What’s the position of medical communication skills training in India?
Medical communication skills training in India is still in infancy. Before 2019 there wasn’t any formal curriculum though in that year the Medical Council of India revised the medical curriculum and introduced the AETCOM module (Attitude, Ethics and Communication module). Spread over five years of medical school, the module covers skills around attitude, ethics and communication. Since 2019, communication has been taught in all medical schools in a staged manner.
In the absence of any regular programs, I have conducted more than 1500 both short and long programs for multiple medical schools and hospitals across the country in the last 10 years. These programs are specifically focused on clinical communication including topics like conducting patient interview and information sharing (based on the Calgary Cambridge guide), handover tools, understanding patient’s expectations, breaking bad news etc.
Do you teach medical communication as a skill, independent of the language being used? Or are your programmes about communication in English only?
All programs in the medical schools are in English. Other programs for residents and nurses across the country are conducted as per the preferred language of the audience. It is mostly English or Hindi.
Are your programmes specifically aimed at medical professionals looking to work an English-speaking culture? Do you work with a range of healthcare professionals, including nurses?
Although most of the programs are conducted in English they are not meant to only prepare professionals for working with an English speaking culture. Rather, I have designed my programs to meet the communication needs of my country. The programs are designed to suit the healthcare delivery system specific to my country. I do work with a range of healthcare professionals including nurses and paramedics. Selection of the language is done based upon the audience and their preferred language.
Medical culture varies quite a bit from country to the next, particularly in how patriarchal the culture is and in the expected roles of doctors and patients. How does this variation affect how and what you teach? Or how the programme is received by participants?
Doctor-patient communication in our country is very peculiar and has changed drastically over the last few decades. Patients, who never asked anything, now wish to ask questions and be informed about their illness and the options available to treat a medical condition. This comes as a shock to some of the doctors, who are not used to this kind of communication expectation. As a result, many are not receptive to communication skills programs. They feel they are being forced to learn communication skills. Many of them also are resentful of the fact that poor communication is leading to lots of violence against doctors and they put the blame on patients for being too demanding.
Keeping this in the background, I design my programs very carefully. Through my programs I help them see the changing doctor-patient relationship. I also help them see the benefits of communication in terms of a better doctor- patient relationship, reduced errors in patient care leading to ensured patient safety, continuity in patient care and better health outcomes. Without offending anyone, I help them understand the need for these programs.
I have attended lots of communication programs in US and India, but I do not try to transfer all the learning as is. It’s important to generate genuine understanding for the subject rather than loading them with everything in one go. Some of the communication practices I learnt abroad are practically too difficult to be implemented immediately.
I have customized the programs based on my experience of working with Indian healthcare industry for the last 30 years and my learning at various institutes. I have made an amalgam of the same and move from basic to advanced level depending upon the training needs of the specific healthcare facility and receptivity.
How does your background as a psychologist inform your work in the field of medical communications?
My background as a psychologist helps me greatly in the field of medical communication programs. There are lots of soft skills trainers in India trying hard to work on medical communication programs but my background as psychologist and having had worked in healthcare greatly helps me quickly develop rapport with my audience. I am able to bring lots of examples from healthcare to help them relate with the content I deliver. Being a psychologist also helps me design and deliver my program in a manner that highlights the benefits of medical communication to the audience. They are able to see what is in it for them.
My understanding of adult learning helps me design the delivery of the program, which is based on adult pedagogy. Most of the content is delivered through hands on training, including role plays and videos followed by discussion, self- introspection questionnaires leading to self- reflection and discussion. I also make use of the professional skills I’ve developed as a psychologist, skills such as being non-judgemental, being accepting, empathetic and being receptive without blaming or complaining. It helps me develop wonderful rapport with my audience and makes them receptive to my programs.
Dr Indu Arneja, Director of the Indian Institute of Healthcare Communication, holds a PhD in Psychology and an MBA in Hospital Administration. She is a visiting professor at a number of universities in India and is a member of the advisory board of the National Human Rights Commission.
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