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Indian J Psychiatry
Indian J Psychiatry
IJPsy
Indian J Psychiatry
Indian Journal of Psychiatry
0019-5545
1998-3794
Wolters Kluwer - Medknow India

IJPsy-66-589
10.4103/indianjpsychiatry.indianjpsychiatry_583_24
Editorial
Teaching communication skills to Indian Medical Graduates: Time for psychiatrists to take the leading role!
Sarkhel Sujit
Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India
Address for correspondence: Dr. Sujit Sarkhel, Institute of Psychiatry, 7, DL Khan Road, Kolkata - 700 025, West Bengal, India. E-mail: sujitsarkhel@gmail.com
7 2024
17 7 2024
66 7 589590
08 7 2024
08 7 2024
08 7 2024
Copyright: © 2024 Indian Journal of Psychiatry
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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pmcCommunication skills have long been recognized as essential requirements of medical graduates. Effective communication includes empathetic, nonjudgmental approaches; it encourages frank communication and clarifying questions and doubts and involves active listening among others. Although the need to develop communication skills was recognized in the 1997 Graduate Medical Education regulations of the Medical Council of India (MCI),[1] proper teaching of such skills was virtually nonexistent in medical colleges in India. The Competency Based Medical Education (CBME) Undergraduate Curriculum was launched by the National Medical Commission (NMC), which replaced the MCI as the apex regulatory body for medical education in the country. It became effective from 2019 and specifically emphasized teaching communication skills to Indian Medical Graduates (IMG). Communication skills formed a part of a separate module consisting of Attitude, Ethics and Communication Competencies (AETCOM) that were to be taught in each professional MBBS. The module included various communication skills like “demonstrate empathy in patient encounters”, “demonstrate ability to communicate to patients in a patient, respectful, non-threatening, non-judgmental and empathetic manner”, and “ demonstrate empathy to patients and families with a terminal illness in a simulated environment.”[2] The parent body did not lay out the specialty which will teach a particular module and left it to the institute and its teaching faculty to choose the modules as per their convenience and expertise. In a revised guideline published in the year 2023,[3] the NMC clearly allotted the competencies to specific specialties in order to provide clarity. It allotted communication skills to physiology in the first year; pharmacology in the second year; ophthalmology and ENT in third year part I; medicine and allied, surgery and allied, and obstetrics and gynecology in the third year part II. The document did not mention the role of psychiatry anywhere in the entire MBBS course when it comes to teaching communication skills.

Psychiatry as a branch has built itself on a strong foundation of communication skills; rather, effective communication skills is the sine qua non of a good psychiatrist. Psychiatrists use such skills in various spheres of clinical care: history taking, mental status examination, counseling of patients and family members, and psychotherapy. Empathy and rapport building are emphasized from the very first day in psychiatry clinical rounds. Effective communication skills are necessary for all medical professionals, but no specialty other than psychiatry lives, breathes, and dies by these skills. Thus, psychiatry as a specialty and psychiatrists as professionals have the maximum knowhow and expertise to impart communication skills to medical undergraduates.

The NMC has also brought out the PG CBME curriculum for all postgraduate and postdoctoral degrees and diplomas wherein the subject-specific learning objectives for each subject are clearly laid out in the beginning of the documents.[4] A look at the learning objectives of postgraduate courses of individual subjects shows that only psychiatry training emphasizes strongly on communication skills training. Learning objectives for psychiatry clearly mention “demonstrate empathy and humane approach towards patients and their families and respect their sensibilities” and “demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities.”[4] This further points out the essential, rather pivotal, role that psychiatrists must play in designing and teaching communication skills to the IMG.

The nature of psychiatry requires a high level of competence in communication skills. In fact, the unique facets which are routinely utilized by psychiatrists in regular communication with their patients like attending to countertransference, active listening, remaining silent, and neutral and naming emotions have been adopted by specialties like palliative care to enhance communication skills of their colleagues.[5]

Psychiatry teachers must also play their part in revamping this system. Psychiatrists, like many other clinical specialists, are not much involved in Medical Education Units (MEU), which mostly comprise faculties from pre- and paraclinical subjects. Since the Basic Course in Medical Education has been made mandatory for all faculties by the NMC, more psychiatrists are getting exposed to various aspects of medical education and developing interest in it. As a result, some of them are pursuing Advanced Course in Medical Education, which makes them eligible to become members of MEUs of their respective medical colleges. Consequently, they can exert themselves in framing UG curricula and play an important part in UG teaching. The PG CBME curriculum needs to place greater emphasis on teaching specific competencies like breaking bad news in collaboration with departments like oncology and palliative care. Communication skills should be formally taught to psychiatrists, and they should be made aware of various communication skill models. Thus, it is necessary to have a relook at the communication skills curricula for the IMG. These should be reframed and redesigned by a team of specialists led by psychiatrists and taught uniformly across 4 years of UG training. The culmination of training may take place in the final year posting in the department of psychiatry, where it may be assessed by the concerned faculty. The Indian Psychiatric Society should play an active role in this regard and prepare a consensus document with teachers’ bodies like the Indian Teachers of Psychiatry to communicate with the NMC for a strategic restructuring of communication skills training of the IMG. Communication is the forte of psychiatry, and this should be utilized in imparting superior communication skills to medical students. This will not only improve the quality of patient care and satisfaction but also go a long way in destigmatizing psychiatry!
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REFERENCES

1. Regulations on Graduate Medical Education 1997 Medical Council of India Available from: https://www.nmc.org.in/rules-regulations/graduate-medical-education-regulations-1997/. [Last accessed on 2024 Jun 25]
2. AETCOM competencies for the Indian Medical Graduate National Medical Commission Available from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.nmc.org.in/wp-content/uploads/2020/01/AETCOM_book.pdf. [Last accessed on 2024 Jun 25]
3. Competency Based medical education curriculum regulations 2023 National Medical Commission Available from: http://www.nmc.org.in. [Last accessed on 2024 Jun 26]
4. Guidelines for competency based PG programs Available from: https://www.nmc.org.in/information-desk/for-colleges/pg-curricula-2/. [Last accessed on 2024 Jun 27]
5. Datta-Barua I Hauser J Four communication skills from psychiatry useful in palliative care and how to teach them AMA J Ethics 2018 20 E717 23 30118421
