Teaching ‘hand’ (skills) have been taken care of, the

Attitude and Communication skills to medical students: A need of the hour

“Harmonious development of the
head, the heart and the hand is the mark of model man” (read as Medical
Swami  Vivekananda

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The roles of an Indian Medical Graduate (IMG), as
defined by MCI in Regulations on
Graduate Medical Education, 2012, are; a clinician
who provides holistic care to the patient, a leader, a communicator, a
lifelong learner and a professional. Because of the skewed
doctor-patient ratio in our country, it is imperative that an IMG should be a
competent doctor of first contact to the community, at the same time being
globally relevant.

Over the years, medical
education in our country is changing, from being knowledge based to competency
based. While the ‘head’ (knowledge) and ‘hand’ (skills) have been taken care
of, the ‘heart’ (affective domain) is often neglected. Unfortunately, “Science of
treating a sick” has taken over “the art of healing a sick”.

As medical teachers, we
often presume that students already know about attitude, professionalism and
communication skills, and therefore, need to formally teach them these
attributes is often undermined. However, the recent incidences of strained
doctor-patient relationships have highlighted the fact that it is high time
that we start teaching the attitude and communication skills to
medical students right from the beginning.

Now the question is that how and when can these skills
be taught and more importantly, as medical teachers, how to assess these
skills. In July 2015, the Academic
Committee of Medical Council of India came up with revised Regulations on
Graduate Medical Education and curriculum, accompanied by guidance for implementation
of new teaching–learning approaches including a structured longitudinal program
on attitude, communication, and ethics which is known as the attitudinal and
communication (ATCOM) competencies. It introduces competency pattern in
the undergraduate curriculum and tends to strike a balance between explicit
teaching and experiential learning incorporating values of professionalism.1

The ATCOM module lists 54
competencies (39 core or must know and 15 non-core or good to know/ nice to know),
divided into 27 modules, pertaining to affective domain, which are to be taught
at different phases of MBBS training. Very clear guidelines are provided as to
when these competencies should be taught (See Road map below), what should be
the teaching-learning methods and the assessment methods. Grossly
speaking, foundation of communication in the First year, bioethics in the
Second year, medico-legal issues, ethics, and doctor-patient relationship in
the third year, and medical negligence and dealing with death in the final
year, are some of the important topics (see Box 1).

Medical Council of India has announced to implement Attitude and Communication
module (ATCOM) in all medical schools across the country over the next two
years, after release of ATCOM document in 2015, giving liberty to the
institutions to make modifications at their level. We propose that the module
in its present form be implemented phase wise and the first year-five modules can
be implemented from the coming batch of first professional year in 2018. It is
also suggested that 3-4 ATCOM trained faculty members may take initiative in
formulating implementation strategy. More innovative methods can be
incorporated subsequently, apart from what is included in the existing document.

Success of implementation will depend on appropriate
training of medical teachers by experts, commitment of faculty members to
integrate assigned hours with existing syllabus and evolve assessment
strategies at all levels. As a part of the faculty development program, the
faculties of various colleges are being trained in implementation of the ATCOM
module in their respective colleges. So far, about 260 faculty members have
been trained at MET-NHL Centre, Ahmedabad.

Box 1: Summary of the ATCOM

Total ATCOM Modules 27, Total teaching
hours 139


Professional year 1

Professional year 2

Professional year 3

Professional year 4

Number of Modules/ Hours





Module 1

and empathy

(Active listening)

Communication (dealing with emotions)

Communication (diagnosis and treatment decisions)

Module 2

between healing and cure


Disclosure of Errors

Medico legal

Module 3

Nature of
doctor-patient relationship

health care needs

Communication (informed consent)

As above

Module 4


Team work


Empathy and doctor-patient relationship (termination)

Module 5

Respect for
human body and tissues

Ethics principles: Autonomy and decision making

Health care delivery-As Fiduciary Duty

Doctor Industry relationship

Module 6


Ethics Case studies


Professional Relationship

Module 7


Ethics Case studies


Ethics (care of child)

Module 8


Empathy-Family of sick


Thanatology (Dealing with Death)

Module 9






It is hoped, that
after successful implementation of the ATCOM module, the MCI goal,to create an  “Indian Medical Graduate” possessing requisite knowledge, skills,
attitudes, values and responsiveness, so that he or she may function appropriately
and effectively as a humane doctor of first contact of the community while
being globally relevant, will be realized.


1.      Mitra J, Saha I.
(Editorial) Attitude and communication module in medical curriculum:
Rationality and challenges. Indian J Public Health. 2016;60:95-8.



Dr Ajeet Kumar Khilnani                                                                   Dr

Associate Professor                                                                             Associate

Departments of Otorhinolaryngology                                                 Department of

Adani Institute of Medical Sciences, Bhuj.



[email protected]






RC = Regional Centre, NC = Nodal Centre, MC = Medical

BCW = Basic Course Workshop, MEU = Medical Education