|Year : 2022 | Volume
| Issue : 2 | Page : 307-309
Medical students' perspective on working in a health-care team - Revealed by thematic analysis
Department of Pathology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Dayananda Sagar University, Ramanagara, Karnataka, India
|Date of Submission||28-Sep-2022|
|Date of Acceptance||12-Nov-2022|
|Date of Web Publication||23-Dec-2022|
Dr. Archana Shetty
Professor, Department of Pathology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, A Unit of Dayananada Sagar University, Devarakaggalahalli, Kanakapura Road, Ramanagara - 562 112, Karnataka
Source of Support: None, Conflict of Interest: None
Implementation of Competency-Based Medical Education in 2019 has brought significant changes in the delivery of medical education in India. Attitude, ethics, and communication module has been introduced in to focus on the much-overlooked soft skill aspects and real-life scenarios that will be encountered during future medical practice. The present study has used thematic analysis to understand the effect of this newly implemented module on undergraduates. Qualitative data analysis of thematic type was performed for gaining in-depth perceptions. Analysis revealed that students observed the importance of various roles and their hard work involved in hospital functioning. Students felt they would practice attributes of collaborative work, enhanced communication, and respect for all support systems in future practice. Students perceived the module positively and got to know the facets of under-recognized roles of health-care workers other than medical professions, whose role is crucial for delivering quality health-care services.
Keywords: Competency-based education, curriculum, teaching, undergraduate
|How to cite this article:|
Shetty A. Medical students' perspective on working in a health-care team - Revealed by thematic analysis. Arch Med Health Sci 2022;10:307-9
| Background|| |
In consonance with World Federation for Medical Education, the National Medical Commission in India, (erstwhile known as the Medical Council of India), with a vision to ensure high standards in medical education, implemented the Competency-Based Medical Education (CBME) for undergraduate MBBS curriculum starting from the batch of 2019-2000 onward. CBME is student centric and emphasizes the role of students as active learners. Although theoretical aspects were made familiar through formal training sessions and available literature, the real-life challenges faced over the years in the life of a doctor during practice had been overlooked till date. To address this issue and emphasize soft skill training attitude, ethics, and communication (AETCOM) has been incorporated in the CBME. Although given flexibility without any stringent regulations, being a new concept, designing and implementing the same comes with challenges for faculty. Concurrently, it is pertinent to understand how students perceive the teaching module put into practice. Hence, thematic analysis of students' reflective writing was undertaken with the intent to get in-depth understanding at the end of implementing the AETCOM module – 2.4 working in a health-care team assigned as per the reformed curriculum.
| Implementing the Attitude, Ethics and Communication Module|| |
As per the master timetable, AETCOM module of 2.4 – working in a health-care team was allotted to be covered over a period of 6 hours, each one hour each on every Saturday for our department. On every Monday, students were intimated about the type of health-care worker who will be interviewed on the coming Saturday. Throughought the week, they were asked to observe the work pattern and interact with the personnel by going to their workplace in the hospital. The various health-care workers to be observed included billing staff, technicians, junior residents with not more than 6 months of post undergraduate experience and Group D workers. The personnel were briefed in advance about students visiting and interacting with them as a part of their learning. Every Saturday session of 1 h had two personnels from each category come to class for interview sessions which was moderated by a faculty. Students participated actively and asked questions based on their observation of the working pattern of the health-care worker that they had observed over the past few days. At the end of sessions, two open-ended questions were given to students and 15 min were allotted to write narratives about their experience on two sheets of paper. A total of 142 transcripts were collected and filed [Figure 1]. Confidentiality of students' identity was maintained. Two salient points to be asked were: (1) What did you observe during throughout the AETCOM module sessions? (2) How do you think this module will affect your future practice as a doctor?
| What the Students Perceived|| |
Thematic analysis of students' narratives was performed in six steps as per the Braun and Clarke method. The first stage was to get familiar with data by repeated and in-depth reading of narratives. In the second stage, codes were generated that implied significant information from transcripts. Coding was done manually without the use of any software, and codes were numbered serially starting from 1. They were framed in a language of understanding most proximate to students' responses. In the third stage, codes that implied similar meanings were grouped to derive themes. In the fourth stage, the themes were further reviewed to rule out redundancy and for refinement. Fifth and the sixth stage comprised of defining the codes and interpretation of results respectively. A total of 9 and 5 codes and 2 and 3 themes were derived, respectively, for each of questions 1 and 2 [Table 1] and [Table 2].
|Table 1: Codes and themes generated for Q1: What did you observe during the attitude, ethics, and communication session – working in a health-care team?|
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|Table 2: Codes and themes generated for Q2: How do you think the attitude, ethics, and communication session will help in your future medical practice?|
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| Discussion|| |
Attributes of good AETCOM are pertinent to face “real-life case scenarios” in medical careers. This aspect was unfortunately not covered in the traditional undergraduate curriculum as a part of formal training. This not only made medical graduates feel anxious but also apprehensive when faced by real-life clinical situations for which they were under-trained and psychologically unprepared. AETCOM module has rightly been incorporated into the CBME curriculum with an objective for students to understand the various facets of soft skills. At our institute, we were allotted the AETCOM module 2.4 – working in a health-care team during which students were made to understand the role of members of personnel like billing, Group D workers, technicians, and junior residents who form an integral part of healthcare but whose contribution in hospital functioning is often overlooked. Students interacted with the personnel at their workplace and observed their job responsibilities which gave them an overview of how a health-care team functions.
Post sessions perception of students was collected in the form of written narratives. This gave freedom for students to express their views without the restriction of words, thereby providing a wide scope for interpretation of their perception. Narratives were analyzed by Thematic analysis – a type of qualitative data analysis that emphasizes identifying, analyzing, and interpreting patterns of meaning within qualitative data. This was done with the intent to know the effectiveness of the newly introduced module and also to get an in-depth understanding of the students' perspective. Codes in the thematic analysis are short representations that capture salient features of the main idea put forth by participants through their responses. In the present study, codes generated when asked what was observed during thematic analysis reflected on the fact that students were unaware of the many roles that form an integral part of the hospital health-care team, like junior residents, billing section, and group D workers. A few student narratives were “I got to know that there are so many roles other than doctors and nurses who play an important role in patient care.” “So many types of job roles help indirectly in patient care.” I understood how teamwork is essential even in my field. Thus, themes generated from codes disclosed that students observed hard work put in by each member and challenges encountered by them as a part of their job responsibilities.
Focus on patient care, along with the willingness to act in the best interests of patients, necessitates acknowledging each other's expertise., From codes generated on how the conducted AETCOM module of 2.4 – working in a health-care team help for future practice, it was apparent that students would make an attempt to acknowledge the importance and respect all roles and jobs. The ability to communicate effectively is fundamental to medical practice. The interview sessions gave students an opportunity to interact with various members of health-care system. Students felt the need to develop effective communication skills and need of interaction with various personnel involved in patient care. Themes generated (respect for all, good communication, and collaborative work) evidently imply the positive attitude practices the students observed in this module.
To summarize, at the beginning of the session, our students were of the opinion that it is only the nursing and doctors who are the patient caregivers. Student narratives supporting this were “This session was a unique and eye opener experience as till now I was thinking only doctors and nurses are important” I got to know many new things which I would not have observed if not told and taught. I will not underrecognize any type of work and will treat all with jobs with respect.” After implementing this session, they realized that a variety of jobs, like those of housekeeping staff, billing personnel, and technicians, also form an important part of patient care and equally deserve respect. In addition, importance of learning attributes of communication and good ethics – value-based training was also reflected in the students' narrations. From the faculty point of view, we got to understand that soft skill modules of AETCOM need to be designed and implemented by giving a real-life experience to students to make them more receptive.
| Conclusion|| |
Students perceived the AETCOM module of 2.4 - working in a health-care team positively. They were receptive to developing attributes of respect and good communication toward all members of health-care team and the importance of collaborative work in delivering enhanced health outcomes.
I would like to acknowledge the support of the entire teaching faculty from the department of pathology of our institute for the smooth conduction of this module.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gupta S, Menon V. Psychiatry training for medical students: A global perspective and implications for India's competency-based medical education curriculum. Indian J Psychiatry 2022;64:240-51. [Full text]
Lal S, Sehgal P. Integration of attitude, ethics, and communication competencies into competency-based UG curriculum. Indian J Community Med 2022;47:4-7. [Full text]
Shrivastava SR, Shrivastava PS. Whether introduction of competency-based medical education should be advocated in India? Indian J Pharmacol 2019;51:212-3. [Full text]
Ghosh A, Bir A. Role of written examination in the assessment of attitude ethics and communication in medical students: Perceptions of medical faculties. J Educ Health Promot 2021;10:23.
Schneider NC, Coates WC, Yarris LM. Taking your qualitative research to the next level: A guide for the medical educator. AEM Educ Train 2017;1:368-78.
Coates WC, Jordan J, Clarke SO. A practical guide for conducting qualitative research in medical education: Part 2-Coding and thematic analysis. AEM Educ Train 2021;5:e10645.
Pype P, Mertens F, Helewaut F, Krystallidou D. Healthcare teams as complex adaptive systems: Understanding team behaviour through team members' perception of interpersonal interaction. BMC Health Serv Res 2018;18:570.
Buljac-Samardzic M, Doekhie KD, van Wijngaarden JD. Interventions to improve team effectiveness within health care: A systematic review of the past decade. Hum Resour Health 2020;18:2.
Choudhary A, Gupta V. Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J Appl Basic Med Res 2015;5:S41-4.
[Table 1], [Table 2]