Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : JC15 - JC20 Full Version

Introduction of Module-based Training on Communication Skills among Interns in a Tertiary Care Teaching Hospital of Kolkata, India


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52388.16110
Sinjita Dutta, Meghna Mukherjee, Vineeta Shukla, Ankita Mishra, Ripan Saha, Subhra Sammujwal Basu, Mausumi Basu

1. Associate Professor, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 2. Statistician Cum Tutor, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 3. Resident, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 4. Resident, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 5. Resident, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 6. Associate Professor, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 7. Professor, Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Sinjita Dutta,
Eden Astor Park; Flat-B1A; 834, Uttarpurba Fartabad, Kolkata, West Bengal, India.
E-mail: sinjita@gmail.com

Abstract

Introduction: Many of the problems in Indian healthcare settings resulting in mistrust, violence, allegations and litigations against doctors can be solved by effective communication between doctors and patients or their relatives. Interaction of the students as a community physician needs training in communication skills. A structured module-based training on communication skills during internship will help the interns to communicate effectively with patients and their relatives.

Aim: To develop, introduce and evaluate a structured, validated module on communication skills for interns in a Tertiary Care Teaching Hospital of Kolkata, India.

Materials and Methods: A quasi-experimental, prospective, non randomised educational intervention study was conducted in the Department of Community Medicine at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, from January to December 2020. A structured and validated module for teaching communication skills to interns was used to train one batch of interns posted (n=40) in the department, over two days. To establish the content validity of the module, the items on content validation were rated on a scale of 1-4 by 10 experts. The validators were asked about their responses favouring face validity of the module and the average of their responses were calculated. Post-training their knowledge, skills and self-reported efficacy were assessed. Feedback from the faculty (n=6), and the interns (n=40) were collected using structured survey forms with likert scale ratings and open-ended questions. The trained cohort of interns was also assessed on communication using the SEGUE (Set the stage, Elicit information, Give information, Understand the patient’s perspective, and End the encounter) Framework during patient encounter.

Results: Post-training knowledge score (16.68±2.5) was significantly higher than the pretraining score (15.45±2.9). Also, there was significant increase in self-assessed knowledge (11.08±3.7 and 17.23±3.3) and skills (9.60±4.6 and 16±2.9) before and after the training. All the interns had positive attitude towards communication skill on the Communication Skills Assessment Scale (CSAS). The mean score of interns on assessment using the SEGUE framework was 16.6±3.59. The satisfaction index of the items on the feedback survey obtained from interns ranged from 82.5% to 93%. There was 100% agreement by the faculty on the relevance, usefulness and use of the module by other departments for communication skill training. More faculty involvement and more such sessions were suggested by both groups as evident from thematic analysis of open-ended responses to the feedback questsions.

Conclusion: The development and delivery of a structured training module on communication skills for interns improved the knowledge and skills of the interns. Both the faculty and the interns were satisfied with the module.

Keywords

Attitude, Doctor, Faculty, Feedback, Internship, Patient, Satisfaction, Self-reported efficacy

Communication is a two way process of exchanging ideas, feelings and information. It is necessary to pave way for desired change in human behaviour (1). Many problems in Indian healthcare settings occur due to lack of effective communication between doctors and patients or their relatives. This often results in mistrust, violence and allegations, and litigations against doctors. Patients expect politeness, empathy and human touch from doctors. Some of the barriers to good communication include use of medical terminology, communicating in a language that is difficult for the patient to follow, cultural insensitivity, arrogance, telephone calls, inadequate time given to the doctor-patient encounter, and interrupting the patient frequently while the patient is narrating his/her problems (2),(3),(4).

Traditionally, medical students have been learning some basic communication skills consciously or subconsciously by merely observing their teachers; however, these are unstructured, not uniform across all batches of Indian Medical Graduates (IMG) and largely inadequate to exhibit good communication skills in their professional careers (5). Another problem encountered in teaching interpersonal interactions in clinical settings is that teachers may display both positive and negative role model behaviours. These unspoken messages form part of the “hidden curriculum” and influence the behaviour of the learners (6),(7). Physicians, apart from being clinicians, must be good communicators as the very basis of doctor-patient relationship is formed on communication skill of the doctor. The acquisition of communication and interpersonal skills is recognised and documented as a core competency for physician training in many countries (8),(9),(10).

The revised regulations on Graduate Medical Education (GME)-2019 envision the IMG as a doctor of first contact of the community who possesses requisite knowledge, skills, attitudes, values and responsiveness. This requires development of competencies in the domain of knowledge, skill, attitude and communication and their reflection in daily practice for the benefit of the individual and community being served. The vision 2015 document of the MCI mentions the need to schedule dedicated time for training in communication skills for IMG (11).

In India, while this is included as a requirement in the 1997 GME regulations of the Medical Council of India (MCI), undergraduates are not being taught or assessed in most medical colleges (12). Due to this, Indian medical students often have less than adequate communication skills. In the present study institution too, there is currently lack of any structured communication skills training program for the interns. A medical student is exposed to patient care after completing all the professional examinations during internship for the first time. The communication skills of the nascent IMG are put to maximum testing during this period as he/she is exposed to patients and patients’ relatives in the hospital. So, this education innovation project was undertaken to develop and implement a structured module on communication skill training for interns.

The study hypothesised that a structured module-based training on communication skills during internship will train the interns to communicate effectively with patients and their relatives. The primary aim of the study was to develop, introduce and evaluate a structured, validated module on communication skills for interns.

Material and Methods

A quasi-experimental, prospective, non randomised educational intervention study was conducted in the Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, from January to December 2020. The batch of interns posted in the department during July to September 2020 were included in the study. Permission to conduct the study was obtained from Ethics Committee of Institute of Post Graduate Medical Education and Research, Kolkata. Informed consent form was prepared according to the requirement of the Ethics Committee and submitted. Informed written consent was obtained from the participants prior to the study. Complete enumeration was done. Total 40 interns and six faculty of the Department participated in the study.

Inclusion and Exclusion criteria: All interns who gave written consent to participate were included and those who were absent on either day of the training were excluded from the study.

Study Procedure

A module for training interns on communication skill for a total duration of six hours (two training sessions of three hours each spread over two days) was developed and validated by the faculty of the department. A core committee comprising of three faculties from the Department of Community Medicine was formed to develop the training module for interns on communication skills. This was followed by internal validation of the module by the core committee members as well as by the other faculties of the department and compilation was done by the main researcher. The final module was sent to ten experts outside the institution for external validation. The basic goal of this module was to develop the communication skills of interns so that they would be able to communicate effectively with patients and their relatives. The module was suitable for training interns on communication skills before they start their internship in batches. The competencies addressed by the module included ability to communicate adequately, sensitively, effectively and respectfully with patients in a language that the patient understands and in a manner that will improve patient satisfaction and healthcare outcomes; ability to establish professional relationships with patients and families that are positive, understanding, humane, ethical, empathetic, and trustworthy; ability to communicate with patients in a manner respectful of patient’s preferences, values, prior experience, beliefs, confidentiality and privacy and ability to communicate with patients, colleagues and families in a manner that encourages participation and shared decision making.

Data collection tools: The data collection tools included module validation forms, pre/post-training knowledge assessment questionnaire, self-efficacy questionnaire for interns and feedback questionnaires for faculty and interns as well as Communication Skill Assessment scale (CSAS) (13). The CSAS is a validated tool consisting of two subscales:

• The Positive Attitude Scale (PAS) and
• Negative Attitude Scale (NAS).

Each of these has 13 items, accompanied by a 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. The score for each scale ranges from 13-65, with higher scores indicating stronger positive or negative attitudes towards communication skills learning. The items in the scale have got good internal consistency (Cronbach’s alpha: 0.80) and satisfactory test-retest reliability.

Conducting the training workshop: The batch of interns were informed regarding the time, venue and duration of the training sessions when they reported for joining the department at the beginning of their posting, through WhatsApp. On the first day of the training workshop, pretesting of knowledge of interns regarding communication was done using the pre/post-training knowledge assessment questionnaire before beginning the training. The attitude towards communication was assessed using CSAS. Subsequently the interns were trained using the training module and appropriate TL method for two days.

Assessment of the interns: On completion of the training, knowledge of the trained interns regarding communication skills was assessed using the same pre/post-training knowledge assessment questionnaire. Feedback was obtained from the interns as well as the faculty using predesigned and pretested survey questionnaire. The trained cohort of interns was observed at the time of community medicine posting by the faculty members using the SEGUE framework during patient encounter in Outpatient Department (OPD) (14). Self-perceived improvement in knowledge and skills was recorded using predesigned and pretested questionnaire four weeks after the training.

SEGUE framework: The SEGUE framework contains 25 items divided into five content areas (set the stage; elicit information; give information; understand the patient’s perspective; and end the encounter). Total 17 of the items focus on the content. These tasks include topics to be covered or behaviours to be enacted at least once during the encounter. Each of these items is coded “YES” if the topic is covered/behaviour enacted at least once during the encounter. It is coded “NO” if it does not happen at all. The other 8 items focus on process. These are communication behaviours that should be maintained throughout the encounter. Thus each of the process oriented items is coded “NO” if the behaviour is not enacted once during the encounter.

Feedback: Feedback from interns and faculty of the Department of Community Medicine (n=6) regarding the training program was collected using validated questionnaire.

Outcome measures of the intervention:

1. A structured module for training of interns on communication skills was developed.
2. Face and content validity of the module was established.
3. Attitude of interns towards communication skills was assessed.
4. Knowledge of interns regarding communication improved after training using the module.
5. Self-perceived knowledge and skills regarding communication improved after delivery of the module.
6. Faculties were satisfied with the delivery of module based communication skills training.
7. Interns were satisfied with the training on communication skills.

Statistical Analysis

Data collected was entered in MS Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 25.0. Median of pre and post-training knowledge and self-assessment scores was determined and compared using Wilcoxon-signed rank test. Agreement on CSAS was determined. The summary scores for assessment using the SEGUE Framework were generated by assigning a value of “1” to “YES” and “0” to “NO” for each item. Mean±SD scores were calculated. Descriptive statistics was used to present the data. A p-value of <0.05 was considered to be significant.

Results

A. Analysis of Quantitative Data

Mean pretraining and post-training knowledge scores were calculated (Table/Fig 1). Post-training knowledge score (16.68±2.5) was significantly higher than pretraining knowledge score (15.45±2.9, p-value <0.002). Also, there was significant difference in self-assessed knowledge and skills regarding communication before and after the training workshop (p<0.05).

On the PAS of CSAS all the interns agreed to the fact that “learning communication skills has helped or will help facilitate team-working skills” and “learning communication skills is important because ability to communicate is a lifelong skill” while least number (70%) of interns agreed upon the fact “learning communication skills is fun. Majority of the interns (95%) disagreed on the statement “I can not see the point in learning communication skills” while over 30% agreed to the fact that “learning communication skills was too easy” and “ability to pass exams will get me through medical school rather than my ability to communicate” on NAS of CSAS. There was 100% agreement on PAS (62.5% strongly agreed while 37.5% agreed to PAS). A 65% interns had disagreement towards negative attitude (Table/Fig 2). The (Table/Fig 3) shows the mean score (16.6±3.59) of interns on post-training assessment using the SEGUE framework was.

There was 100% agreements (agree or strongly agree) on the relevance of the topics covered in the module by the interns, while 95% felt that the module achieved the learning objectives. 95% of the interns agreed on the fact that the TL methods used as well as delivery of the module by the faculty made the sessions effective. Majority (95%) of the interns felt that the training led to the improvement of their knowledge, rapport building and information eliciting capacity. However, a little above 30% were neutral on their ability to communicate effectively with patients after the training. An 80% of the interns felt adequate time was allotted for the training, while 77.5% demanded more such training sessions. The satisfaction index of the items ranged from 82.5% to 93% (Table/Fig 4).

There was 100% agreement by the faculty on the relevance, usefulness and use of the module by other departments for communication skill training. However, two out of six faculties disagreed to the adequacy of time for training. One faculty disagreed to the fact that interns will be able to use the SEGUE framework while communicating with patients, while two others remained neutral. Faculty satisfaction index (96.7) was maximum for the item “The training module will be useful for interns to communicate effectively with patients/patients’ relatives” (Table/Fig 5). A 92.5% of the interns and 100% of the faculty were overall satisfied with the training program.

B. Analysis of Qualitative Data

The themes generated from the feedback of interns and faculty were topics covered during the training which were found useful, aspects of the Training which were liked and what else could have been included in the training or suggestions for improvement (Table/Fig 6), (Table/Fig 7). The topics considered useful by both faculty and the interns included “breaking bad news, doctor-patient relationship and basic counseling”. Aspects of the program liked by both the groups were coverage of relevant topics, use of role plays and skills training. More faculty involvement and more such sessions were suggested by both groups (Table/Fig 8).

Discussion

Better patient compliance, better health outcomes, decreased litigation, and higher satisfaction both for doctors and patients are the rewards of good communication practice. Communication skill training during the formative years is challenging and can be achieved more readily during internship allowing students and faculty to see their relevance (15). More recently, the Attitude, Ethics and Communication (AETCOM) module has also identified the competencies like doctor-patients communication including counseling, breaking bad news, health education to be delivered during final years and internship (16). Realising the need for teaching communication skills to the interns, a structured module was developed and validated by the faculty of the Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, India. The module was delivered over a period of two days. The findings of the current study are similar to a study by Brahmbhatt K and Lodhiya K, (2019) in the Department of Community Medicine of a medical college of Junagadh, India, who reported a significant improvement in self-assessment of communication competence by third MBBS students after training (17). A study by Hausberg MC et al., also reported significant improvement in pre and post-training communication skills through self-assessments by psychosocial medicine students, which is similar to the present study (18). Results of a study by Tanwani R et al., among second year MBBS students reported that 96.43% of the students agreed that a course on special basic communication skills training had improved their communication skills with the patients (19). Similar findings were observed by Jagzape TB et al., in their observational study which reported a 78.46% improvement in communication skills experienced by the students (20). The current study found that 95% of the interns felt the training led to the improvement of their knowledge, rapport building and information eliciting capacity. A study by Wagner PJ et al., stated that students have reported increased confidence in their interviewing skills and clinical preceptors have reported increased levels of preparedness among students who have participated in the structured skill-based training on communication (21).

Attitude towards communication skill was assessed using CSAS. There was 100% agreement on PAS (62.5% strongly agreed while 37.5% agreed to PAS). On NAS 30% of the interns reported negative attitude, while 5% were neutral. A study by Choudhary A and Gupta V, among final year MBBS students using CSAS found that a total of 78.1% had a positive attitude toward learning communications skills, 11.3% students displayed negative attitude, and 10.6% were neutral (22). A study by Alofisan T et al., using a self-administered questionnaire developed by Harvard University for assessing attitude towards communication reported that 85% of senior level residents and 65% of junior level residents believed that learning communication skill was important, whereas in the current study 70% of the interns reported that “learning communication skills is important because ability to communicate is a lifelong skill” (23). The present study found that 92.5% of the interns and 100% of the faculty were overall satisfied with the training program, which was similar to a study by Choudhary A and Gupta V, where 90% of the students were satisfied with a teaching program on communication (22). In response to open-ended questions on feedback form, both the interns as well as the faculty liked the use of role plays for teaching communication skills. For communication skills training, instructional methods such as lectures and seminars are less effective than experiential methods supplemented with feedback (15),(24). Methods like role plays, or interaction with simulated and real patients are preferred by students as they help in reinforcing strengths and identifying weaknesses in the component skills of communication (25),(26). In the present study, the interns also requested more training time, follow-up sessions and more such programs emphasising the fact that communication skills are best learnt when taught as part of a longitudinal teaching plan rather than single occasion training (27),(28),(29). A study by Tanwani R et al., also echoed similar findings (19).

A study by Towle A and Hoffman J, found that students rated an advanced course on communication skill training highly (30). The relevance of the weekly themes was rated 4.21 on a five-point scale. The effectiveness of the SP interviews was rated 4.10 while the effectiveness of the group discussion and feedback was rated 4.18. The overall course effectiveness in enhancing communication skills was rated as 3.91.

The interns were assessed post-training using the SEGUE framework. The mean post-training score of interns was 16.6±3.59, which was similar to the findings reported by Brahmbhatt K and Lodhiya K (17). The later found the mean post-training communication skills assessment score of 16.1±2.87.

Thus, this curriculum innovation project led the researchers to develop, validate and deliver a structured module for training of interns on communication with improvement in knowledge and skills of the interns after the training.

Limitation(s)

This study was not a randomised control study. Only one batch of interns could be trained and assessed during the study period. The pretraining communication skills of the interns could not be assessed due to time and faculty constraints.

Conclusion

A structured module for communication skills training for interns was developed and validated. There was significant improvement in knowledge and skills of the interns regarding communication after delivery of the module. Both the interns as well as the faculty were satisfied with the implementation of the module.

Structured module based training on communication will lead to improvement of the communication skills of the interns. The module can be used to teach communication skills as a part of training in AETCOM. This will help the IMG to be competent in communication skills and thus lead to better doctor-patient relationship, lesser incidents of conflicts and violence and better utilisation of health services.

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DOI and Others

DOI: 10.7860/JCDR/2022/52388.16110

Date of Submission: Sep 14, 2021
Date of Peer Review: Nov 17, 2021
Date of Acceptance: Dec 21, 2021
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS: [Jain H et al.]
• Plagiarism X-checker: Sep 15, 2021
• Manual Googling: Dec 13, 2021
• iThenticate Software: Jan 19, 2022 (14%)

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