A STUDY TO ASSESS THE ATTITUDE OF MEDICAL STUDENTS TOWARDS LEARNING COMMUNICATION SKILLS IN A TEACHING HOSPITAL IN ANDHRA PRADESH

Objective: Communication plays an essential role in present era of medical and health system where doctor should maintain good interpersonal relationship with patients. Teaching of communication skills to medical students as a part of the curriculum has gained importance in recent past. This study was conducted to assess attitude of medical students towards learning communication skills. Methods : Prior institutional ethical committee approval and prior informed consent obtained from participants. Study conducted among medical students of second and third year MBBS. Students were given a questionnaire (google forms). Questionnaire consisted of 26 items related to positive and negative attitude; 13 items in each subscale. Responses received were entered and analysed in Microsoft excel. Results: Total of 300 students participated, with a response rate of 76%. 132(57.9%) students were second year and 96(42.1%) were third year. 159(69.7%) students were females and 69(30.3%) were males. Reliability of scale was calculated using Cronbach’s Alpha, 0.859 for PAS and 0.704 for NAS; which were good and acceptable values. Better positive attitude scores (52.34±6.03) observed over negative attitude scores (40.07±6.40), implies students having a positive attitude towards learning communication skills. There were no significant differences between scores when compared between males and females and between second and third year MBBS students. Conclusion: Results of study emphasize that introduction of AETCOM learning modules in the medical curriculum has a positive impact on students towards learning communication skills. Doctor-patient inter-relationship, treatment decision-making, etc., are dependent on doctor’s communication skills; which can be improved and strengthened with AETCOM implementation in medical curriculum.


INTRODUCTION
Communication is a key element in the present era of medical and health system.A doctor should have the capabilities to carry out the range of services in health settings which are relevant, cost-effective and are of good quality.This was included in the concept of the Fivestar doctor proposed by World Health Organization (WHO); which emphasizes the five qualities of caregiver, decision maker, communicator, community leader and manager [1].Efficient doctorpatient communication is a critical part of patient care and a decisive basic skill for doctors that cannot be delegated [2].
A productive doctor-patient communication helps in building a good interpersonal relationship, exchanging information and taking treatment decisions [3].In addition to other skills such as intellectual skills, conceptual skills and observational skills; a doctor should also have the ability to communicate properly and efficiently.If the doctor fails to address the queries, expectations and concerns of the patients and relatives, can lead to dissatisfaction.This may be one of the reasons for the hospital attacks and assault on the doctors [4].
Greater number of complaints against doctors occur as a result of communication-related problems rather than clinical expertise and this in turn leads to allegations of malpractice [5].
Good communication plays a key role in improving the efficiency of healthcare systems, patient satisfaction and reducing the number of malpractice complaints [6].The clinical competence of a doctor is significantly affected by communication skills [3].The focus of medical education curriculum in India was mainly on the clinical skills of the medical student.Nontechnical skills like communication skills, interpersonal and managerial skills are being identified as essential, needed to work as a team and to deal with the patient.Communication skill considered as a bedside manner or history taking is, changing to a skill which can be learnt [7].
Attitude plays an important role in that it can bring about changes in people's behaviour and assessment of the same helps better understand the behavioural patterns in a given population [8].Hence assessing the attitude of medical students towards learning of communication skills is essential as it ultimately affects their communication behaviour in a clinical setting [9].
A health professional with good knowledge, problem solving and physical examination skills but poor communication skills may not have good clinical practice.Communication skills is gaining more attention throughout the world and emphasis is being given to its training [10].Communication skill has been identified and included as a competency in the AETCOM module of the MBBS curriculum in India since 2019; which is a competency-based medical education curriculum.There are few studies assessing the effect of AETCOM learning among medical students.This study was conducted to assess the students' attitude towards learning communication skills.
This study was carried out with the primary objective of studying the attitude of medical students towards learning communication skills and secondary objectives of comparing the attitude towards learning communication skills between males and females and comparing the attitude towards learning communication skills between 2 nd and 3 rd y medical students.In this study, a pre-validated 26 item communication skill attitude scale developed by Rees and Sheard was utilized [11].

MATERIALS AND METHODS
This was a cross-sectional study conducted at Government Medical College, Anantapur, Andhra Pradesh; after obtaining approval from Institutional Ethics Committee.Study was conducted between June 2023 and September 2023.A total of 300 students who gave informed consent were enrolled in the study.They were provided with a google form questionnaire and asked to answer and submit their responses.
This study was done to assess the medical student's attitude towards the communication skills learning; using a pre-validated and widely used 26 item questionnaire on communication skill attitude scale (CSAS) developed by Rees and Sheard.This CSAS was developed to understand the attitudes of the medical students towards communication skill learning [11].This scale consists of 26 items divided into two sub-scales assessing positive and negative attitudes by Rees et al.; based on initial psychometric analysis.The scale had good reliability and internal consistency in our study.
The responses were recorded on a five-point Likert scale for all the 26 items.Questions pertaining to positive attitude were scored with 5 points for strongly agree, 4 for agree, 3 for neutral, 2 for disagree and 1 for strongly disagree, while the negative attitude questions were scored in reverse order, 5 points for strongly disagree, 4 for disagree, 3 for neutral, 2 for agree and 1 for strongly agree.Scores ranged from 13 to 65 for each item; with higher scores reflecting a stronger attitude.Mean scores and standard deviation calculated for each question and also for both sub-scales, positive and negative attitude scales.Comparison between males and females and second and third MBBS students done with student t-test.
The responses were received to gmail from google forms and they were downloaded in excel format file.All the data was entered and analysed using Microsoft excel 2016.

RESULTS
Out of the total of 300 students enrolled in the study, only 228 students completed the study with a response rate of 76%.132 (57.9%) students belonged to second year and 96 (42.1%) students to third year MBBS.Out of the 228 students, more than half of the participants were females (n=159, 70%), of which 92 (40.3%) were second-year and 67 (29.3%) third year students.The reliability or internal consistency of the assessment scale was analyzed using Cronbach's alpha and were found to be 0.859 for PAS and 0.704 for NAS, which are considered to be of good internal consistency and acceptable, respectively.Analysis of the scores between the second-year and third-year MBBS students showed no significant difference in attitude towards learning communication skills with respect to both positive and negative attitude subscales.

DISCUSSION
This study, conducted in a cross-sectional manner, assessed the attitude of medical students towards learning communication skills of second and third MBBS professional.Reliability of the questionnaire was calculated using Cronbach's alpha for each sub scale.In a study; Cronbach's alpha was calculated to be 0.92 for PAS and 0.71 for NAS from Turkey [12] and 0.90 for PAS and 0.68 in an Iranian study [13].In another study by Sreelatha, et al., [14] Cronbach's alpha for PAS 0.83 and NAS 0.60.The values in this study were 0.85 and 0.74 for PAS and NAS, respectively.These values are indicative of good internal consistency.
In this study, the mean of total positive attitude score was 52.34±6.03and mean of total negative score was 40.07±6.40indicating that there is an overall positive response to learning communication skills.These results were similar to a study, which showed 54.19±5.99 and 33.42±5.27,respectively for positive and negative attitude scores [14].Another study conducted in Saudi Arabia also gave similar results [15].Students' spending time for learning communication skills and its application in clinical practice is influenced by their attitude [16].
In our study, the comparison between male and female students regarding attitude towards learning communication skills showed no significant difference pertaining to both positive and negative attitude scale scores.Similar results were found in a study conducted in Nepal, which showed no significant difference between males and females with a * p value 0.686.A study conducted at Saudi Arabia showed higher positive scores among female students (57%) compared to among male students (46.9%) was not statistically significant but the higher negative scores among male students (60.3%) as opposed to female students (42.4%) was significant with * p value 0.003 [17].Similar results were also obtained in various multicentre studies [18,19].A study conducted in Iran [20] also showed a more positive attitude to learning communication skills in girl students (mean±SD =56.4±6.4) compared to boys (mean±SD =52.3±8.1).This may point to a fact that, female students have more positive attitude than male students.This can be attributed to the open nature of female students towards information sharing and building rapport compared to male students [19].Changes in attitude can bring about changes in behaviour.It is important that these students must not belittle the importance of communication skills [19].

Fig. 1 :
Fig. 1: Showing the number for males and females in second and third year

Table 3 : Showing comparison between males and females
With respect to comparison between male and female students; the mean positive scores were 52.11±5.83and 52.44±6.13respectively, with * p value of 0.70, which was statistically not significant and the mean negative scores were 38.63±7.43 and 40.59±5.83respectively with * p-value of 0.06, which was also statistically not significant.

Table 6 : Showing mean±SD comparing second and third-year students 2 nd y (mean±SD) 3 rd y (mean±SD)
*