – 4, SA (Strongly agree) – 5*Open ended question. All students did not respond to these questionsNote - *Open ended question. All students did not respond to these questions