What they didn’t teach you in medical school

Dr Laurian Katengesha decided to teach himself communication skills when he was still in medical school. But he learnt the hard way—at times he could rely on self-help books, reading novels and online video guides—all for self-improvement. That was coupled with his self-determination.

The young medic, a graduate of Muhimbili University of Health and Allied Sciences (Muhas), advocates for a people-centred healthcare system and he dreams of becoming a scientist who can better explain medical jargon in simple language to his clients.

If there is one thing that he wished his medical school should have offered him—it is the ability to communicate well with patients. But, he says, competency in communication skills was not given much priority during his training. That’s why he decided to take it upon himself to nurture his skills.

‘’We were taught medical ethics, psychology and how all those relate to the doctor to patient relationship. But the curriculum did not allow lecturers in communication skills to offer us training,’’ says Dr Katengesha.

Dr Katengesha is one of the final crop of medical graduates from Muhas, who, as future health workers, will not have benefited from a new curriculum introduced about four years ago to streamline medical school training at the Muhas campus. Among the things introduced alongside the new scheme, was a new course on communication skills.

Even then, one of the beneficiaries of the curriculum, a now 4th year medical student (name withheld for fear of reprisal), told Success that the new system was very systematic but the emphasis on communication skills still needed more push.

Since 2011, the varsity embarked on a programme to overhaul the training methodology for future doctors, dentists, nurses and pharmacists—but this will remain a missed opportunity for graduates like Dr Katengesha who enrolled years before the launch of the new system.

However, according to the Muhas Vice Chancellor, Professor Ephatha Kaaya, the new curriculum will not be anything different—it’s rather a more structured and systematic scheme with emphasis on building competency among young health professionals.

He told Success that it may turn out to be a game-changer in the country’s health training programmes because it focuses on all the domains of competency—and each student will be required to demonstrate a certain level of competency before graduation.

‘’It’s a game changer only because the new curriculum emphasises on systematic teaching, assessing and documenting the development of competency by the student,’’ said Professor Kaaya in an interview.

According to him, communication skills is an essential part of any form of medical training because, for a healthcare provider to understand the patients’ or community health problems, it is important to know how to elicit appropriate information from the people.

‘’But also, you [a doctor or nurse…] need to be a good communicator in order for the patients to know the problem affecting them and how it would be treated,’’ he said.

In his experience as a medical professional, communication skills have been part of the medical training since time immemorial and it’s not limited to the doctor-patient relationship.

‘’You (health professionals...) need to know how to communicate to the relatives of the patients and the colleagues politely as well,’’ says the Muhas don. This, according to him, defines a competent professional who has been thoroughly trained.

Currently, Tanzania’s healthcare professionals are said to work in settings for which they were not prepared during their education—some researchers in the country have also cited case studies that highlight this matter.

According to a study in the Journal of Public Health Policy, titled: ‘’Curricular transformation of health professions education in Tanzania: The process at Muhimbili University of Health and Allied Sciences (2008–2011),’’ there is a dire need for the country to create a pool of competent experts with good leadership and communication skills.

‘’Immediately upon qualification, public health and clinical graduates take up assignments in district hospitals with heavy responsibilities,’’ notes part of the study and it recommends that in-service training for young professionals should be offered.

For the young professionals who did not foresee the realities related to this challenge when they were still at college, it may prove a tall order when they start working according to Dr Katengesha again.

He says, “the feedback we get from people who have been attended at various hospitals, is that doctors are generally not good at communicating to their patients.’’

‘’You will always hear cases of two or more patients complaining about something that could have been resolved by simply listening to them,’’ he says as he alludes to the fact that some times the complaints may arise from the lack of some basic medical supplies.

His observation corroborates with studies done at various hospitals in Dar es Salaam, which have indicated a low level of patients’ satisfaction when they visit the health facilities.

One, published in last year in the BMC Health Services Research Journal, recommended that there was a need for the hospitals’ management and the government to take an active role in improving communication skills among staff especially at their outpatient departments.

‘’If the policy can improve, patients will notice the reality on the ground and hence indirectly improve their satisfaction,’’ says the study, titled: ‘’Patients’ level of satisfaction on quality of health care at Mwananyamala hospital in Dar es Salaam.’’

The researchers found out that showing compassion, politeness and active listening as well as ensuring the availability of essential drugs, and improvement on clinicians’ prescription skills would greatly improve the attitude of the patients towards the hospital.

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