Abstract
Background:
Metered dose inhalers (MDI) remain the mainstay of drug delivery in patients with bronchial asthma and other respiratory diseases for the last few decades. India has an estimated 15-20 million asthmatics; rough estimates indicate a prevalence of between 10-15% in 5-11 year old children. Its advantages include better adherence and safety profile with improved efficacy. However, imperfect inhaler use technique worsens health outcome with poor disease control. Communication and demonstration skills of health care professionals are thus vital parts of asthma therapy while educating patients regarding MDI use. Use of different devices has been included in Phase II of CBME Curriculum. Hence, communication and demonstration skills need to be learnt by all Indian medical graduates. Thus, a study was planned to assess communication and demonstration skills regarding MDI use of phase II MBBS students.

Aim:
To evaluate and analyse the communication and demonstration skills on the use of MDI among Phase-II MBBS students of a Medical College in Kolkata.

Methods:
A total of 243 second year MBBS students participated in the study. They were asked to demonstrate the correct technique of use of an MDI along with suitable communication with the interviewer who posed as a patient. The assessment of their demonstration and communication skills was done on the basis of scores obtained on a pre-validated and tested checklist. For assessment of skills, a single interviewer was appointed to avoid inter-individual bias. Students were categorised according to performance into excellent (>75% scores), good (60-74%), fair (50-59%) and fail (<49%) which was further classified into poor (49-35%) and very poor (<35%).

Results:
Average scores obtained by the students were 59.2 ±28.99% and 91 ±11.64% in communication and demonstration skills respectively. Students performed significantly better with demonstration compared to communication skills (p<0.001; Unpaired t test). During demonstration quite a significant number of students missed stating the steps involving deep and steady breathing to the dummy patient. As per results of communication skills 32.9%, 13.9% and 13.9% students were in excellent, good and fair categories respectively. As per results of demonstration skills 95.47%, 2.8% and 1.23% students were in excellent, good and fair categories respectively. Only 1 student failed in demonstration. However, 95 students failed in communication out of which 13.58% and 25.5% scored poor was very poor respectively.

Conclusion:
The study concludes that phase II medical students in this college were well versed with the steps and technique of using the MDI as seen from the high scores of demonstration skills. However they seem to be lacking in adequate communication skills while explaining the technique to a patient. Hence, there is a need for more training regarding communication skills.

Key words: Drug delivery, Metered dose inhaler, Communication skills, Bronchial asthma