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ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 226-230

Attitude of dental interns toward learning communication skills in Bangalore city: A cross-sectional study


Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka, India

Date of Submission04-Mar-2018
Date of Acceptance11-Jun-2018
Date of Web Publication6-Aug-2018

Correspondence Address:
Dr. Shruti Ramesh
Department of Public Health Dentistry, Bangalore Institute of Dental Sciences, Bengaluru - 560 027, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_61_18

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  Abstract 

Background: Positive health outcomes are a result of effective physician-patient communication and assessment of the attitude of dental students toward learning communication skills may help dental educators to devise effective plans to orient students toward learning communication skills and make proactive efforts to hone their skills. Aims: The aim of this study is to assess the attitude of dental interns toward learning communication skills. Materials and Methods: A cross-sectional study involving 400 dental interns involving both males and females were selected from various dental colleges in Bangalore city for this study. Data were collected using the dental communication skills attitude scale, which consists of 24 items, 13 indicative of positive attitude and 11 indicative of the negative attitude toward learning communication skills. Statistical Analysis: The positive attitude scale and negative attitude scale scores were calculated and compared among different groups using SPSS software version 22. P < 0.05 was considered to be statistically significant. Results: Out of 400 participants, 150 (37.5%) were male and 250 (62.5%) were female. There was a significant difference in mean score of positive attitude between males (52.4 ± 5.6) and females (51.1 ± 6.0) (P = 0.03). The mean score of negative attitude was significantly higher among students whose teaching language was other than English (31.9 ± 5.1) when compared to students whose teaching language was English (29.8 ± 5.0) (P = 0.03). Conclusions: Dental interns have a strong positive attitude toward learning communication skills; however, negative attitudes should not be ignored, as they may subdue the importance of such programs.

Keywords: Attitude, communication, dental students


How to cite this article:
Ramesh S, Vanishree N, Anushri M, Chaithra V, Bullappa D, Pragathi D S. Attitude of dental interns toward learning communication skills in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:226-30

How to cite this URL:
Ramesh S, Vanishree N, Anushri M, Chaithra V, Bullappa D, Pragathi D S. Attitude of dental interns toward learning communication skills in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2018 Nov 17];16:226-30. Available from: http://www.jiaphd.org/text.asp?2018/16/3/226/238590


  Introduction Top


Communication is the art of transmitting information and meaningful interaction to exchange ideas and attitudes with one another. It can be viewed as a professional practice where appropriate rules and tools are applied to enhance the utility of the information being communicated.[1] Active communication is fundamental to the building of an effective physician–patient relationship and an integral component which encompasses knowledge, experience, and skills to deliver care.[2]

Communication between patients and healthcare professionals is a key element of their relationship from the initial consultation onward and thus an area that deserves attention during education. Communication in healthcare is not only a personality trait on the part of the dentist but also a series of skills that can be taught, learned, and retained.[3]

Communication skills play a major role in communicating adequately, sensitively, effectively, and respectfully with patients in a language that the patient understands better and in a manner that will improve patient satisfaction and healthcare outcomes.[4] Evidence exists to suggest that patients surmise a clinician's technical competency and knowledge based on communication abilities. It also ensures high quality and virtuous clinical practice which can increase the health-care providers' diagnostic efficiency and decision making ability, as well as lead to the contentment of the healthcare seekers.[5]

Dental students are generally receptive to learning communication skills and their appreciation for the value of these skills can be significantly improved with training. Over the past years, requirement of communication skills in the dental curriculum have received a considerable amount of attention among scholars.[6] The attitude of dental students toward communication skills training may be important indicators of the importance they place on them, and they may eventually influence communication behaviors in clinical settings. Kurtz in 2002 said that there is increasing evidence that good communication skills had a positive influence on positive health outcomes such as patient satisfaction with healthcare, compliance with medication, correct diagnosis, and reduction in malpractice claims.[7]

Effectiveness of a communication skill training program could be improved if we had a greater understanding of the students' beliefs and attitudes toward doctor-patient communication. According to Sangappa and Tekian proficiency in communication skills, team-building skills, and global knowledge is slowly becoming an essential part of dental education in India. However till date, literature does not include reports of any evaluation or training in communication skills during undergraduate dental education in India.[3]

A training program can aid the students in surpassing the difficulty of organizing their dental interviews, obtaining of accurate information from patients, and accessing the patients' perceptions of their oral healthcare needs. A person's attitude and desire can strongly influence the behavior of the individual which makes communication a learned skill. Exploring the attitudes of the dental students becomes the need of the hour as that may help dental educators to devise effective plans to orient students toward learning communication skills and make proactive efforts to hone their skills and also thwart negative attitudes from hindering the success of such training programs.[8]

Literature shows a number of studies on the attitude of dental students toward learning communication skills in the western context but very few in the Indian context. Hence, the present study aimed to assess the attitude of dental interns toward learning of communication skills in various dental colleges of Bangalore city, India.


  Materials and Methods Top


A cross-sectional study was conducted among dental interns involving both males and females of various dental colleges in Bangalore city for the duration of 2 months from April 01, 2016 to May 30, 2016. Ethical approval was obtained from the Institutional Ethical Review Board of and permissions for the study were sought from the head of the institutions before commencing the study (Ethical approval ref. no. BIDSPHD0023). The sample size was calculated as 400 using the following formula:



Where, Z = Z value for confidence chosen (1.96 for 95% confidence interval).

P = 50% = 0.50 (percentage of samples who had positive communication skills).

q = 1-p = 0.50.

Δ = margin of error which is acceptable = 0.05 (5%).

Therefore,

Sample size = ([1.96] 2× [0.50] × [0.50])/(0.05) 2 = 384

This was rounded off to 400,

Eight dental colleges were randomly selected from the list of colleges affiliated to the Rajiv Gandhi University of Health Sciences to attain the sample size of 400. Dental interns who were present on the day of study and those who were willing to participate were included in the study. Informed consent was obtained from the interns by disclosing the purpose of the study and only those who satisfied the eligibility criteria were given the questionnaire.

The final questionnaire was administered in English and consisted of an introductory letter followed by thirty-one questions organized into two parts. Part A consisted of five demographic (name, age, gender, and mother tongue) and three education-related questions (teaching language in school, self-rated academic performance, and self-rated skills as communicator). For the question on skill as a communicator and academic performer, students were asked to rate their skills on a four-point scale (1 = Excellent to 4 = Poor). Part B included the validated dental communication skills, attitude scale (DCSAS) questionnaire consisting of 24 questions on positive and negative attitudes.

Dental communication skills attitude scale questionnaire

DCSAS is derived from Communication Skills Attitudes Scale published by Rees and Sheard, Davies[9],[10] in 2002 which measures students' attitudes toward learning communication skills during medical school and further validated by Laurence et al. in 2012 among dental students as DCSAS.[11] The 24-item questionnaire was accompanied by a five-point Likert scale ranging from 1 (strongly agree) to 5 (strongly disagree). Overall, two scores were determined from the adapted CSAS: the mean positive attitude scale (PAS) and negative attitude scale (NAS) scores. These were achieved by summing the scores of the thirteen PAS and eleven NAS items, respectively, and dividing them by the number of items in each scale. The range of scores was from 13 to 65 for the PAS and 11–55 for the NAS. The highest mean or median score would indicate stronger attitude.

The data were processed and analyzed using the Statistical Package for Social Sciences (SPSS Inc., SPSS for Windows, Version 19.0. Chicago, IL, USA). The level of significance was set at <0.05, and the results were analyzed using descriptive analysis, t-test, ANOVA, and Pearson's correlation test.


  Results Top


A total of 400 dental interns participated in the present study, and the age of the participants ranged between 20 and 30 years with 58.5% in the age range of 20–23 years. Among them, 62.5% were female, and 37.5% were male. Two questions were asked to the study participants for self-assessment as a student and a communicator. About 7.3% of the students considered themselves to be outstanding students. About 54% of the participants rated themselves good as students, 38.3% of average students and only 0.5% rated themselves as poor students. As communicators, 10.3% of the students rated themselves excellent, 54.5% good as communicators, 33.8% average, and only 1.5% of them rated themselves as poor communicators.

The total mean score of positive attitude according to gender was slightly higher among males compared to females and this difference was statistically significant (P = 0.03), whereas the total mean score of negative attitude was also slightly higher among males (30.45 ± 5.27) compared to females (29.78 ± 5.02), but this difference was not statistically significant [Table 1].
Table 1: Total positive and negative attitude mean score according to gender

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For the calculation of mean score of positive attitude and negative attitude questions according to self-rating as a student, the average and poor ratings were combined since only two subject participants had rated themselves as poor students. The highest mean total positive attitude was seen in students who rated themselves as outstanding students (52.72 ± 8.15), whereas the lowest mean total positive attitude was seen in students who rated themselves as average (50.66 ± 5.68). The mean total positive attitude score for good students was 52.18 ± 5.74. This difference was statistically significant (P = 0.03). The highest mean total negative attitude was seen in students who rated themselves as average students (30.51 ± 4.79) while the lowest mean total negative attitude was seen in students who rated themselves as outstanding students (50.66 ± 5.68). The mean total negative attitude score for good students was 29.74 ± 5.26. This difference was not statistically significant [Table 2].
Table 2: Mean score of positive and negative attitude questions according to self-rating as a student

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The highest mean total positive attitude score was seen in students who rated themselves as excellent communicators (54.34 ± 7.23) while the lowest mean total positive attitude score was seen in students who rated themselves as average communicators (50.39 ± 5.20). The mean total positive attitude score for good communicators was (51.85 ± 5.97) and for poor communicators was (52.83 ± 6.36). This difference was statistically significant (P = 0.002). The highest mean total negative attitude score was seen in students who rated themselves as average communicators (31.05 ± 4.79) while the lowest mean total negative attitude score was seen in students who rated themselves as excellent communicators (28.22 ± 5.39). The mean total positive attitude score for good communicators was (29.72 ± 5.17) and for poor communicators was (30.67 ± 5.16). This difference was statistically significant (P = 0.009), [Table 3].
Table 3: Mean score of positive and negative attitude questions according to self-rating as a communicator

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On Pearson's correlation, as there was an increase in the self-rating as a student and communicator, there was an increase in the positive attitude which was statistically significant (P = 0.02, 0.001). Furthermore, as there was an increase in the self-rating as a communicator, there was a decrease in the negative attitude which was statistically significant (P = 0.001), [Table 4].
Table 4: Correlation between self-rated as student, self-rated as communicator, attitude

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Discussion

Despite a substantial amount of literature relating to communication skills of predoctoral dental students, there is a dearth of evidence on their attitudes toward communication skills learning. Widespread emphasis on the importance of communication in medical and dental students has made studies on medical students' attitudes towards communication skills learning to be of relevance to dental students.

In the present study, dental interns were chosen because they had completed their undergraduate curriculum and were more clinically experienced than the junior students.

Furthermore, in this study, the dental students of various dental colleges possessed both positive and negative attitudes toward communication skills learning. This finding was comparable with the outcome from a previous study on a group of Malaysian students.[12]

In the present study, the mean scores for PAS and NAS of the dental students were 51.63 ± 5.96 and 30.03 ± 5.12, respectively. The PAS scores are comparable with the other studies;[13],[14] however, the NAS scores are very less than the scores of the medical students of Nepal,[14] Sri Lanka,[15] and Iran.[13] These results may motivate the implementation of “communication skill training program” to the dental students, as positive attitude reflects caring patient orientation, thus a better health outcome. Though the negative attitude scores are low, it should not be overlooked, because the negative attitudes may trivialize the importance of the learning of communication skills.

In the present study, there were no significant gender differences in the positive and negative attitude scores of the dental students. Though these results go contradictory to previous studies done in Iran,[13] two studies done on Nepal medical students[14] and other on Sri Lankan medical students[15] observed a similar outcome as the present study.

In the present study, the students who rated themselves as good-to-excellent communicators had a higher mean PAS score than the students who rated themselves as poor-to-average communicators. Similarly, the students who rated themselves as poor-to-average communicators had a higher mean NAS score than the students who rated themselves as good to excellent communicators. This finding suggests that the students who perceived themselves as good communicators tended to have better attitudes toward communication skills learning and vice versa. One possible explanation is that those students able to communicate well were more confident and more willing to participate in the various activities and show their talent in communication. They would also tend to find the course more enjoyable. This finding is consistent with findings from a study conducted by Nor et al.[12]

In the present study, those who gave a poor rating to themselves as a student had progressively higher mean NAS scores. The difference was statistically significant (P < 0.05). This was in accordance with a study conducted by Nor et al.[12] This suggests that communication skills learning is usually appreciated, estimated very highly and necessary by students who considered themselves to be excellent or good students. Furthermore, such students had a higher willingness to learn communication skills.

Limitations

The self-reported questionnaire contained questions regarding the attitude of the students which could have led to a social desirability bias. The convenience sampling method used may have added to the bias.

Furthermore, in this study, communication in local languages or vernacular languages was not considered as there were no questions regarding communication in the local language in the scale used in this study.

Recommendations

Communicative competence is considered as an important aspect of the dentist's work, and an integration of communication-related topics into the dental curriculum needs to be well thought out. Communication skill training programs may be incorporated in the undergraduate dental curriculum which can improve student's knowledge, change negative attitudes and enable them to acquire specialized competence in communication, thereby favoring a better health outcome.


  Conclusions Top


In this study, a good positive attitude score of the dental students towards learning communication skills discloses the dental students' perception over the importance of communication skills in dental practice. Furthermore, a dental student who has internalized positive values associated with communication skills training would likely behave in ways that are consistent with those values, such as listening to patients more, explaining treatments in ways that the patient will understand, and attend to the physical, psychological, and social needs of the patients.

However negative attitude scores though low, in our study, cannot be ignored, as they may belittle the “Communication skill training” component in the undergraduate dental curriculum.

Acknowledgment

The authors would like to thank the principals and students of the dental schools for participating in the research project. We are grateful to them for contributing their valuable time and support to the research work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Ha JF, Longnecker N. Doctor-patient communication: A review. Ochsner J 2010;10:38-43.  Back to cited text no. 2
    
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Sangappa SB, Tekian A. Communication skills course in an Indian undergraduate dental curriculum: A randomized controlled trial. J Dent Educ 2013;77:1092-8.  Back to cited text no. 3
    
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Yashoda R, Puranik MP. Dental students' attitude toward learning communication skills in Bengaluru city, India. J Indian Assoc Public Health Dent 2016;14:327.  Back to cited text no. 4
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Hannah A, Millichamp CJ, Ayers KM. A communication skills course for undergraduate dental students. J Dent Educ 2004;68:970-7.  Back to cited text no. 6
    
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Kurtz SM. Doctor-patient communication: Principles and practices. Can J Neurol Sci 2002;29 Suppl 2:S23-9.  Back to cited text no. 7
    
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Venkatesh SP, Soundariya K, Deepika V. A study on attitude of medical students towards learning of communication skills. J Evol Med Dent Sci 2014;3:7567-73.  Back to cited text no. 8
    
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Rees C, Sheard C. The relationship between medical students' attitudes towards communication skills learning and their demographic and education-related characteristics. Med Educ 2002;36:1017-27.  Back to cited text no. 9
    
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Rees C, Sheard C, Davies S. The development of a scale to measure medical students' attitudes towards communication skills learning: The communication skills attitude scale (CSAS). Med Educ 2002;36:141-7.  Back to cited text no. 10
    
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Laurence B, Bertera EM, Feimster T, Hollander R, Stroman C. Adaptation of the communication skills attitude scale (CSAS) to dental students. J Dent Educ 2012;76:1629-38.  Back to cited text no. 11
    
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Nor NA, Yusof ZY, Shahidan MN. University of Malaya dental students' attitudes towards communication skills learning: Implications for dental education. J Dent Educ 2011;75:1611-9.  Back to cited text no. 12
    
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Fazel I, Aghamolaei T. Attitudes toward learning communication skills among medical students of a university in Iran. Acta Med Iran 2011;49:625-9.  Back to cited text no. 13
    
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Shankar RP, Dubey AK, Mishra P, Deshpande VY, Chandrasekhar TS, Shivananda PG, et al. Student attitudes towards communication skills training in a medical college in Western Nepal. Educ Health (Abingdon) 2006;19:71-84.  Back to cited text no. 14
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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