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December 2021, Volume 71, Issue 12

Research Article

Teaching Communication Skills Programme in Basrah Medical College: A new curriculum and students-oriented evaluation and feedback

Authors: Sawsan Issa Habeeb  ( Department of Pediatrics, College of Medicine, University of Basrah, Iraq. )
Abdul Salam Saleh Sultan  ( Ministry of Health, Iraq. )

Abstract

Objective: To elicit the opinion of students about various aspects of teaching and learning of communication skills.

 

Method: The questionnaire-based study was conducted at the Basrah Medical College, Basra, Iraq, for the first year medical students, academic year 2016-2017. All the students of the class were included. Data was collected using a questionnaire that explored students' opinion regarding the curriculum related to the communication skills programme, like level of satisfaction with the teaching methods, the important information they had received during the course, their perception of the strengths and weaknesses of the curriculum. Data were analysed to quantify the students' views and opinions on specific points.

 

Results: Of the 100 students approached, 95(95%) responded. Overall, 69(72.6%) students showed high degree of satisfaction; 52(54.7%) mentioned the skill of listening as one of the most important things they had learned, which was associated with emphasis on patient's narration 41(43.2%). In terms of programme's strength, 38(40%) students identified the ability to knowing how to deal with patients, while, among the weaknesses, 25(26%) students pointed out reliance on theoretical lecture and lack of practice. The gender of the students was not considered.

 

Conclusion: Teaching communication skills to first year medical students was found to be successful because of intensive preparation, working as a team, consulting international experts, students' positive interaction and high satisfaction rate.

 

Keywords: Teaching undergraduates, Communication skills, Basrah, Curriculum, Arabic language. (JPMA 71: S-35 [Suppl. 9]; 2021)

 

Introduction

 

Communication skills (CS) between doctor and patient has been described in the past as an innate skill which students acquire from observing the behaviour of their teachers. It was represented as an implicit training and based on imitation of the behaviour of senior professionals.

Over the last few decades, it has became one of the basic subjects in medical curriculum of many international teaching institutions, and its content is derived from modern communication theories, human, social, psychological and educational sciences, and is based on empirical research and outcome of many international studies.1 Mastering CS is now considered an essential skill alongside clinical competence, knowledge base, physical examination, and the ability to solve problems.2 This holistic approach to healthcare is called the biopsychosocial approach.3 Studies indicate that modern medical history-taking based on CS can reach a diagnosis of 60-80% cases and has proven therapeutic utility.4

The current study was planned to elicit the opinion of students about various aspects of teaching and learning of CS in a medical college in Iraq.

 

Subjects and Methods

 

The questionnaire-based study was conducted at the Basrah Medical College (BMC), Basra, Iraq, where CS is part of the undergraduate programme.

The project was started at BCS after regular discussions with faculty directors as well as national and international experts for developing, implementing and monitoring the curriculum and its delivery. Regular workshops are run for faculty members on how to teach CS. An Arabic textbook, 'The Art of Medical Dialogue'5 has been prepared, revised and approved as the curriculum for undergraduates. It addresses the need of healthcare professionals regarding basic CS6 and to overcome the challenges of introduction of Arabic language in medical education. It clarifies the importance of adopting the concept of biopsychosocial aspect in medical practice and explains in sufficient detail the most important dialogue tool in the medical history-taking; Invite, Listen and Summarise (ILS),7-9 followed by discussing the sequence of the medical encounter. The book elucidates cultural disparity and language issues between healthcare professionals and patients. The BMC syllabus has been modified to make room for introducing basic concepts of CS for medical students of first and second years. Highly motivated clinical faculty members take one-hour sessions per week in the second semester of the first year. Besides, the BMC has prepared a questionnaire to identify the views of first year students regarding their perceptions of teaching as well as about the strengths and weaknesses of the programme. This has been done with the aim of upgrading the programme on the basis of the feedback from the students.

The current study included all the first year medical students among whom the questionnaire was distributed. Through the questionnaire, data was collected about students' opinion regarding the CS curriculum, their level of satisfaction with the teaching methods on a scale from 0% to 100%, the important information they had received during the course, their perception of the strengths and weaknesses of the curriculum, and their suggestions for improvement. Data were analysed to quantify the students' views and opinions on specific points.

Ethical approval was obtained from the Ethical Review Committee of Basrah Medical College.

 

Results

 

Of the 100 students approached, 95(95%) responded. Overall, 69(72.6%) students showed high degree of satisfaction (Figure).

 

 

Besides, 52(54.7%) students mentioned the skill of listening as one of the most important things they had learned, which was associated with emphasis on patient's narration cited by 41(43.2%) students (Table-1).

 

 

In terms of programme's strength, 38(40%) students identified the ability to knowing how to deal with patients (Table-2).

 

 

Among the weaknesses, 25(26%) students pointed out reliance on theoretical lecture and lack of practice (Table-3).

 

 

Students' suggestions about improving teaching communication skills revealed that 29 (30.6%) of the students suggested their needs for practical training of the skills and watching history-taking videos and role play, while 11(11.6%) expressed their concern about the exam and assessment in the subjects of CS, as shown in (Table-4).

 

 

 

Discussion

 

Medicine is a humane profession, and the patients need attention as much as they need diagnosis and tratement. CS encourages doctors to meet patients with a smile, choose appropriate words, be keen to understand non-verbal expressions, and to start the conversation with open-ended questions rather than closed questions.

The Arabic language was adopted in CS teaching which seems to have the potential to adversely affect the scientific level of teaching, but this approach is consistent with studies that support the introduction of local languages in the teaching of communication skills in non-English speaking societies.10,11 One of the students mentioned that he had difficulty with English terms, and when the same professor delivered that material in Arabic, there was a big difference in comprehension, and the same material became simple and smooth.

The weakness of the CS programme most identified by the students was its reliance on theoretical lecture and lack of practical work. The weak points should be studied carefully and must be addressed as the curriculum is still in its elementary stage. The repetition of explaining some concepts becomes boring for the students. The adoption of the spiral education method in teaching CS is an option, as it repeats the previous material and then builds on it the new; that completes the discussion.12

Studies have indicated that a subject with no end-of-term examination is often neglected by the students who consider it a secondary subject.13 Some students consider CS content as social, and not scientific, which is not the case.

The BMC can conduct constructive assessments in the second year, such as presenting model videos, role-playing, recording interviews, and critiquing these interviews in small groups. Students can practise the art of communication and medical history-taking in a safe environment before reaching the third year where they come into direct contact with patients. There are ways to convert patients into advisors14 which is win-win situation for both the patients and the treating physicians.

In terms of limitations, the current study did not calculate the sample size scientifically.

 

Conclusion

 

The CS curriculum was prepared in response to a real need in medical education. The introduction of the Arabic language in teaching the CS curriculum for the first time in Iraq seems to indicate early success of the CS programme.

 

Acknowledgment: We are grateful to Professor (Dr) Juliet Draper and Professor Frederic Platt for their support in establishing the programme. Thanks are also due to former Dean of BMC Professor Ahmed M. Alabassi for his support and guidance, to the Curriculum Development Committee Asst. Prof. Nazar Hadad and Prof. Abdulla M. Jawad for monitoring and evaluation, and to faculty members Asst. Prof. Alaa K. Musa, Dr. Rafid A. Muhamad and Prof. Maison Sharef for their enthusiastic teaching of the subject.

 

References

 

1.       Sultan ASS. “Arabic”, The Medical encounter and its Basic Techniques. Baghdad, Iraq: Ministry of Health Press; 2001.

2.       Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients, 2nd ed. Oxford, United Kingdom: Radcliffe Publishing Ltd; 2004.

3.       Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-36. doi: 10.1126/science.847460.

4.       Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992;156:163-5.

5.       Sultan ASS, “Arabic”, The Art of Medical Dialogue in Medical encounter, 3rd ed. Baghdad, Iraq: Ministry of Health Press; 2017.

6.       Kalitzkus V, Matthiessen PF. Narrative-based medicine: potential, pitfalls, and practice. Perm J 2009;13:80-6. doi: 10.7812/tpp/08-043.

7.       Lin CT, Platt FW, Hardee JT, Boyle D, Leslie B, Dwinnell B. The Medical Inquiry: Invite, Listen, Summarize. J Clin Outcomes Manag 2005;12:415-8.

8.       Boyle D, Dwinnell B, Platt F. Invite, listen, and summarize: a patient-centered communication technique. Acad Med 2005;80:29-32. doi: 10.1097/00001888-200501000-00008.

9.       Haidet P, Paterniti DA. "Building" a history rather than "taking" one: a perspective on information sharing during the medical interview. Arch Intern Med 2003;163:1134-40. doi: 10.1001/archinte.163.10.1134.

10.     Mazor SS, Hampers LC, Chande VT, Krug SE. Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction. Arch Pediatr Adolesc Med 2002;156:693-5. doi: 10.1001/archpedi.156.7.693.

11.     Hu A. Reflections: Using a Second Language to Build a Practice. Otolaryngol Head Neck Surg 2016;154:199-200. doi: 10.1177/0194599815618390.

12.    Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine, 2nd ed. Oxford, United Kingdom: Radcliffe Publishing Ltd; 2004.

13.     Southgate L. Assessing communication skills. In: Whitehouse C, Roland M, Campion P, eds. Teaching Medicine in the Community: A Guide for Undergraduate Education, 1st ed. Oxford, United Kingdom: Oxford University Press; 1997.

14.    Hanson JL, Randall VF. Patients as Advisors: Enhancing Medical Education Curricula. Bethesda, MD: Uniformed Services University of the Health Sciences, 2007; pp 156.

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