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Rapid Responses: Rapid Responses published:
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Clinical and Communication Skills
- Erik T Walbeehm (20 February 2005)
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Need for the incorporation of communication skill topics in the medical curriculum
- Dr. Mohandas Rao (21 February 2005)
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How important communication skills are
- Syukri Hasyim (22 February 2005)
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Deliver me from the affably incompetent
- Srinivasan Ravi (22 February 2005)
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Re: How important communication skills are:- THE MEDICINES PARTNERSHIP CONSULTATION
- susanne mccabe (22 February 2005)
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Limitations of surrogates and models in testing real clinical skills
- Mansur Ilahi Shaikh (23 February 2005)
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Communication Skills - leading by example
- Victoria R Walker (23 February 2005)
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Re: Deliver me from the affably incompetent
- William G. Pickering. (24 February 2005)
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Teaching communication skills to senior oncologists
- Anna Costantini, Walter Baile University of Texas, Luigi Grassi University of Ferrara, Renato Lenzi University of Texas (25 February 2005)
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Re: Re: Deliver me from the affably incompetent
- Dr. Herbert H. Nehrlich (25 February 2005)
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Clinical and communication skills. Learnt side by side in Cuba
- Alfredo D. Espinosa-Brito, Alfredo A. Espinosa-Roca, Luis G. Del Sol-Padrón, José M. Bermúdez-López (3 March 2005)
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How to bring clinical and communication skills together ?
- Luc Debaene, Sandrina Schol, Benedicte De Winter (9 March 2005)
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New GMC booklet supports shared decision making
- Joanne Shaw (9 March 2005)
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The inclusion of sign language in the undergraduate curriculum to facilitate better care for patients with communication impairments.
- Alexandra A Khoury (12 September 2006)
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Erik T Walbeehm, SpR Plastic Surgery Rotterdam, 3022 BC, The Netherlands
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Dear Sir, Madam, With interest I read the article on clinical and communication skills. Every doctor needs communication skills, from pathologists to surgeons and physicians. In the country I work in, the undergraduates spent considerable time on communication with patients. But I think the wrong group is targeted. Time is taken away from essential pre-clinical and clinical studies. Students learn to talk to simulation patients with for example a dukes D colon carcinoma..... at a time in their studies that they don't have a clue what cancer is, what a dukes D colon carcinoma means and what the impact is on a patient!! The student receives this kind of training in his second year and has forgotten about it when he reaches SHO - level. What amazes me, is that it should be the SHO's and Registrars that need training. We do the damage in our bad news talks. We know what we are talking about and we do it daily. We should be the ones filmed on camera and evaluated. This should be done with clinicians with experience, together with "communicators", and not only by people who studied communication skills, but never had to tell anybody that they have cancer and are dying, or to tell the family that a patient has died.... The impact of this is greater than most people can imagine, and I think bad communication on those subjects often reflect the inability of the doctor to deal with his own feelings. The same goes for communicating with colleagues. I can only applaude recent advances in my hospital that the emergency rooms are now filmed in major trauma cases, and that the people on the floor are actually the ones being filmed. Scrupulously. But also evaluation is done by the surgeons, together with a psychologist. On conclusion, communication skills are essential, but not to the expense of our medical students' pre-clinical and clinical curriculum. Therefore, the target groups are the SHO's and SpR's. Erik Walbeehm Competing interests: None declared |
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Dr. Mohandas Rao, Assistant Professor of Anatomy Melaka Manipal Medical College, Manipal, India
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Success of a doctor in his/her profession depends not only on his/her medical knowledge but also the way he/she communicates with his/her patients, the way he explains the problems, diagnosis and the treatment to his patients. Most importantly, breaking the bad news to the patient and his family is a really testing time for the communication skills of a doctor. Since medicine is a subject which is learnt from the interactions with patients, it is very essential that students develop their communicating capacity even in their undergraduate days. Many of the Medical schools in the world especially in India have significant number of students of foreign origin. For such students lack of knowledge about the local language is a major set back during their interaction with the local patients in their clinical years. To overcome these problems, it is essential that subjects like communication skills, learning the local language are incorporated in to the medical curriculum. Competing interests: None declared |
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Syukri Hasyim, medical student Ireland
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Hi..I'm a medical student from malaysia, but I'm currently studying in Ireland.. I must say here, that after reading the article, and the responses, especially from Dr. Mohandas Rao, I realize now how important communication skills are for doctors. Frankly speaking, I've seen many medical students here, ranging from 1st year students up to final years, and I must say the lack of communication skills among them should never be taken for granted. I can see, that many medical students, including me, are not able to explain medical terms in simple, layman language. As pre-clinical students, we have our communication skills classes once a week. And it is sad that sometimes we have no idea whatsoever how to explain diseases when talking to patients.. (we are being exposed to early patient contacts). I have to admit here that while proficiency in English is very important when it comes to explanation, other factors still contribute to poor communication skills too. Many foreign students like me still in doubt about our fluency in English, resulting in us having trouble with our communication skills. However, the same problem happens for English-speaking students too! Therefore from my own observation, I think it is important for medical students to start learning more on how to develop the skills. Foreign students should spend more time practising the language and have confidence to talk more to the public. The bad idea of learning by blindly memorising facts should be stopped, and it is essential to really understand concepts to be able to explain them using our own words.. Communication skills classes should be carried out more often, but what is more important is the student's initiative to work it out.. learning communication skills is not just about explaining terms, it is also about how we talk to the patients, how we give response to them, and how to consult the patients too. I hope that by the time we graduate, we are good doctors who not only know our stuff, but really have good connection with the patients through the skills that we have developed. Good luck to all medical students.. Competing interests: None declared |
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Srinivasan Ravi, Consultant Surgeon Blackpool FY3 8NR
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It is all very well teaching doctors to communicate well but we must never loose sight of the fact that the main purpose of ‘doctoring’ is to doctor the ill, efficiently. I have, many times asked myself the question whether I would prefer to be treated by the competent but poor communicator or the good communicator who is not as competent. I certainly know the answer. In an ideal world we will have doctors who are good at both but failing that we should impress trainees above all to be competent in what ever they do; recognise when they fail to reach the acceptable levels of competence and seek help; deliver the best health care at all times and be courteous and pleasant. Competency must come above affability and not the other way round; Certainly not the common parlance of 'affability,availability and ability in that order'! Competing interests: None declared |
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susanne mccabe, retired cf24 3pf
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For those who may not be aware of it yet the MEDICINES PARTNERSHIP is holding a CONSULTATI0ON PROCESS on it's operational plan for 2005 - 2006. As suggested this emphasises the partnership approach being promoted by the DoH and uses 'Expert Patients' as part of the team. Communication skills are a vital part of good practice as you point out. Ireland and Wales may have their own Health Departments (whatever we think of that) but it is still possible to contribute to the consultation on-line or on paper. After all citizens do move across boundaries. It is a useful way of focussing on aspects of both the technical side and the relationship between various healthworkers and those who consult them. The GMC has included the views of the Medicines Partnership in it's new booklet NEW DOCTORS so it is necessary to be aware of these developments. They may also incorporate some in an updated version of GMC Good Practice, Guidance for doctors. Best wishes with your studies (Reference MEDICINES PARTNERSHIP SEE WEB SITE (FREE SUBSCRIPTION TO E -ALERTS). Competing interests: None declared |
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Mansur Ilahi Shaikh, Consultant Geriatrics Islamabad, 44000
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The current practise of testing communications skills on both undergraduate and postgraduate students on surrogate patients is indeed a wrong practise . I was looking at the modern day MRCP clinical format known as PACES and was shocked to find out that no where is a complete real patient is to be clerked and tested upon and that rather a surrogate is used for communications skills . The so called station system suits only those clinical subjects which can to some measure lend themselves to such type of testing , Internal Medicine is not such a system , and it needs dynamic testing not static models which can suit subjects like pathology etc.The fact that many Royal college officials involved in testing are not medical doctors at all has to do with such tragic discoveries about the manner we test people in clinical arts . Surrogate communication skill models suit the examining bodies however as it prolongs the duration of examinations and makes them an event for which good charges can be obtained seperately from the prospective candidates . One cannot disagree even one measure from the observation of the author of this article when it is stated in the article that " The current practice of teaching communication skills separately from clinical skills reflects a reductionist paradigm—by breaking down the complex phenomenon of a consultation to its basic components". A more dynamic system of testing clinical and communication skills is much needed possibly outside the constraints of a single day exams but then only time will tell that such a model will be time and cost effective and wholly welcome by all! Competing interests: None declared |
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Victoria R Walker, Clinical Teaching Fellow Education Dept, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH
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Integrated learning for medical students is certainly the way forward(1). But should we be concentrating more on teaching the teachers to integrate communication skills into all aspects of their teaching rather than developing a new module or curriculum? Students are less likely to adopt behaviour that is not demonstrated by their role models. Communication skills are undoubtedly important, for good practice and improving health care(2). There is now an appropriate place in undergraduate curricula for teaching such skills, and some of the challenges this presents were highlighted in the editorial(3). I agree that communication skills need to be taught in clinical context, and we also need adequate assessment. Assessment drives learning and provides valuable feedback. The editorial talks about breaking down a consultation to its basic components, but surely one way of educating the students about such a complex phenomena is to provide them with the building blocks necessary to create a good consultation, to help them discover their own style and skills. These skills are then generic. Simulated patients are a valuable resource(4). But the inherent unpredictability of a consultation or counselling session is difficult to replicate(5). References 1. Yedidia MJ, Gillespie CC et al, Effect of communications training on medical student performance, JAMA 2003; 290(9):1157-65 2. Little P, Everitt H et al, Observational study of effect of patient centredness and positive approach on outcomes of general practice communication, BMJ 2001; 323: 908-11 3. Kidd J, Patel V et al, Clinical and communication skills Need to be learnt side by side, BMJ 2005; 330: 374-375 4. McMahon GT, Monaghan C et al, A Simulator-Based Curriculum to Promote Comparative and Reflective Analysis in an Internal Medicine Clerkship, Academic Medicine, 2005 80: 84-89 5. McDonald IG, Daly J et al, Opening Pandora's box: the unpredictability of reassurance by a normal test result, BMJ 1996; 313(7053): 329-32 Competing interests: None declared |
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William G. Pickering., Doctor 7 Moor Place, Gosforth, Newcastle upon Tyne.NE3 4AL.
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Consultant Surgeon Mr Srinivasan Ravi's excellent letter should be compulsory reading for all preachers in and around the medical profession. This should include many high-rankers in the BMA, GMC, DoH and Royal Colleges — whose own 'communication' is actually puffery. Competence is so often incorrectly presumed to reside behind veils of 'affable' and 'caring' words. Clinical competence is the first and key issue in health services. Communication too is important, in all walks of life, medicine no less [1,2,3]. But certain recent medical miscreants, and one in particular, were known to be skilful (and wily) communicators. We have all seen these types, and a curdling experience it is. Slipshod medicine buried in 'communication'. Communication can sometimes be idiosyncratic and good, or formal and atrocious. Some say it can be learned at medical school and thereafter. It is notable however that, for example, many grandmothers, children, teachers and nurses - not to say some doctors - have caught the art as if they were constitutionally endowed. And a very beautiful thing it is to behold too. Perhaps an A level in English as a prerequisite to a medical career might (just might) stir communication genes, if present, to exercise themselves and so augment still further patient benefit accruing from clinical competence. William G. Pickering. 23.2.05 wgpi@hotmail.com References: 1. Pickering W. G. The Relief of Communication. Lancet Oct 14,1989. 911. 2. Pickering W. G. Kindness, prescribed and natural, in medicine. J of Med Ethics. April 1997;23:116-118. 3. 3. Pickering W.G. An Independent Medical Inspectorate. In: Gladstone D, ed. Regulating doctors. London: Institute for the Study of Civil Society, 2000: 47-63. ISBN 1-903 386 Competing interests: None declared |
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Anna Costantini, Coordinator of Psychoncology Unit Sant'Andrea Hospital University of Rome, Via di Grottarossa 1035 - 00189 Rome Italy, Walter Baile University of Texas, Luigi Grassi University of Ferrara, Renato Lenzi University of Texas
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Recent comments by Dr Walbeehm (BMJ 20 Feb 2005) and Dr Kidd (BMJ 2005; 330:374-375) address the importance issue of the timing of communication and interpersonal skills teaching in the medical setting and the importance of applying already existing educational models to the communication skills learning process. This is especially important in training teaching faculty how to teach and helping them find ways to incorporate communication skills training into clinical rotations. At the University of Rome we have initiated a training program for senior oncologists who are Departmental Directors at Regional Hospitals and as such are in charge of trainees' clinical rotation curricula. They also play an important part in influencing the "communication culture" on their clinical units. This is especially important because many southern European countries are still in a phase of transition from a paternalistic medical culture to one which has begun to recognize the autonomy of the patient in decision-making. Our teaching program for senior oncologists was initiated in September 2004 and is today in its second edition. The model incorporates principles od adult learning (1), medical interviewing and oncology communication utilized in the "Oncotalk" model (2,3) and adapted to the Italian culture. The central component is a three-day residential retreat of 30 hours in which clinician-teacher, as "participant-observers" are exposed to the communication skills learning process. The curriculum consists of didactic lectures, skill practice in small groups with standardized patients and reflective exercises to improve awareness of how personal attitudes and emotions affect communication. Standardized patients portray patients across the trajectory of the cancer illness and case scenarios challenge the learners to deal with contemporary cultural obstacles to giving bad news, such as the family's tendency to protect the patient by demanding that medical information be witheld. A final session is focused on how to teach communication skills. Evaluation questionnaires (4) test knowledge, attitudes and communication confidence. Our preliminary data are encouraging and suggests that such workhops can to improve the cultural practices, attitudes and communication competence of senior physicians at the height of their careers and assist them in planning communication skills teaching in their own institutions. 1) Kaufman DM. Applying educational theory in practice. BMJ 2003 Jan 25;326 (7382):213-6 2)Back AI, Arnold RM, Tulsky JA, Baile WF and Fryer-Edwards KA. Teaching communication skills to medical oncology fellows. J Clin Oncol 2003 Jun 15;21(12):2433-6 3)Fryer-Edwards K, Arnold R, Back A, Baile WF, Tulsky JA. Though Talk: Helping Doctors Approach Difficult Conversations. At http://depts.washington.edu/toolbox/ 4) Lenzi R., Baile WF, Back A, Buckman R et al. Design, Conduct and Evaluation of a Communication Course for Oncology Fellows. In Press j Cancer Education Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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I agree with the general gist of Dr. Pickering's comments. There are many preachers around, more outside the church than within, the world has fallen for charismatic communicators since the days shortly after Adam and Eve. However, slipshod medicine buried in communication is one subject we may disagree on. Slipshod medicine is being practiced by mainstream medicine today, and in many parts of the world. There are countless examples, suffice it to mention the thousands of unnecessary operations, the continued pre-occupation with the Bogeyman cholesterol (in the face of overwhelming evidence to the contrary), the mass poisoning of the masses with unproven and often harmful medication and the crafty efforts of the screening industry. An industry, here the Sickness Industry, that is a top player in the game of killing human beings has little justification for bragging about its "clinical competence". Joseph Mengele had considerable clinical competence but he did not use it to the benefit of his subjects. Yes, I have known some shining examples of incompetent physicians, some of them looked like Dr. Kildare (an unfortunately timely name) and they did seem to get away with some mayhem. Having said that, I would prefer to be attended by a good communicator with a wonderful (thus re-assuring) bedside manner and just average clinical competence than by one of today's arrogant medical merchants for whom patients are an easy (if sometimes smelly) road to riches. So, Dr. Pickering, we have somewhat differing ideas of what constitutes clinical competence (I think), and come to think of it, when you look back in the pages of the BMJ and find the discussion triggered by Professor Baum, I must say that I would prefer to have Prince Charles at my bedside if given a choice. Camilla could hold my hand and shower me with encouraging smiles. Competing interests: None declared |
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Alfredo D. Espinosa-Brito, Professor of Internal Medicine Hospital Dr. Gustavo Aldereguía Lima, Ave 5 de Septiembre and Calle 51A, Cienfuegos 55 100, Cuba, Alfredo A. Espinosa-Roca, Luis G. Del Sol-Padrón, José M. Bermúdez-López
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Dear Editor: We carefully read the very interesting Kidd, Patel, Peile and Carter editorial “Clinical and communication skills. Need to be learnt side by side”. (1) Last October 2004 we sent a Rapid Response (2) to another BMJ editorial and one paper published in the same issue, about the benefits of early contact with patients for medical students (3,4) As we wrote at that time: “All Cuban Medical Faculties curriculum are problem based, community oriented, fully horizontally integrated, and –as an especial characteristic-, they provide very early and long clinical experience. Since decade of 80´s of the last century, medical students in Cuba start their first year “learning by doing”, at primary care services (policlinics and family physicians´ offices). So, they can observe by themselves, from the beginning, the “true world” and social context of their future practice”. (2) In this real scenario the students learn communication and clinical skills side by side, because, as Kidd, Patel, Peile and Carter addressed “important skills for clinical practice can be improved”.(1) Trained medical doctors and other health professionals of different disciplines, who daily work at primary care, are the teachers in practice. Students learn communication skills and how to do complete physical examinations, at the same time, with many patients in this scenario. In the Cuban medical education strategy, it is very difficult to imagine how to teach –and more to learn- them, separatedly. Kidd, Patel, Peile and Carter regret “the shortened hours of work with limited windows of opportunity for training (that) oblige us to make the most of the time available, and are conducive to integrated models of medical education”. (1) In our country, when students arrive at the hospitals, they have fulfilled a precedent curriculum, which was very close to communication and clinical skills in clinical practice. From the third year on, medical students go to different hospital wards, and they participate in almost all activities of the clinical services (rounds, different types of diagnostic discussions, duties, consultations, minor surgical activities, etc.). We named all clinical practice activities during the medical career as “educación en el trabajo” (“education in the workplace”), and a lot of time is dedicated to them in each course. For example, only in the two semesters of the third year they have to fulfilled 520 hours of “education in the wokplace” activities in Semiology (first semester) and also 520 hours in Internal Medicine (second semester). In all of these activities, and in their evaluation, communications skills are included as a very important issue. Finally, we agree with Kidd, Patel , Peile and Carter that: “The (clinical) scenario also gives students an opportunity to practise talking to patients and relatives, who report lasting impact from doctors' communication skills at a time of crisis. Learning side by side also implies that trainee professionals of different disciplines learn some team skills together so that interpersonal communication and role linkages become embedded”. Sincerely, Prof. Alfredo Espinosa-Brito, MD, PhD
Internal Medicine Department,
Teaching Hospital "Dr. Gustavo Aldereguia Lima", Ave 5 de Septiembre and
Calle 51A, Cienfuegos, 55100, CUBA
REFERENCES 1. Kidd J, Patel V, Peile E and Carter Y. “Clinical and communication skills. Need to be learnt side by side”. (editorial). BMJ 2005;330:374-375 (19 February). 2. Bermúdez-López JM, Espinosa-Brito AD, Espinosa-Roca AA. Early contact with patients is beneficial in Cuba. BMJ 2004;329 Rapid Response. (10 October 2004) 3. Editorial. Early contact with patients is beneficial BMJ 2004;329 (9 October). 4. Dornan T, Bundy C. What can experience add to early medical education? Consensus survey. BMJ 2004;329:834. Competing interests: None declared |
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Luc Debaene, teacher communication skills University Antwerp (Belgium), 2610, Sandrina Schol, Benedicte De Winter
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Kidd e.a warn in their Editorial (1) that separate teaching of communication and clinical skills reflects a ‘reductionist paradigm’ and doesn’t warrant doctors being able to communicate satisfactorily with their patients. In our opinion this hypothesis is narrow-minded and not reflecting the actual state in skills teaching in reformed medical curricula. Cognitive psychological theories state that automatisation of a general schema goes through particularisation (2). Complex skills can only be acquired when divided in small sequences which are understood and practised separately and are gradually integrated in the performance. For a doctor with the aspiration to become a good communicator, this means that he must start to learn specific communication skills like listening actively or using explorative questions. Afterwards he learns to build up a consultation while using these skills. A further step is learning to deal with more complex situations like breaking bad news, giving a correct and clear explanation, being able to motivate people. We believe in ‘separation’ as a first step in learning complex skills and not as a divorce of communication and clinical skills. Taking these considerations into account, we agree with the author’s plea for integrated learning as a necessary - but second - step in medical education. In Antwerp (Belgium), communication and clinical skills are integrated and move up through the undergraduate and graduate curriculum. There is one team responsible for the entire ‘clinical and communication competence teaching package’. Almost all the teachers are doctors, bearing in mind that doctors who teach young fellows themselves to communicate, are strong role models. Starting from the first year, students get in contact with simulated patients and have clinical work where they practice their skills. They get feedback on their performances. In the following years the communication and clinical skills are taught in subsequent modules: in the module ‘locomotory system’, situated in the second year of medical school, students learn to take a history from simulated patients that really suffer from for example back pain, they also learn the technical skills of the examination of the different joints on fellow students and finally on a patient. In the hospital they integrate these new acquired skills with physical examination skills on real patients. As the curriculum goes on, the two skills programs are being integrated more and more. For instance in the modules ‘urologic tract’ and ‘sexuality and reproduction’ in the fifth year of medical school they learn the intimate clinical examinations of men and women, specially trained for this purpose. These patients give the students feedback both on their technical skills as well as on their communication skills and attitude. In the module ‘hormones and metabolism’ the students have to perform the totality of a history taking, a clinical examination and the complex skill of health education and promotion with real diabetic patients. Also in this setting, students get feedback on their communication and technical skills from the patients and the teachers. The core objective of our teaching package is the development of a competent and patient-centered doctor. At the same level of skills (communication and technical), we focus on the students’ attitude, consciousness and humanistic values. We aim for personal growth through the students’ education and for skills blended in with their motivation and inspiration. We don’t believe our experiment is unique. Keeping up with professional literature and congresses on medical education, shows us that more and more curricula are trying to find the right balance between clinical and communication skills and their integration. Nevertheless, we strongly believe that this process needs to be two-stepped: first learning the basics of both skills program separately to achieve integrated skills training later on in the curricula but certainly before the start of the fulltime clerkship in the sixth year of medical school. The authors’ statement that integrated learning only exists at an embryonic level in the undergraduate curriculum appears to be a rather pessimistic perspective. Luc Debaene, Sandrina Schol, Benedicte De Winter - Skillslab, Faculty of Medicine, University Antwerp, Universiteitsplein 1, 2610 Wilrijk - Belgium (1) Kidd J, Patel V, Peile E, Carter Y. Clinical and communication skills. Need to be learnt side by side. BMJ 2005; 330: 374-5 (19 February) (2) Regehr G, Norman G. Issues in Cognitive Psychology: Implications for Professional Education. Academic Medicine 1996; 71: 988-1001 Competing interests: None declared |
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Joanne Shaw, Director Medicines Partnership, 1 Lambeth High Street, London SE1 7JN
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I agree with the authors that good communications with patients are integral to the effective practice of medicine. It makes sense, therefore, for the teaching of communication skills to be fully integrated into clinical training. It is encouraging that a new GMC guidance booklet highlights the importance of shared decision making with patients. The Task Force on Medicines Partnership welcomes the recent publication of the transitional edition of the GMC's booklet The New Doctor. We are glad that the GMC found our input helpful and we are very pleased that our contributions have been largely incorporated. We see the inclusion of guidance on shared decision making with patients as a clear thread running through the booklet and this is a major step forward. We have some residual concerns in two particular areas: 1. The guidance does not make clear that, except in very special circumstances, patients are the decision-makers in relation to their own health and treatment. In the Introduction on page 5, the booklet states that PRHOs must be able to: “offer patients choices, work with patients as partners and recognise that patients are able to make decisions”, which is a much weaker point than our original suggestion, that PHROs should “recognise that the patient is the decision maker”. 2. Research undertaken for us by MORI shows that 32% of patients prefer the doctor to make decisions about their treatment, 39% want to share decision making with the doctor and 24% want the doctor to explain the treatment choices, but to make the decision themselves. The GMC guidance has turned these three potential decision-making models into two, thereby losing completely the option for the patient to decide, advised by the doctor. Page 5 describes the alternatives as: “shared decision making, or by the doctor explaining the options and the patient asking the doctor to decide”. Based on our research we proposed that PHROs need to be able to “understand how to identify the way the patient wants to make decisions – by delegating the decision to the doctor, through shared decision making or by the doctor explaining the options and the patient making the choice”. We hope that this wording will be adopted in the final version of the booklet. In our view, the latest version of The New Doctor demonstrates that the GMC is making real progress in supporting a long-overdue change in the culture underpinning relationships between doctors and patients. There is clearly more to be done and Medicines Partnership would be glad to support this pivotal work. Competing interests: None declared |
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Alexandra A Khoury, Sixth Form Student Benenden School, TN17 4AA
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The inclusion of sign language in the undergraduate curriculum to facilitate better care for patients with communication impairments. The editorial focuses on the integration of learning communication skills with clinical skills in the medical curriculum. Although this may substantially improve the communication skills of doctors, it does not necessarily result in adequate comprehension by all patients. There is no mention of the estimated 2.5 million people in the UK (1) with communication impairments (CI) requiring specific communication skills. As part of my work experience I spent some time at a school for children with special needs and learning difficulties with the intention of gaining some experience of working within a community prior to applying to medical school. It was here that I quickly realised the importance of the communication skills demonstrated by the staff, and that these skills are also vital in a medical context. British Sign Language (BSL) is used in conjunction with spoken word throughout the school and allows those with CI as well as those with hearing impairments to understand and communicate more effectively. It is not often appreciated that good hearing alone is inadequate, and that the combination of the two methods of communication is often necessary. My experience led me to question whether people with CI have access to equal healthcare opportunities. The very few publications available emphasise only the need for doctors to be able to communicate with deaf patients (2). Similarly, BSL courses offered by few universities as an option during undergraduate study are focused on care of the deaf and fail to explore the needs of patients with other learning difficulties. This is despite the fact that only 214,000 people in the UK are registered (3) as deaf or hard of hearing compared with the 2.5 million with CI. Both groups would benefit equally from the use of sign language by healthcare professionals, and courses should include the recognition and understanding of patients with CI, and the management of those with complex communication disorders, as well as the use of sign language. Studies (4, 5) carried out recently by the Department of Health (DoH) demonstrated the need for inclusion of patients with CI in healthcare decision-making. To facilitate this, BSL courses are desirable in the medical curriculum and students may be encouraged to participate by the credits system. Not only would this accord with the policy of the DoH, but would also pave the way for some thoroughly rewarding experiences. After only a short time, I established good rapport with children who had severe CI. With the correct training and acquired skills, doctors could achieve in the time of a consultation what I managed to achieve only after a week of constant interaction. This would surely improve the standard of care and reduce the need for the extended consultations suggested in the Department of Health’s report, thus saving valuable NHS time. REFERENCES 1. Communications Forum Network Registered Charity. 2 White Hart Yard, London SE1 1NX 2. Cultural deafness: about more than language. Emma Joanne Wilding. Student BMJ 2006;14:265-308 July ISSN 0966-6494 3. People who are Registered Deaf or Hard of Hearing. Online. Department of Health March 2004. 4. Making Sense in Primary Care: Improving Communication between Practitioners and people with Communication Difficulties. Study by Department of Health 2000. 5. Involving People with Communication Difficulties. Study by the Department of Health 2003. Competing interests: None declared |
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