Short communicationCommunication skills teaching in Brazilian medical schools: What lessons can be learned?
Introduction
Physician-patient communication is at the core of medical practice with evidence-based studies demonstrating that effective communication skills (CS) improve patients’ medical and psychological outcomes, as well as patient and physician satisfaction [[1], [2], [3], [4]].
Guidelines and consensus papers support systematic communication training of medical and allied health professionals [[5], [6], [7], [8], [9], [10], [11]]. Since the 1990′s, many medical schools (MS) worldwide have adopted formal CS curricula. Systematic reviews describe effective interventions for teaching and learning CS [12,13].
The world has become increasingly interconnected and interdependent, and educational systems can improve by sharing their teaching programs with each other [14].
After a literature review of comprehensive national surveys of the CS teaching curricula, published surveys from only three countries were found: US [15], UK [[16], [17], [18]] and Spain [19]. In the US, by 1999, 95.6% of the MS reported teaching CS [15]. In the UK, by 1998, almost all MS reported teaching CS [18]. In Spain, by 2005, 71.4% MS reported teaching CS [19]. We found no comprehensive Brazilian survey of CS curricula.
Since 2001, the Brazilian guidelines for undergraduate medical education (BGUME) have required that CS be taught in Brazilian MS [20,21]. Brazil is a vast country, highly diverse in terms of geography, demographics, culture, as well as socioeconomic and health conditions [22,23]. The Brazilian National Health System, the Unified Health System (SUS, as per the Portuguese acronym for Sistema Único de Saúde) provides free access to equal, humanistic and comprehensive healthcare to the entire Brazilian population [23,24]. One strategy to implement SUS principles is the “acolhimento” (translated into English as “embracement”). It requires that all those connected with healthcare delivery “embrace” a dedication to caring for patients and the communities in which they live [[25], [26], [27]]. Brazilian physicians are expected to communicate effectively with the multiprofessional teams, patients, families, and community members.
We wondered, given the imperative to teach CS in Brazilian MS, about the current status of CS teaching in Brazil. In what ways are the curricula responsive to the healthcare system demands? What specific skills and topics are being taught that might be unique to Brazil, but might be of interest to educators in other countries?
In order to answer these questions, we conducted a national survey to assess current practices in CS teaching in Brazilian MS, looking for similarities and differences with other countries.
Section snippets
Study design and participants
This survey was conducted after approval of the research project by the Federal University of Santa Catarina Research Ethics Committee (protocol No. 551.143//2014, CAEE: 25541213.7.0000.0121), from January 2015 to June 2016. The participants were representatives of all 237 Brazilian MS registered in the national information database on Higher Education Institutions’ electronic system, available at http://emec.mec.gov.br. The deans of the medical courses on the institution’s website were
Communication skills programs
The response rate for the survey was 68.3% (162 schools); 104 among them (64.2%) offered formal CS training. The distribution of 413 CS programs offered by these MS, by curriculum design and stage of the course is presented in Table 1. The programs were generally offered in the pre-clinical years. Only 7 MS had CS as a longitudinal course over the pre-clinical and clinical years of training.
Teachers involved in CS training and CS content and their teaching methods
The CS programs were frequently taught by physicians, mostly those in internal medicine (n = 83, 79.8%),
Discussion
When compared to the US and UK MS, it is evident that Brazil has less adherence to the BGUME. In the US, an important driver for the incorporation of CS into MS core curricula was the Liaison Committee on Medical Education requirement of CS for school accreditation [28], and the requirement of the National Board of Medical Examiners, as a condition of licensure that all graduating medical students pass a standardized patient Objective Structured Clinical Examination evaluating CS [29]. In the
Informed consent and patient details
We confirm all personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.
Funding
This research did not receive any specific grant from funding agencies, the public, commercial, or not-for-profit sectors.
Acknowledgements
We are grateful to the Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina (Foundation for Research Support of Santa Catarina) that granted Rafaela Liberali a doctoral scholarship, and to all Brazilian Medical School representatives that participated in the study. We are also grateful to the Associação Brasileira de Educação Médica (Brazilian Medical Education Association) and the Foundation for Advancement of International Medical Education and Research (FAIMER) for their
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