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 Table of Contents  
MINI-REVIEW ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 2-4  

Communication skills courses: A plea for inclusion in the medical curriculum


Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication13-Apr-2012

Correspondence Address:
Mohammad Y AL-Shehri
Professor of Surgery, College of Medicine, King Saud University, P. O. Box 245, Riyadh 11411
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.94976

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  Abstract 

Communication is an essential skill in the armory of any worker in the health field. It is an integral part of the skills required, not only in medical doctors, but in all health workers. Communication is more than history taking; it includes all methods of interaction with patients, patient's relatives, members of the health care team, and the public. Many studies stressed that the main complaints of patients are related to communication problems and not to clinical competency. This has contributed to an increase in the number of law suits, non-adherence to medical regimens, and the tendency of patients to keep changing physicians and hospitals. Also, it has been shown that health outcome is positively affected by proper communication. This includes patient's satisfaction and cooperation, decrease in treatment duration, decrease in painkillers requirements, and decrease in hospital stay. Also, it has been shown that communication skills can be taught and important changes in physician's behavior and in their communication skills have been demonstrated after courses of communication skills. Thus, many medical colleges in the world are including communication skills courses in their undergraduate and graduate curricula. We should do the same in our medical colleges in Saudi Arabia.

Keywords: Communication skills, medical curriculum, Saudi Arabia


How to cite this article:
AL-Shehri MY. Communication skills courses: A plea for inclusion in the medical curriculum. Saudi J Health Sci 2012;1:2-4

How to cite this URL:
AL-Shehri MY. Communication skills courses: A plea for inclusion in the medical curriculum. Saudi J Health Sci [serial online] 2012 [cited 2022 Jan 24];1:2-4. Available from: https://www.saudijhealthsci.org/text.asp?2012/1/1/2/94976


  Introduction Top


Communication is an essential skill in the armory of any worker in the health field. It is an integral part of the skills required, not only in medical doctors, but in all health workers. [1],[2] Communication is more than history taking and eliciting signs and proper communication requires adequate knowledge, suitable skills, and the right attitude.

The importance of formal teaching of communication skills has been recognized. Many medical colleges in the world and an increasing number of nursing schools have included communication skills courses in their undergraduate as well as postgraduate curriculum. [2],[3] This paper is a review of the issue of communication skills from the following points of view:

What are communication skills?

What is the importance of communication skills in the health care?

Can communication skills be taught?

How can communication skills be taught?

What are communication skills?

History taking is an essential component of communication by which information can be retrieved from patients. But, communication with patients is more than just history taking; it includes all methods of interaction with patients. This includes the ability to:

  • Take a complete history of the disease including past, social, and family history.
  • Discuss diagnosis, treatment options, prognosis, and possible complications.
  • Understand the physical, psychological, social, and religious concerns and needs of patients.
  • Convey trust, comfort, and relieve mental blocks.
  • Deliver bad and distressing news.
  • Deal with ethical and controversial issues.
  • Deal with difficult or distressed patients and their relatives.
  • Communicate with patient's relatives, colleagues, health workers, administrators, and decision makers.


What is the importance of communication skills in the health care?

The Toronto Consensus statement stressed that the main complaints of patients are related to communication problems and not to clinical competency. [4] Furthermore, substantial communication deficiencies were noticed in physicians including residents and trainees. [4] Similarly, the main remark made by patients in the primary health care centers in Riyadh was that physicians were not listening enough to their complaints. [5] The magnitude of the problem of poor communication is demonstrated by the increase in patient's complaint, the increasing number of law suits against doctors and hospitals, the tendency of patients to keep changing physicians and hospitals, and non-adherence to medical regimen. [4],[6],[7] The association between specific communication patterns and law suits was found in a study done on primary care physicians. [8] Many hospital administrators, heads of departments and other health care leaders will testify to the fact that a great deal of their daily energy is spent in issues related to patient's complaints. The majority of these are related to poor communication and most of them could have been solved by a proper communication. Another important observation is the tendency of the same person to have one complaint against him after another. Many of these are related to a fault in communication rather than a mistake in management.

Effect on health outcome

Many studies reiterate that effective communication and relationship-building are important in the delivery of high-quality health care. [9],[10],[11] Stewart, [11] in a review of several studies about effective physician-patient communication and health outcome concluded that health outcome is positively affected by probing the thoughts, feelings, and expectations of patients, encouraging them to ask questions, and allowing patients to share in the decision making. These effects are documented in the reduction of anxiety, psychological distress, pain relief, symptom resolution, mood improvement, and reduction of high blood pressure. Improved communication has also been shown to increase satisfaction of patients, cooperation of patients, decrease in the duration of treatment, decrease in the intake of painkillers, and decrease in hospital stay. [12],[13],[14],[15]

Can communication skills be taught?

Evidence is clear that communication skills of physicians can be changed and this change can last. [16],[17],]1[8] Important changes in physicians' behavior and in their communication skills have been demonstrated after a short course of communication skills. [19] In a recent review of communication skills training, it was shown clearly that there was strong evidence for the positive effect of communication skills training. [2] This includes medical students, students of dentistry, nursing students, junior doctors, senior doctors, and oncology nurses. [2] Furthermore, it was shown that students, who scored least on the pretest, benefited the most. [2]

The General Medical Council in UK and the Association of American Medical Colleges recommend that communication skills training should be an integral part of any medical curriculum. [1],[3] Communication skills are an obligatory course in 139 medical schools in the United States of America, 26 of these as a separate course. The other 25 medical schools offer communication skills as an elective. [20] In Canada, all the 17 medical schools offer the course as an obligatory part of the curriculum. [20]

How can communication skills be taught?

There is some evidence to suggest that short courses of one day or less are not sufficient. [2] Also, learning communication skills during clinical rotations is probably more beneficial than in the pre-clinical period. [2] Learning by doing has been shown to be more effective than by the traditional lecture approach and feedback is valuable in the learning process. [21],[22],[23] Therefore, experiential methods should be used rather than the traditional instructional methods. Video tape or audio tape recordings can be used for demonstrations. Consultations can be done using real patients, simulated patients, or even role plays. [24] The most commonly used teaching methods in the British medical colleges are tutorials, video feedback, role playing, and lectures. [25],[26],[27] Some communication skills teaching models have been well described in the literature, with instructions on how to teach the model. [24] One can choose among these according to the objectives of the course. [24]


  Conclusions Top


Communication skills are an important component of the learning objectives of medical doctors and health care workers in general. The lack of which can adversely affect the health outcome of patients. Similarly, it can be a source of conflict, stress, and waste of resources. Communication skills can be taught and many medical colleges in the world are including communication skills courses in their undergraduate and graduate curricula. We should do the same in our medical colleges in Saudi Arabia.

 
  References Top

1.General Medical Council, UK, Education Committee. Tomorrow's Doctors. London, General Medical Council. Available from: http://www.gmc-uk.org/education/undergraduate/undergarduate_ policy/tomorrows_doctors.asp. [Last accessed on 1993].  Back to cited text no. 1
    
2.Aspegren K. Teaching and learning communication skills in medicine: A review with quality grading of articles. Med Teach 1999;21:563-70.  Back to cited text no. 2
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3.Association of American Medical Colleges. Contemporary Issues in Medicine: Communication in Medicine. Medical Schools Objectives Project, Report III, Washington, DC: Association of American Medical Colleges; 1999.  Back to cited text no. 3
    
4.Simpson M, Buckman R, Stewart M, Maguir, P, Lipkin M, Novack D, et al. Doctor-patient communication: The Toronto consensus statement. Br Med J 1991;303:1385-7.  Back to cited text no. 4
    
5.Saeed AA, Mohammed BA, Magzoub ME, Al-Doghaither AH. Satisfaction and correlates of patients' satisfaction with physicians' services in primary health care centers. Saudi Med J 2001;22:262-7.  Back to cited text no. 5
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6.Vincent C, Young M, Phillips A. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 1994;343:1609-13.  Back to cited text no. 6
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7.Meryn S. Improving communication skills: To carry coals to newcastle? Med Teach 1998;20:331-6.  Back to cited text no. 7
    
8.Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA Am Med Assoc 1997;277:553-9.  Back to cited text no. 8
    
9.Roter DL, Hall JA, Katz NR. Relations between physician's behaviors and analogue patient's satisfactions, recall, and impressions. Med Care 1987;25:437-51.  Back to cited text no. 9
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10.Bertakis KD, Roter D, Puntnam SM. The relationship of physician medical interview style to patient satisfaction. J Fam Pract 1991;32:175-81.  Back to cited text no. 10
    
11.Stewart MA. Effective physician-patient communication and health outcome: A review. Can Med Assoc J 1995;152:1423-33.  Back to cited text no. 11
    
12.Egbert LD, Batitt GE, Welch CE. Reduction of postoperative pain by encouragement and instruction of patients. New Engl J Med 1964;270:825-7.  Back to cited text no. 12
    
13.Eisenthal S, Lazare A. Evaluation of the initial interview in a walk-in clinic. J Nerv Ment Dis 1976;162:169-76.  Back to cited text no. 13
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14.Mumford E, Schlesinger HJ, Glass GV. The effect of psychological intervention on recovery from surgery and heart attacks: An analysis of the literature. Am J Public Health 1982;72:141-51.  Back to cited text no. 14
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15.Van Dalen J, Bartholomeus P, Kerkhofs E, Lulofs R, van Thiel J, Rethans JJ, et al. Teaching and assessing communication skills in Maastricht: The first twenty years. Med Teach 2001;23:245-51.  Back to cited text no. 15
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16.Stewart MA. What is a successful doctor-patient interview? A study of interactions and outcomes. Soc Sci Med 1984;19:167-75.  Back to cited text no. 16
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17.Maguire P. Can communication skills be taught? Br J Hosp Med 1990;43:215-6.  Back to cited text no. 17
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18.Roter DL, Hall JA, Kerr DE, Barker R, Cole KA, Roca RP. Improving physicians interviewing skills and reducing patient's emotional distress: A randomized clinical trial. Arch Intern Med 1995;155:1877-84.  Back to cited text no. 18
    
19.Levinson W, Roter DL. The effect of two continuing medical education program on communication skills of practicing primary care physicians. J Gen Intern Med 1993;8:318-24.  Back to cited text no. 19
    
20.Curriculum Directory. Association of American Medical Colleges 1997-1998.  Back to cited text no. 20
    
21.Maguire P, Clarke D, Jolly B. An experimental comparison of three courses in history-taking skills for medical students. Med Educ 1977;11:175-82.  Back to cited text no. 21
    
22.Maguire P, Roe P, Goldberg D, Jones S, Hyde C, O'Dowd T. The value of feedback in teaching interview skills to medical students. Psychol Med 1978;8:695-704.  Back to cited text no. 22
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23.Maguire P, Fairbairn S, Fletche C. Consultation skills of young doctors: 1 - benefits of feedback training in interviewing as students persist. Br Med J 1986;292:1573-6.  Back to cited text no. 23
    
24.Snadden D, Ker JS. Communication skills. A practical guide for medical teachers. London: Churchill Livingstone; 2001.  Back to cited text no. 24
    
25.Whitehouse CR. The teaching of communication skills in United Kingdom Medical Schools. Med Educ 1991;25:311-8.  Back to cited text no. 25
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26.Consensus Statement from the Workshop on the Teaching and Assessment of Communication Skills in Canadian Medical Schools. Can Med Assoc J 1992;147:1149-52.  Back to cited text no. 26
    
27.Frederikson L, Bull P. An Appraisal of the current status of communication skills training in British Medical Schools. Soc Sci Med 1992;34:515-22.  Back to cited text no. 27
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