Electronic Media

An intensive IEC campaign over the Electronic Media (Radio and TV) was
undertaken through Prasar Bharati for optimum dissemination of information
on rural development programmes. In order to meet the area and region
specific communication needs of Rural Development Programmes, half an hour
audio and video programmes were produced and broadcast/telecast over local and primary stations of All Programmes of the Ministry, workshops at the national level in Delhi and also at regional levels were held during the year before the production of audio visual software. In addition to the Programmes and spots produced and broadcast through Prasar Bharati during the year, the Ministry continued to sponsor a weekly magazine format radio Programme ‘Jage Jan Jan Jage Gaon’ over Vividh Bharati Stations of AIR. The Programme is produced in Hindi and 12 regional languages and broadcast every Friday from 7.45 to 8.00 PM over 39 Commercial Broadcasting Stations. The broadcast of another weekly radio Programme of
thirty minute duration based on folk music over Primary and Local Radio Stations of AIR is also to start shortly. The Programme would be field based and produced in regional languages besides major dialects of Hindi, to meet the region specific communication needs relating to Rural Development Programmes.


The broadcast of Programmes and spots over regional kendras of Doordarshan and
primary and local radio stations of AIR is largely intended to meet the communication needs of the target groups in rural areas. In order to sensitize the opinion makers, urban elites and corporate bodies etc about issues relating to rural development and to facilitate their participation in the development process, weekly Programmes to be telecast over News and Current Affairs channel of Doordarshan were produced. Also to address the international community and to project the resurgent rural India in proper perspective, weekly Programmes were produced and telecast over DD (International).

In addition to the intensive IEC campaign through the print and electronic media , the Action
Plan also envisages utilization of the other modes of conventional and non conventional
Communication for disseminating information on Rural Development
Programmes. The Song & Drama Division, media unit of Ministry of Information and
Broadcasting, disseminates information on evelopment issues, among target groups
through the medium of performing arts, raditional arts, puppet shows, folk media,
mythological recitals and the like. As the edium of transmission is rooted in the
local ethos and traditions, the evelopmental messages are more easily rasped by the target groups. During the ear, from the financial assistance provided
by the Ministry, the Song & Drama Division resented Programmes through their field
units on the themes of the Programmes of he Ministry.

During the year Ministry participated in the epublic Day Parade 2002 with a tableau on the
theme of the Sampoorna Grameen Rozgar Yojana. he Ministry also took part in the India International rade Fair and set up a pavilion ‘Saras’ where poducts made by rural artisans from all over the ountry were displayed to provide them with maketing support and exposure to national andinternational buyers.

For meeting expenditure on IEC activities, the IEC Division utilizes budgetary allocations provided under the Communication Cell in the Department of Rural Development. In addition, the allocations provided for IEC activities under different Programmes in all the three Departments viz Department of Rural Development, Department of Drinking Water and Department of Land Resources are pooled together and utilized by the IEC Division for undertaking IEC activities in respect of all the Programmes in a holistic manner. Though as per BE 2001-2002, the total allocations available for IEC activities is only Rs.22.50 crore, the expenditure likely to be incurred on IEC activities during the year, on account of intensive IEC campaign, would be around Rs.75 crore. The expenditure in excess of the budgetary allocations are proposed to be met out of the savings available under different Programmes.

Using Cinemeducation (Film) To Teach Interpersonal and Communication Skills

Goal:

To raise awareness and stimulate reflection and discussion among residents and faculty about such issues as breaking bad news, medical interviewing, and the psychosocial impact of terminal illness

Objectives:

1. Residents will be able to reflect on the importance of physician-patient communication skills
2. Residents will be able to apply good methods of delivering bad news
3. Residents will be able to describe the impact of terminal illness on the patient and the family.


Learning Activity:

Cinemeducation is an excellent way to promote discussion on a wide range of topics in Interpersonal and Communication Skills. This article describes the use of “The Doctor,” to teach communication skills such as interviewing, breaking bad news, and the psychosocial impact of terminal illness. Initially, the film is introduced to residents and they are asked to view the video clip. Discussion questions are provided in the article for residents to discuss in a group format.
Program Directors also should encourage residents to bring forth their own cases or experiences in order to encourage application of information. Small group or large group discussion format can be used with the following types of questions:

• What are might the physicians have done differently to more successfully deliver the bad news to the patient and his wife?
• How can you be of assistance to patients and their families in facilitating open discussion about serious illness?
• What are challenges faced by physicians in balancing work and home lives?

For a broader list of topics, please see the resource guide Cinemeducation. Ideas for teaching communication skills, specific time counters for the film clips and specific discussion questions are included for a wide range of films and topic areas.

Resource Guide:

Alexander M, Lenahan P, Pavlov A. Cinemeducation. Radcliffe Publishers. Dallas, Texas. 2005.

Using the ILS (Invite-Listen-Summarize) Model to Teach and Assess Patient Centered Communication

Goal:

To improve a resident’s communication skills with patients in the ambulatory clinic and inpatient settings.

Learning Objectives:

1. Residents will be able to identify the components of the ILS model
2. Residents will be able to apply the ILS model to interactions with patients

Learning Activity:

The ILS model encourages residents to establish rapport with the patient (Invite), engage in active listening (Listen), and summarize the patient’s story throughout the interview (Summarize). These skills are part of a patient-centered interviewing technique that seeks to elicit the patient’s perspective. The authors of this model used standardized patients to provide feedback to learners on their ability to apply the model. This is a longitudinal curriculum and scenarios of graded difficulty are used throughout the year. Learners in small groups, working
with a standardized patient, are instructed to apply this model to the medical interview. Feedback from peers and standardized patients is used to improve communication skills.

A number of specialties could use this model in a variety of ways, depending on the resources of the program. This model is a more compressed version of the communications model developed by the Kalamazoo Consensus Statement.

Use of Standardized Patients:

Many academic medical centers have standardized patient programs and are happy to help construct specialty specific scenarios that reflect typical communication issues. The model could be presented in a short didactic form followed by resident interaction with a standardized patient who was instructed to give feedback regarding the resident’s application of this model. The advantage of this activity is that it provides residents with excellent feedback on their
interviewing skills. Standardized patients can also perform formative and summative assessment. Many standardized patient assessment centers have developed scenarios with high reliability and validity.

Role Play:

Role-play is another method that can be used to teach this model. A short didactic could be presented on the model. Ideally, one resident might take the role of the physician while one resident plays the role of the patient. The resident playing the patient could provide feedback to the “physician” on his/her ability to find it easier to do this activity if cases are chosen eforehand and are relevant to their specialty.

Video/Audio tape:

Videotaping and/or audiotaping allows the resident to self reflect on their communication style with a patient. Faculty review allows for significant discussion and formative feedback designed to improve a resident’s communication skills and enhance the development of an individualized learning plan. Residents and faculty should review the tape with an evaluation tool using
behavioral anchors.

Cinemeducation:

A fourth way to teach this model, which is fun for residents, is to present a short didactic on the model. Video clips of popular movies can be used to stimulate discussion about the model and about communication skills in general. For an extensive list of video clips, including discussion items, please see the resource guide section under Cinemeducation. For issues related to copyright, please consult this book as well.

Many of these strategies can be used to teach a variety of topics in Interpersonal and Communications Skills. Please see the bibliography at the end of this booklet for more excellent ideas.

Assessment:

Many of the assessment tools for patient-centered communication skills involve focused observation of the resident interacting with a patient. Program Directors should consider using a focused observation tool about twice a year. A focused observation tool allows faculty to identify a resident’s strengths and weaknesses in patient centered communication and helps residents develop a learning plan for improvement. There are many excellent focused observation tools, such as the Harvard Medical Schools Communication Skills Form or the SEGUE (see assessment section).

Using the Griev-ing Model to Teach and Assess Interpersonal

Goal:

To improve residents ability to notify family members and significant others following the death of a patient

Objectives:

1. Residents will be able to articulate the stages of the “GRIEV-ING” Model
2. Residents will be able to apply this model during various role plays

Learning Activity (2-hour workshop):

1. Short didactic on why death notification is an important skill and the significant verbal and nonverbal characteristics of empathic communication (20 minutes)
2. Small group activity facilitated by program faculty, hospital chaplain or hospital social worker. The focus of this small group activity is to ask residents to share personal experiences about the death of a patient and share communication skills that individuals felt were effective or ineffective for interacting with the family. Discussion questions are included in the appendix to the article.
3. Mini-lecture introducing the GRIEV-ING mnemonic. This mnemonic helps residents remember the appropriate steps to take when notifying family members or significant others about death.
4. Paired role-play – In these role-play residents received and delivered a death notification using the GRIEV-ING mnemonic. They were encouraged to provide helpful feedback to their colleagues
5. Simulated survivor encounter – Residents provided death notification in each of three scenarios portrayed by the simulated survivors. .Residents received feedback on their performance. Example scenarios and checklists for the simulated survivors are included in the article

Assessment:

The assessment for this activity is contained in the simulated survivor feedback and assessment tool included as an appendix to the article.

Comment:

While this model was used within an Emergency Medicine program, it would be equally valuable for other specialties in which notifying families and significant others of a patient’s death are required.

Using the Humanities to Teach Interpersonal and Communication Skills and Professionalism

Goal:

To improve resident’s interpersonal and communication skills and professionalism

Objectives:

1. Residents will develop a deeper understanding of professional and communication issues.
2. Residents will begin to explore their own feelings regarding their practice of medicine using narratives.

Learning Activity:

The authors describe weekly case based small group discussions focusing on such topics as medical errors, ethical issues, medical malpractice, and racism. Examples of discussion questions are given in the article. Specific readings designed to deepen the reflections of the discussion group are given throughout the year; these include novels, essays, and journal articles by physicians. Residents are also encouraged to write about their experiences with patients.
Active participation and discussion by senior faculty help residents reflect on and integrate this experience into their daily activity. Senior faculty were trained in problem based learning and group facilitation through the medical school in order to develop their skills in small group facilitation. As an alternative, behavioral science faculty or social workers might also be helpful in facilitating the discussions.

Assessment:

The authors present a theoretical model for assessment of this curriculum. Currently, they assess this module through required attendance and participation. Interpersonal and communication skills are assessed via a 360 evaluation from physicians, nurses, and patients.
A reflective narrative delineating their experiences and summarizing key individual learning points might be an additional method of assessment. These reflective narratives could become part of the resident’s portfolio. The narratives could be assessed by the Program Director using a standard checklist or rubric.

Assessment Tools for Interpersonal and Communication Skills

360-Degree (Multi-Source) Assessment Techniques

360-degree (Multi-Source) assessment involves evaluation by individuals in a full circle of reporting relationships. For residents, 360-degree (Multi-Source) assessment might entail evaluation by attendings, other residents, medical students, nurses, ancillary staff, and clerical/administrative support staff. Selfevaluation is an important part of the 360-degree (Multi-Source) assessment.

The 360-degree (Multi-Source) assessment tool from the Urology Resident Evaluation System10 is provided on the following page. The items were derived from the professionalism and communication skills literature and modified using comments from two physician reviewers. Pilot testing of the instrument is in progress; evaluation of the instrument’s reliability and validity will be conducted as a part of the pilot.

Suggestions when using a 360-degree (Multi-Source) Assessment:

• Ask members of the healthcare team (e.g. nurses, technicians, allied health professionals, resident peers) to complete a 360- degree (Multi- Source) evaluation immediately following a rotation in order to capture a current snapshot of the resident’s performance.
• Collect 360-degree (Multi-Source) assessment data and give residents
aggregate feedback at the biyearly meeting with the Program Director (this helps protect the anonymity of the raters).
• Use an electronic database to manage the information.
• Include a resident self-evaluation to compare the resident’s self-perception of their skills with the information from the other 360 evaluators.

Benefits:

• Multiple perspectives on resident abilities can be obtained
• Ratings from multiple evaluators can help increase data validity and reliability
• Residents’ ability to accurately self-assess may improve through comparison of self-and other assessments.

Disadvantages:

• A large number of evaluators may be needed before a stable estimate of performance is obtained
• Electronic data systems are needed to ease the difficulty of collecting and aggregating data

The invention of environmental

E nv i ronmental commu n i c ation emerged from the notion of ‘ green commu n i c at i o n ’ thought up by Th i e rry Libaert in 1992; although Paul Deb a cke r discussed it in his book ‘Le Management Ve rt ’ ( G reen Management) in the same ye a r. The book i n cluded so-called green management in a fi rm ’s ove rall planning. Libaert did the same, defining environmental commu n i c ation as:

• protecting the environment;
• teaching people about the environment;
• publicity campaigns to mobilize people on environmental issues.

Such communication must take into account:

• the state of public opinion;
• the strategic aim of the message communicated;
• definition of the target audience;
• the goals of communication;
• the message and the means to convey it;
• how measures develop.

On this basis, Vigneron and Francisco came up with what they called the ‘ten commandments’
of environmental communication.
i. Environmental communication must take the complexity of the environment into
account, especially the number of people involved, their status and the nature of the
resources which define and drive human ecosystems.
ii. The individual is the vital element in environmental communication. Social models
are overridden by cultural identities which link each person to his environment. 36 CSI info No. 7, 1999
iii. E nv i ronmental commu n i c ation seeks to involve the individual and relies on neighbourhood or even door-to-door communication. It uses dialogue, participation, interactivity
and partnership.
iv. The final effectiveness of environmental communication is judged by a permanent change in individual behaviour. The modern social trend towards individualism cuts people off from their bearings and their membership of social groups which means their behaviour is crucial in protecting the environment.
v. Time is essential for environmental communication, to allow people to reconsider and change their attitude towards the environment. Because this takes place over years, memory plays an important part in it, as a link between the past, the present and the future. Events are only important if they can be incorporated in a long-term strategy.
vi. Inside a firm, internal communication used in staff management defines environmental
communication.
vii. Eco-tools (product lab e l i n g, e c o l ogi c a l inventories, projects and charters concerning
the environment) which rely on volunteer workers are the technological part of environmental communication. They also fit in with the growth of individualism by giving each partner a reference and a guarantee of the quality of a product or service.
viii. E nv i ronmental commu n i c ation ch a n ge show societies work, with interactive networks
replacing hierarchical pyramids.
ix. The role of education is constantly emphasized in environmental communication. The
behaviour of tomorrow’s citizens is shaped by their education.
x. Reference to ethics enables people involved in the environment to relate its local management
to the stability of the global environment. Eco-citizenship arises from the need for each person to choose a morality based on universal values and a code of conduct to behave as a responsible consumer. Eco-citizenship, environment, sustainable development and citizen-run organizations
are the basis of a new morality, which includes and completes environmental
communication.

In this spirit, the UN Population Fund, at the end of the 1980s, encouraged the idea of IEC in its
programmes.

EDUCATION, COMMUNICATION AND SUSTAINABLE

A f rican economies are in crisis part i c u l a rly where the development of coastal regions and
small islands is concerned. So too is the relationship between the physical state of the land
and that of coastal regions, the sea and ecosystems. Education and communication are clearly
the most neglected factors in the equation. It is hard to list all the programmes of United
Nations (UN) agencies in this field around the world. The state of data-gathering projects in
individual countries makes it difficult to draw up summaries by sector. The UN Secretary General’s report to the Sixth Session of the Commission for Sustainable Development illustrated the wide range of UN action in the field of water resources, such as:

• the gathering and analysis of data and making surveys and reports;
• holding meetings and workshops with appropriate backup;
• technical help (providing consultancy services and working projects).

The problems and delays in communication and education in Africa, particularly in the countries
concerned, block out the inevitable developments going on worldwide. Communication and
education influence a country’s development of its resources because they are at the root of all
development. Sustainable development in count ries with a coastline and in small islands
depends largely on the ability of local people to communicate in modern or traditional fashions
and form local links between individuals to initiate new forms of co-operation and action.
So the people of the countries invo l ved first h ave to be made awa re of the need to protect the
e nv i ronment and taught how to do it in the hope t h ey will include it in their development pri o ri t i e s . They need to assess the status of the major coastal problems as part of the education and communication programmes of African countries. The rather hasty surveys done on this so
far are modest and generate little optimism about the present ability of education and communication to solve the demographic and environmental problems of coastal regions and small islands. In addition, future projects can only be carried out over the long term by including the problems and their solutions in education programmes, and by developing formal and informal education.

African countries need to formulate an information- education-communication (IEC) strategy
and consider ways to raise public awareness, ‘strengthen’ participation and decision-making
and encour age a change in people’s behaviour; since many problems are due to the way people
damage the environment. This method involves training IEC instructors for target groups so as
to bring communities closer together to consider the problem. Many international projects could be adapted to local communities which are in the main unaware of such things. These include drawing up regional communication plans, local use of new information and communication technology (setting up web sites) and developing traditional media as well as supporting local media and formal and informal education.