1Medical Student, Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
2Education Development Center, Golestan University of Medical Sciences, Gorgan, Iran
3Nursing Research Center
Golestan University of Medical Sciences
Background: Communication is a human skill that can develop through learning and teaching, Although, this is an integral component of clinical activities of physicians, still the dominant attitude in medical education is biological. There is a little attention to communication skills in formal medical education program. The aim of this study was to determine communication skills and professionalism of medical students of Golestan University of Medical Sciences by self-assessment. Methods: In this cross-sectional study in 2009, eighty medical students through non-random sampling were studied. The data collected by a valid and reliable questionnaire contained demographic, communication skills, and professional behaviors questions. Results: Eighty% of the students were female and the mean age of them was 22.3 years. 2.5% of the students evaluated their communication skills at average level, 25% good, 56.2% very good, and 16.2% excellent. None of students were assessed as weak in communication skills. 48.8% of the students evaluated their professionalism as "good". The relationships among communication skills, professional behavior, and demographic date were not statistically significant (p>0.05). Conclusions: Some of the evidences indicate that in spite of positive attitudes of physicians to having good behavior with patients, failure is common. Although the students evaluated their communication skills and professional behaviors at good level, however they were not in touch with real professional situations as the same independent physician.
Communication is a human skill which can be developed by training and learning, this development appears as communicative skill (1). These skills are inseparable parts of physician’s clinical activities. Studies have shown that 60 to 80 percent of disease diagnoses and treatment decisions are done and made based on the physician’s interview (2). An interview in which human communications play a basic role. Unsatisfied patients do not follow medical prescriptions very much, care their treatment process less, and are more likely to change their physician (3). Based on these studies it seems that physicians are not trained enough in the case of general communication skills and on the other hand communication skills are mostly acquisitive and educatable and clinical experience plays a lesser role in its development (4). Also the relationship and interaction of the physician with the patient play a more effective role in patient’s satisfaction, treatment results, medical expenses, physician’s clinical qualification, and complaints from physicians. The reflection of day by day increasing emphasis on communication skills in medicine and medical education can be observed in international communities statements, medical faculty tips, and educational and professional standards of physicians (6, 5).
A review of the courses of different degrees of medicine shows that these skills are not included in the formal curriculum of medical education in Iran and physicians’ education are mostly based on indirect and experimental patterning from professors with a majorly bio-medical viewpoint (7, 8). Followers of socio-psycho-biological model believe that a comprehensive understanding of the patient and treatment success depend on not only physicians’ enough information of the patients’ medical status, but also psychological, social, and cultural data must be included as well (6). A lot of studies have shown that failure of the treatment team specially physicians and other staff in making the appropriate relationship with patients not only costs a lot but also makes patients unsatisfied. Also studies have expressed that examinations less than 10 minutes prevent making an appropriate relationship and doing a through and passionate examination and decrease patients’ satisfaction. Of course a lot of physicians have a positive point of view toward the principle of making a relationship with patients but lack communications skills (7, 9).
In today’s world professionalism in medicine has become very meaningful and important and is a vast concept (10). Professionalism is considered as the collection of behaviors which cause trust and certainty in interactions among physician, patient, and society. The main dimensions of professionalism can be considered as humanism, being responsible, honor, reliability, respecting others, job promotion, and justice (11). Content, process, and comprehension skills are different kinds of communication skills. Content and process skills are mostly interpersonal.
As professionalism and communication are humanistic skills and inseparable parts of clinical skills of physicians, therefore we determined to study communication skills and professionalism among medical students.
This study was a descriptive, cross sectional one and sampling was done among fourth year and higher medicine students in Golestan University of Medical Sciences in 1388. The including criteria were at least one term of internship in hospital and relationship with the patients.
Data collection tool was a questionnaire including two parts which were 18 questions on demographic information, age, gender, ethnicity, marital status, and educational status including degree. The second part of the self-assessment questionnaire which assessed communication skills and professionalism of medical students included 11 questions which were derived from Simon et al.’s study (12). The questionnaire was translated and its content validity was determined with faculty members’ comments and its reliability was achieved through Alpha Cronbach coefficient which was 0.86. The questionnaire was distributed among 100 students and 80 of them were filled completely and turned back. Data was analyzed through T-test, qui-square, and Regression Logistic.
The average age of participants was 22.28 (19-36 years old). 80% Torkman and from the point of marital status 91.3% were single. 2.5% of the students assessed themselves as about average from the point of communication skills, 25% good, 56.2% very good, and 16.2% excellent. None of the students assessed himself as weak. 48.8% of students assessed themselves good at professionalism. There was not a statistically significant relationship among variables, communication skills, and students’ professional behavior (P>0.05).
Table 1. The frequency of Communication Skills and Professionalism among Medical Students in Golestan University
Communication Skills and Professionalism
As table number one shows, the largest percent of medical sciences students assessed themselves as very good in communication and professional skills in making a relationship with the patient.
As table number two shows starred statements got the highest scores by the students in self-assessment. They included talking to the patient in simple words, greeting and behaving politely, not ignoring patients while talking to them, and alerting them while doing examination. On the other hand unstarred statements had the lowest average. They included helping in making decisions for the disease, explaining hows, and whys of the illness, telling the patient the necessary things they should know.
Table 2. The Mean & Standard deviation of Communication Skills and Professionalism itmes among Medical Students in Golestan University
The items of professionalism behavior of the students
Telling them everything; being truthful, upfront and frank; not keeping things from them that they should know
Greeting them warmly; calling them by the name they prefer; being friendly, never crabby or rude
Treating them like they're on the same level; never "talking down" to them or treating them like a child
Encouraging them to ask questions; answering them clearly; never avoiding their questions or lecturing them
Showing interest in them as a person; not acting bored or ignoring what they have to say
Warning them during the physical exam about what you are going to do and why; telling them what you find
Discussing options with them; asking their opinion; offering choices and letting them help decide what to do; asking what they think before telling them what to do
Letting them tell their story; listening carefully; asking thoughtful questions; not interrupting them while they're talking
Explaining what they need to know about their problems, how and why they occurred, and what to expect next
Using words they can understand when explaining their problems and treatment; explaining any technical medical terms in plain language
How would you rate your level of professionalism?
* The highest scores of the students
The results showed that generally 56.2% of the students assessed themselves as very good in communication skills, and there was not a significant relationship among variables, communication skills, and professional behaviors of the students. In a study comparing the patients’ and clinical faculty members of medical faculty viewpoints toward patient-centeredness, there was a significant difference in physician and patient relationship. Thus, according to different viewpoints of clinical faculty members and patients, they suggested holding patient and physician communication skills workshops, therefore with appropriate training of physicians the social need of changing the type of relationship of patient and physician would be fulfilled (13). As most of the students especially in medical sciences try to make a relationship with the patient while getting trained, therefore they try to communicate well with the patient. In the present study the largest percent of students assessed having this skill as very good but they considered themselves more successful in social and informal relations such as greeting and respecting the patient than job professional skills. In a way that statement number 2” I say hi warmly, I call them with a name the like….” And statement number 7 “I discuss their illness with them, ask their opinion, and help them in decision making “ got the highest and lowest means respectively, this can be because of their being a student; as they haven’t’ become skillful enough and depend on their clinical professors for making decisions and planning for the
patients. These skills are achieved after graduation and getting more experiences. However, there is this question that if Medical Sciences University graduates are prepared to work? Are the educational expectations of universities reaching students to 100% professional skills? And if the answer of this question is no, are there any programs such as getting familiar or mentory available in treatment and health system of the country? Or can a graduate act independently in making decisions for the patients and planning at the start of his/her job? In a study, residents had achieved 43.3% of the communication skills, 63.3% of socio-psycho skills, 20% of diagnostic skills and 26.7% consultancy and training skills and with the improvement of residents’ skills, the average of satisfaction score had increased as well (14). Communication and social skills of residents had been mostly in consultancy and diagnostic fields which match the results of the present study. Although students didn’t assess themselves as weak in communication but as it can be get from assessed statements, social and psychological communication got the highest score and professional statement got the lowest, communication skills are inseparable parts of physicians’ clinical skills. They can increase the effectiveness of medical interview and patients’ satisfaction by using appropriate verbal and communication skills, such as respecting patients, caring and sympathizing with them, asking open-ended questions, active listening, and using comprehensible terms for the patients. It is clear that people in charge of medical education must hold the necessary training courses for improving students’ and
staff’s communication skills. Medical sciences students must be aware that one of the treatments tools is a good relationship with the patients. Patients who make a good relationship with their physician are more satisfied with their treatment (15). Treatment process can predict variables of following medication instructions (16). Communication is always mutual and the treatment team play an important role in its appearance. One of the concepts which are continuously discussed in treatment communication is achieving trust and achieving patients and treating team’s trust becomes possible with professional communications. Studying the learning of communication skills in medicine showed that if the training of communication skills is not a short-term process it can change physicians’ skills (17). Also it has been represented that this education can be effective for specialists as much as general physicians (18). Patients’ satisfaction, following physicians’ instructions, decreasing the necessary time of explain the matter to the patient, reduction of complaints from physicians, positive assessment of the physician’s function are all cases which are related to the quality of the relationship of the physician with patient (19), therefore
The authors wish to thank the medicals students of Golestan University of Medical Sciences whom accurately responded to the study questionnaire.
Conflict of Interest: None.
Funding and support: The study was an approved project supported by the EDC of Golestan University of Medical Sciences.
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