|Year : 2022 | Volume
| Issue : 1 | Page : 6-9
Clinical communication skills in India: Current trends and future perspectives
Tooba Khursheed1, L V Simhachalam Kutikuppala2, Akatya Vidushi Sinha3, Krishna Naineni4
1 Tentishev Satkynbai Memorial Asian Medical Institute, Kant, Kyrgyzstan
2 Intern, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
3 MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
4 Glocal Academy, 88 Greenlee Drive, Newcastle Upon Tyne, NE7 7GA, United Kingdom
|Date of Submission||18-Jan-2022|
|Date of Acceptance||28-Jan-2022|
|Date of Web Publication||12-Feb-2022|
L V Simhachalam Kutikuppala
Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Effective and sensitive communication by the clinicians with the patients and relatives are crucial in achieving a patient-centered consultation. Competent communication is an expertise, which all health-care professionals require, but it is the one that not all of them are obviously good at. Clinical communication skills are related to the speedy recovery of patients, provided with good adherence to the medications, and improved patient satisfaction, thereby affecting the psychological, biological, and social outcomes of the treatment. As time progressed, the situation of learning clinical communication skills has been transformed from “good to have” toward “need to have.” Teaching soft skills of communication to the medical students in a controlled environment before exposing them to real-life conditions could be the key to developing rapport with the patients, leading to more appropriate diagnosis and treatment outcomes.
Keywords: Clinical communication skills, medical education, soft skills
|How to cite this article:|
Khursheed T, Kutikuppala L V, Sinha AV, Naineni K. Clinical communication skills in India: Current trends and future perspectives. J Indira Gandhi Inst Med Sci 2022;8:6-9
|How to cite this URL:|
Khursheed T, Kutikuppala L V, Sinha AV, Naineni K. Clinical communication skills in India: Current trends and future perspectives. J Indira Gandhi Inst Med Sci [serial online] 2022 [cited 2022 Aug 8];8:6-9. Available from: http://www.jigims.co.in/text.asp?2022/8/1/6/338370
| Introduction|| |
Extensive research has proved that no amount of knowledge could ever overshadow the paramount importance of effective clinical communication skills in the field of health care. While poor communication can cause preventable fatal complications and increase malpractices costs, good communication among different health-care workers and the appropriate use of verbal as well as nonverbal tools in doctor‒patient interactions increases patient's trust, adherence, and satisfaction, thereby aiding in the delivery of high-quality care. A good doctor must possess not only experience and considerable knowledge but also the appropriate skills to strike up a strong relationship with the patient in a short time. Thus, it is critical to ensure effective communication in health-care systems and assess its three basic components: health literacy, cultural competency, and language barriers.
In the wake of the worldwide recognition of the significance of clinical communication skills, a shift from the traditional cognitive approach to a more holistic and clinical approach in the medical curriculum has been observed in recent years. Various suggestions have been put forth to seamlessly integrate communication skills training in the inaugural years of the medical course. However, future implications and the challenges of the modifications must also be prudently reviewed.
| Clinical Communication Skills Training|| |
As stated in the Medical School Objectives Project, physicians are expected to possess not only a plethora of knowledge but also altruism and effective communication skills to deliver a patient-centered care and meet the evolving global outlook on health care. Although medical trainees can get the hang of some basic interaction skills by observing their peers and seniors during clinical rotations, the acquired skill set is inadequate, presumably due to individual bias and other issues associated with the boundaries in the supervisor‒trainee relationship. To fill these gaps, it is crucial to introduce training and assessment of communication skills in medical schools. Several studies provide substantial evidence to support the efficacy of such programs.,,,
| Teaching and Assessment Methods for Clinical Communication Skills|| |
Instructional methods such as lectures and seminars have been less effective to enhance the competence of students in the field of clinical communication. However, the following tools can be employed to teach medical students the art of effective communication and enhance their performance in the health-care sector.
Training in clinical communication skills laboratory
Significant research backs up the idea that the medical staff needs to be trained in the basic spheres of communications such as history taking, breaking bad news to patients, etc., in the early years of their study, Such skills can be effectively delivered to the trainees in clinical communication skills laboratories. These are educational facilities that mimic real clinical settings and provide a protected ambience for the learners to imbibe the miniscule details of effective communication. Mannequins, patient volunteers, simulated patients, and information technology can be utilized to implement a student-centered, problem-based, and community-oriented education. Apart from enhancing acquisition, maintenance, and assessment of basic interaction skills, such exposure boosts the confidence of the students and promotes their development as better health professionals. A positive feedback from students, as reported by several studies, also emphasizes the potential benefits of clinical communication skills training laboratories., In fact, such laboratories have already been set up and integrated into the curricula in various medical institutions around the globe, following the footsteps of the University of Maastricht, Netherlands, where the first clinical skills laboratory was established.,,
Simulation-based medical education
Simulation can be defined as the reproduction of realistic processes in artificial scenarios to promote education via experimental learning. A variety of simulators, in combination with virtual reality and roleplay simulation techniques, can be adapted to enhance the competence of medical students and give them the opportunity to learn from experience. Along with providing sufficient exposure, simulation-based education can reduce the incidence of medical errors and address the need of various medical disciplines, thus facilitating teamwork and communication among trainees. Students reported to have developed a deeper understanding of diverse clinical situations through simulation-based training and demonstrated better academic performance and higher levels of confidence while interacting with patients and colleagues.
Video recordings of real and simulated clinical scenarios can be employed to initiate discussion and provide constructive feedback, facilitating the educational process.,
| Obstacles|| |
The setting up of clinical communication skills laboratories and simulation centers is quite costly. Furthermore, the technology and equipment used to replicate real-life situations for students demand high maintenance and care.,
Attitude of teachers and students
Teachers and students who are used to the traditional methods of medical study may find it difficult to comprehend the integration of clinical communication skills in the medical curriculum. To overcome this hurdle, workshops must be organized to equip the faculty as well as the students with the skill set required to supplement the communication skills of medical professionals.
Redesigning medical curriculum
To evaluate the attainment of desirable competency and communication skills, an assessment blueprint consisting of formative assessment and summative performance assessment must be prepared and administered. This necessitates redesigning both medical education and the establishment of expected outcomes in the training programs. Furthermore, the regulatory stakeholders ought to be properly aligned to facilitate the optimization of the learning environment.
| Revision of Traditional Medical Course: Global Perspective|| |
Remodeling of Indian medical study
Addressing the loopholes of Indian medical training, the Medical Council of India revised the curriculum and introduced several reforms to enhance the clinical communication skills of the students. With the goal of refining Indian primary health care and making medical education more patient centric, the use of skill laboratories, which recreate practical situations through a simulated and guided environment, are being encouraged. The new curriculum highlights the competencies which must be imbibed by the students and methods of achieving such results. A foundation course that focuses on polishing the communication skills of undergraduates. Early clinical exposure is proposed which would accomplish horizontal and vertical integration of the subjects. The Attitude, Ethics, and Communication Module has been designed to assess the efficiency and competence of the trainees. Teaching methods are also delineated to aid the delivery of appropriate skills along with an ample amount of knowledge. The implementation of these key elements promises the development of competency of Indian medical graduates and enhances community health care.,
| A Focus on Patient Safety|| |
When considering the importance of communication in health care, patient safety is one of the top reasons to create an effective communication structure in any health-care organization. According to Huntington and Kuhn, the “root cause” of malpractice claims is a breakdown in communication between physician and patient. Various hospital deaths are reported due to inadequate communication and communication errors have severe consequences. Many of these errors are preventable and easy to fix, however, utmost adherence needs to be maintained. Future of communication is in a developing phase. It is not far when future of the medical field starts to inch toward a change with a significant focus on patient engagement as a central aspect of patient care. Adopting various interventions such as widespread use of chatbots and conversational AI, a better understanding of patients through real-time data, etc., have shown certain long-term improvements.
| The Future of Clinical Communication in the Medical Field|| |
It is, however, clear that communication needs to overcome geographic and organizational boundaries. The next leap in clinical communication shall be our frontline clinicians speeding up the care by making it furthermore efficient, patient-centered, and cross-continuum collaboration. Studying cognitive phenomena in a naturalistic setting is a method of inquiry that is increasing in popularity. Spurck et al. found that nurses and physicians felt that their hospital's telecommunication system was more effective when nurses were given portable phones to carry and noted several efficiency gains. A few other studies looked at the effects of voicemail on internal and external customer satisfaction. However, the basis for individual communication choices or the cumulative effect of the choices on clinical teams or on the wider aspect of the organization was not explored well. An exception is a study by Coiera and Tombs, who observed that the communication behaviors of individuals in hospital teams are often individually inefficient or unsuccessful and, when taken as a whole, result in an interrupt-driven environment in the organization. These findings could exponentially add to the development and the molding of clinical communication scenarios in future.
| Conclusion|| |
Learning and mastering clinical communication skills have been reshaped from “good to have” toward “need to have” condition for a clinician. All clinicians and medical students should acknowledge and appreciate the importance of effective and competent communication with the patients, improving their practice and saving the lives of patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tiwary A, Rimal A, Paudyal B, Sigdel KR, Basnyat B. Poor communication by health care professionals may lead to life-threatening complications: Examples from two case reports. Wellcome Open Res 2019;4:7.
Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Soc Sci Med 1995;40:903-18.
Glynn M. Doctor and patient: General principles of history taking. In: Glynn M, Drake W, editors. Hutchison's Clinical Methods. 23rd
ed. UK: Saunders Elsevier; 2012. p. 3-14.
Ratna H. The importance of effective communication in healthcare practice. Harvard Public Health Rev 2019;23. [online]
Devasiri V, Bodinayake C. Integrated Medical Curriculum: Need of introducing clinical medicine in the first year of teaching. Galle Med J 2009;12:42-4.
Modi JN, Anshu -, Chhatwal J, Gupta P, Singh T. Teaching and assessing communication skills in medical undergraduate training. Indian Pediatr 2016;53:497-504.
Sanson-Fisher R, Maguire P. Should skills in communicating with patients be taught in medical schools? Lancet 1980;2:523-6.
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.
Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I. Enduring impact of communication skills training: Results of a 12-month follow-up. Br J Cancer 2003;89:1445-9.
Keifenheim KE, Teufel M, Ip J, Speiser N, Leehr EJ, Zipfel S, et al.
Teaching history taking to medical students: A systematic review. BMC Med Educ 2015;15:159.
Hannah A, Millichamp CJ, Ayers KM. A communication skills course for undergraduate dental students. J Dent Educ 2004;68:970-7.
Geoffroy PA, Delyon J, Strullu M, Dinh AT, Duboc H, Zafrani L, et al.
Standardized patients or conventional lecture for teaching communication skills to undergraduate medical students: A randomized controlled study. Psychiatry Investig 2020;17:299-305.
Fan Z, Chen L, Meng L, Jiang H, Zhao Q, Zhang L, et al.
Preference of cancer patients and family members regarding delivery of bad news and differences in clinical practice among medical staff. Support Care Cancer 2019;27:583-9.
Al-Elq AH. Medicine and clinical skills laboratories. J Family Community Med 2007;14:59-63.
Jagzape TB, Jagzape AT, Vagha JD, Chalak A, Meshram RJ. Perception of medical students about communication skills laboratory (CSL) in a rural medical college of Central India. J Clin Diagn Res 2015;9:JC01-4.
Upadhayay N. Clinical training in medical students during preclinical years in the skill lab. Adv Med Educ Pract 2017;8:189-94.
Remmen R, Scherpbier A, van der Vleuten C, Denekens J, Derese A, Hermann I, et al.
Effectiveness of basic clinical skills training programmes: A cross-sectional comparison of four medical schools. Med Educ 2001;35:121-8.
Soliman MM, Fouda K. Students' perception of one year experience with the clinical skills laboratory at King Saud University Medical College. J Taibah Univ Med Sci 2008;3:140-7.
Al-Elq AH. Simulation-based medical teaching and learning. J Family Community Med 2010;17:35-40.
Abas T, Juma FZ. Benefits of simulation training in medical education. Adv Med Educ Pract 2016;7:399-400.
Chacko VT. Moving toward competency-based education: Challenges and the way forward. Arch Med Health Sci 2014;2:247-53. [Full text]
Caverzagie KJ, Nousiainen MT, Ferguson PC, Ten Cate O, Ross S, Harris KA, et al.
Overarching challenges to the implementation of competency-based medical education. Med Teach 2017;39:588-93.
Supe A, Burdick WP. Challenges and issues in medical education in India. Acad Med 2006;81:1076-80.
Jacob KS. Medical council of India's new competency-based curriculum for medical graduates: A critical appraisal. Indian J Psychol Med 2019;41:203-9.
] [Full text]
Kumar S. Implementation of new curriculum in U.G (M.B.B.S): A dream project of medical education technology. Int J Med Sci Educ 2019;6:8-12.
Chacko VT, Dongre RA. A critical review of new competency-based curriculum for community medicine using various curricular review frameworks. Indian J Public Health 2019;63:362-6.
] [Full text]
Huntington B, Kuhn N. Communication gaffes: A root cause of malpractice claims. Proc (Bayl Univ Med Cent) 2003;16:157-61.
Clark-Carter D. Doing Quantitative Psychological Research: From Design to Report. Philadelphia, Pa.: Psychology Press; 1997.
Spurck PA, Mohr ML, Seroka AM, Stoner M. The impact of a wireless telecommunication system on time efficiency. J Nurs Adm 1995;25:21-6.
Hoban L. Humanizing voice mail in healthcare. J Nurs Adm 1999;29:50-6.
Coiera E, Tombs V. Communication behaviours in a hospital setting: An observational study. BMJ 1998;316:673-6.