Shilpa Khandare et al IJSRE Volume 05 Issue 01 January 2018 Page 7799 Volume||6||Issue||01||January-2018||Pages-7799-7807||ISSN(e):2321-7545
Website: http://jsae.in
Index Copernicus Value- 76.10 DOI: http://dx.doi.org/10.18535/ijsre/v6i1.05
“Effectiveness of Communication skills training in Intern Physiotherapy students”
Authors
Shilpa Khandare 1, Tushar Palekar2, Reema Joshi3, Roopa Desai4 Vishnu Vardhan
1
Associate Professor, Dr. D.Y.Patil College Of Physiotherapy, Dr. D.Y.Patil Vidyapeeth Pune, India
2
Ph.D, Principal, Dr. D.Y.Patil College Of Physiotherapy, Dr. D.Y.Patil Vidyapeeth Pune, India
3
Assistant Professor, Dr. D.Y.Patil College Of Physiotherapy, Dr. D.Y.Patil Vidyapeeth Pune, India
4
Assistant Professor, Dr. D.Y.Patil College Of Physiotherapy, Dr. D.Y.Patil Vidyapeeth Pune, India
5
Assistant Professor, Dr. D.Y.Patil College Of Physiotherapy, Dr. D.Y.Patil Vidyapeeth Pune, India *Corresponding Author
Shilpa Khandare
email- [email protected]
INTRODUCTION
“Listen to your patient, he is telling the diagnosis”. This statement provided 1904 by Osler, has driven communication skills training in the last decades. But communicating is a complex task, one that has to be refined throughout a lifetime. Taking this seriously, we would need to teach students skills to „make the patient talk‟.
These efforts have been resting on ideas on thinking, learning and professional development introduced. by Dewey (1933). The self-reflection process starts with an experience and is followed by the meta cognitive activities of reviewing, analyzing and planning (Koole et al., 2011; Sandars, 2009). Unfortunately this line of research has not provided empirical evidence that encouraging the thinking about one‟s own thinking and actions, as self-reflection is also described, helps in actually identifying own strengths and weaknesses. On the contrary, other researchers, focusing also on student‟s ability in identifying strengths and weaknesses, found that subjects are not always accurate in self-judgments of knowledge and skills .But how may we facilitate students to use suitable cues when judging their communication with patients? Communicating with patients is a complex task making it difficult to define a situation narrowly. This problem is best illustrated by the discussion on whether execution of communication skills will eventually lead to skilled communication (Salmon & Young, 2011).
Shilpa Khandare et al IJSRE Volume 05 Issue 01 January 2018 Page 7800
changes in the culture of medical education have facilitated the emergence of medical interviewing courses that focus specifically on developing the interpersonal skills needed for efficient and effective medical interviewing5. Building the relationship
To build and maintain an effective doctor-patient relationship1,2 An effective partnership serves as the foundation for the rest of the interview, throughout the assessment and management process.
Assessing the patient‟s problems
To obtain information to assess the patient‟s problems, three fourth of all diagnosis can still be made based on the history alone ,despite the technologic innovations of modern medicine.14 .The skillful physician uses data-gathering skills to assess the patient‟s problems and arrive at diagnostic formulations.
Managing the patient’s problems
To educate patients and to motivate them to adhere to treatment recommendations. Successful management requires the use of educational, negotiation, and motivational skills in the interview. Patients do not understand their doctors very well. For example when patients are asked to discuss their illness and its treatment(even immediately after leaving their physicians‟ offices)they can correctly identify only about 50%of the critical information.17 Physicians who learn to communicate information better will have patients who understand more about their illness and who will be more likely to adhere to treatment recommendations.18
Significant shortcomings have been noted in the literature in communication skills training for practicing doctors. Given the importance of competent communication to the doctor-patient relationship and health care in general, these shortcomings should be addressed in future research.
CONTEXT OF THE STUDY:-
Interview training programs in medical schools have undergone significant evolution in recent years .Previously many of these courses were focused on history taking as the principal goal of the communication process it is the only one of the three core functions of the interview .The emotional and adhere-management domains of the encounter were omitted. The courses did not address the specific skills students needed to master in order to obtain this information efficiently; courses tended to focus on the results or “content” of the interview rather than on the skills needed or “process” of how to get the information3
. Thus we under took this study to understand conceptual framework for the medical interview that would help students organize the complexities of the communication process5.
METHODS
Written consent was taken from the students and individuals satisfying the inclusion criteria were selected. Institutional Ethical committee clearance was obtained for Intern BPT batch of 52 students.
All participating faculty were trained in the new method of assessment of the Students by using RANZCOG Assessment of communication Skills.
Pre assessment of the Intern BPT students was taken on the basis of RANZCOG Assessment of communication Skills by the participating faculty. Each encounter was of 15-20 minutes for RANZCOG Assessment of communication Skills and 5 minutes were kept for feedback to the students.
Lectures and role play was taken on introduction and effectiveness of communication skills for Interns BPT students.
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Post assessment of the Intern BPT students was taken on the basis of RANZCOG Assessment of communication Skills by the participating faculty.
Each encounter was of 15-20 minutes for RANZCOG Assessment of communication Skills and 5 minutes were kept for feedback to the students.
Statistical analysis: data collected will be analyzed using SPSS version-17.
RESULTS
A total of 52 Intern students were participated in this study. Pre and Post assessment of the Intern BPT students was taken on the basis of RANZCOG Assessment of communication Skills by the 7 participating faculty. Pre and Post assessment data when studied on applying t test it showed Statistically significant improvement with p value 0.000.
Q. B Poor Fair Good V. Good Excellent
PRE 23 29 0 0 0
POST 0 2 24 15 10
0 20 40
Poor Fair Good V. Good Excellent
Q.A- Builds a Relationship
PRE
POST
0 5 10 15 20 25 30
Poor Fair Good V. Good Excellent
Q.B Opens the discussion
PRE
POST
Q. A Poor Fair Good V. Good Excellent
PRE 29 23 0 0 0
Shilpa Khandare et al IJSRE Volume 05 Issue 01 January 2018 Page 7802
Q. E Poor Fair Good V. Good Excellent
PRE 6 46 0 0 0
POST 0 5 21 15 11
0 5 10 15 20 25 30
Poor Fair Good V. Good Excellent
Q.C Gathers information
PRE
POST
0 50
Q.D Understands the patient
PRE
POST
0 10 20 30 40 50
Poor Fair Good V. Good Excellent
Q.E Shares Information
PRE
POST
Q. C Poor Fair Good V. Good Excellent
PRE 29 23 0 0 0
POST 0 3 29 15 5
Q. D Poor Fair Good V. Good Excellent
PRE 44 8 0 0 0
Shilpa Khandare et al IJSRE Volume 05 Issue 01 January 2018 Page 7803
Q. F Poor Fair Good V. Good Excellent
PRE 43 9 0 0 0
POST 0 4 22 23 3
Q. G Poor Fair Good V. Good Excellent
PRE 11 41 0 0 0
POST 0 4 22 19 7
By Applying Paired t test
Q. A Builds a Relationship
0 50
Q.F Reaches Agreement
PRE
POST
0 20 40 60
Poor Fair Good V. Good Excellent
Q.G Provides Closure
PRE
POST
Group Mean Std Dev SEM
52 1.442 0.5015 0.06955 52 3.75 0.789 0.1094
Difference -2.308 0.8975 0.1245
95% confidence interval for difference: -2.558 to -2.058
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Q.B Opens the discussion
Group Mean Std Dev SEM 52 1.558 0.5015 0.06955 52 3.615 0.8667 0.1202
Difference -2.058 1.018 0.1411
95% confidence interval for difference: -2.341 to -1.774
t = -14.579 with 51 degrees of freedom; P = 0.000 Q. C Gathers information
Mean Std Dev SEM
52 1.442 0.5015 0.06955 52 3.423 0.7501 0.104
Difference -1.981 0.8282 0.1148
95% confidence interval for difference: -2.211 to -1.75
t = -17.247 with 51 degrees of freedom; P = 0.000 Q. D Understands the patient
Group Mean Std Dev SEM
52 1.154 0.3643 0.05052 52 3.615 0.9321 0.1293
Difference -2.462 1.038 0.1439 95% confidence interval for difference: 2.75 to -2.173
t = -17.105 with 51 degrees of freedom; P = 0.000
Q.E Shares Information
Q.F Reaches Agreement
Group Mean Std Dev SEM
52 1.885 0.3226 0.04474 52 3.923 0.7369 0.1022 Difference -2.038 0.8848 0.1227
95% confidence interval for difference: -2.285 to -1.792 t = -16.614 with 51 degrees of freedom; P = 0.000
Group Mean Std Dev SEM
52 1.173 0.382 0.05297 52 3.481 0.7273 0.1009 Difference -2.308 0.8053 0.1117
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Q.G Provides closure
DISCUSSION
Communicating effectively and being aware of one‟s strengths and weaknesses are some of the physicians‟ key competencies. The goal of the research presented in this proposal is to investigate the effect of Communication skills training in Interns Physiotherapy students.
The evidence base of medical communication has been underdeveloped and the field was felt to be in need for thorough empirical investigation. Studying medical communication can help to clarify what happens during medical encounters and, subsequently, whether the behavior displayed is effective. However, before effectiveness can be established, one should argue what functions or goals the communication has and what outcomes are relevant in medical communication research. de Haes H1
Previous studies have isolated the skill of empathy. one qualitative study examined how patients present clues rather than verbalise their emotions and how physicians respond to these clues (levinson, GorawaraBhat and lamb 2000). this study found physicians frequently missed opportunities to respond to patient emotions and to strengthen the patient–physician relationship, as did suchman et al (1997).
While the frequent use of terminators aligns with the model derived from the study of doctor–patient interviews, the reasons for this phenomenon may well be different for doctors and medical students. The authors of the model assert that the prioritising of objective data throughout medical training, and the „quest for control over subjective experience‟ (Suchman at al 1997: 682), is possibly a major reason for the lack of empathic responses in doctors. The argument is that doctors are so concerned about their diagnostic agenda that they neglect patient emotions. Our data consists of CALD (culturally and linguistically diverse ) students at the very beginning of their medical course, taking a social history, with no training in diagnostic interviewing and no pressure to arrive at a diagnosis. Nonetheless, there appears to be a similar pattern of preference for biomedical or purely factual content. The similarity in behaviour between medical students and doctors may be related to the fact that medical students achieve high academic results in science subjects, which predisposes them to focus on the biomedical or factual content of the interview, rather than the emotional.
Furthermore, our teaching experience suggests that, regardless of cultural or linguistic background, students are often uncomfortable about asking patients for personal information, particularly of an emotional and/or sexual nature. Differences between medical students and simulated patients in age, gender, cultural background and life experiences may lie behind the use of terminators and limited empathic responses on the part of the students. Further research interviewing students after their exams with actor/patients would be needed to test this hypothesis.
The researchers added the category limited empathic response to the model to describe the ways in which CALD medical students unsuccessfully attempt to show empathy. This category may be related to linguistic or cultural influences. Although all students, when placed under pressure in exam conditions, have the potential to resort to limited empathic responses, our teaching experience suggests that
Group Mean Std Dev SEM
52 1.788 0.4124 0.05719 52 3.558 0.8264 0.1146
Difference -1.769 1.041 0.1443 95% confidence interval for difference: -2.059 to -1.48
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CALD students may offer limited empathic responses because they are processing patient information more slowly, translating in their heads, searching for the right phrasing and/or encountering culturally challenging ideas from patients. Examples of culturally challenging ideas were the notion of a woman deliberately choosing to be a single mother and not anticipating marriage (Case 1) and the idea that the husband, not the wife, was seeking more children and gaining fulfilment from his family rather than work (Case 2).
Further research is needed to understand if limited empathic responses are, in fact, more characteristic of CALD students and, if so, whether this is due to cultural and/or linguistic factors. If further research comparing the performance of CALD and local students shows that CALD students have a particular style of responding to patient emotions, and if this style is due to cultural and/or linguistic factors, then targeted cross-cultural training would be recommended.
Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations. By linking specific communication elements to concrete endpoints within the six function model of medical communication, communication will become better integrated within the process of medical care. This is helpful to medical teachers and motivational to medical students. This approach can provide the place to medical communication it deserves in the center of medical care.
LEARNING EXPERIENCE WHILE CARRYING OUT THE PROJECT
Availability of faculty for training in the new method of assessment of the Students along with Pre assessment and Post Assessment of the Students by using RANZCOG Assessment of communication Skills was a difficult task. Overall study was conducted very smoothly and all the teachers participated willingly with full cooperation.
CONCLUSION
Thus the study concludes that the Communication skills has a central role in clinical practice .A good doctor must be a good communicator. He should be able to collect accurate information in an efficient manner, to demonstrate sufficient emotional support so as to relieve acute distress and facilitate the development of trust .He should be able to educate the patient about the illness and encourage adherence to treatment recommendation are effective to develop Communication skills training in Interns Physiotherapy students.
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