Assessment of the development of social skills among undergraduate medical students through participation in a socio-educational project during the coronavirus disease (COVID)-19 pandemic: a Brazilian pilot study

Abstract

Coronavirus disease (COVID)-19 had an impact on medical graduation, causing weaknesses arising from social isolation and remote emergency teaching, with an emphasis on deficits in the development of non-technical skills (soft skills). In this context, the interaction between a group of medical students and adolescents who develop activities at the Center for Learning and Mobilization for Citizenship in Campinas/SP, Brazil, was evaluated about the development of soft skills during the COVID-19 pandemic. The observational study was carried out using an electronic questionnaire based on a Likert scale on the feelings of undergraduate medical students regarding participation in project activities in the context of the development of social skills. The study demonstrated an important positive impact of student participation in a socio-educational project for the development of soft skills, emphasizing the ability to deal with adverse situations, decision-making, and the ability to deal with the fear of not corresponding. However, the existence of limitations and difficulties in the development of non-technical skills by students was revealed, further reinforced by the challenges brought by the COVID-19 pandemic. In this aspect, the study demonstrated participation in a voluntary social project as an important strategy to improve the teaching of these skills.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-024-06188-2.

Introduction

Medical education requires the development of two key skill sets: hard skills (technical) and soft skills (non-technical). Soft skills—such as empathy, communication, problem solving, leadership, and teamwork—are essential for effective doctor-patient interactions and healthcare teamwork [1–3]. These competencies are critical for patient satisfaction, safety, and the promotion of diversity and inclusion within healthcare settings [4]. Effective communication, in particular, is recognized as one of the most important skills for physicians, making soft skills vital in both medical training and practice [2, 3].

The coronavirus disease (COVID)-19 pandemic in Brazil caused an intense and negative medical and social impact and underscored the need for medical training that emphasizes soft skills, particularly communication. It exposed gaps in medical education, revealing weaknesses in professionals' communication abilities [5–9]. Remote learning and social isolation further hindered the development of interpersonal relationships, limiting the cultivation of essential soft skills [6, 10, 11]. To address these issues, it is crucial to explore methods to enhance soft skills development in medical education [11]. Voluntary social projects can serve as effective platforms for this purpose, promoting empathy, communication, adaptability, and teamwork while promoting civic and social responsibility among students [12].

In this context, voluntary social projects have emerged as valuable opportunities for students to develop soft skills, such as empathy, adaptability, and teamwork, by engaging directly with communities [12]. The study evaluated the interaction between a group of medical students from the medical course at the Faculty of Medical Sciences of the University of Campinas (Unicamp), with teenagers who carry out activities at the Center for Learning and Mobilization for Citizenship [Patrulheiros de Campinas], Campinas/SP, Brazil, in the context of developing soft skills during the COVID-19 pandemic.

Methods

An observational pilot study was carried out with a group of undergraduate medical students from the Adolfo Lutz Academic Athletic Association, the institution responsible for practicing sports during medical graduation at Unicamp and that participated in two meetings with students from Patrulheiros de Campinas to carry out socio-educational activities in the teaching environment of these teenagers. The activities were programmed according to the needs identified by the institution's management. However, they are always focused on integrating sports with the basics of preventive medicine and first aid.

Before the arrival of the students from Patrulheiros de Campinas, the undergraduate medical students responded to a questionnaire, based on a Likert scale about some feelings regarding participation in these activities in the context of developing soft skills (ability to deal with adverse situations, taking decision-making, prioritization of activities, communication skills, teamwork, ability to recognize limits, receptivity to external help and ability to deal with the fear of not meeting expectations) [13, 14] (Supplement Material 1). After completing the activity, the students responded to the same questionnaire to assess the impact of the activities on them. These responses to the questionnaires before and after the activities were analyzed by the researchers and presented in figures.

The following responses are available in the questionnaire. (Likert scale): (i) I totally disagree, (ii) I disagree, (iii) I neither disagree nor agree, (iv) I agree, and (v) I totally agree. Both stages of the interview were carried out individually with undergraduate medical students who completed the questionnaire on Google Forms. All questions described in the Supplementary Material were answered by completing the checklist containing the Likert scale options as described previously in this paragraph. The entire filling process was monitored by the study researchers (MAA, AMAF). The researchers did not influence the choice of answers.

An exploratory statistical analysis (pilot study) was performed to compare responses to pre-action and post-action questionnaires using the McNemar Bowker test with an alpha error of 0.05. Descriptive and inferential statistics analyses were performed using the Statistical Package for the Social Sciences software [IBM SPSS Statistics for Macintosh, Version 28.0] [15]. The figures presented in the article were constructed using GraphPad Prism version 10.2.3 for Mac, GraphPad Software, Boston, Massachusetts USA, www.graphpad.com [16].

The questionnaire was completed using Google Forms together with the Free and Informed Consent Form. The study was approved by the Research Ethics Committee of the Unicamp (no. 58322622.9.0000.5404).

Results

A total of 18 participants were enrolled in the study. The results highlight that the student's participation in the project generated a positive impact, mainly, on the following soft skills: (i) the ability to deal with adverse situations (Fig. 1a), (ii) the decision-making (Fig. 1b), and (iii) the ability to deal with the fear of not meeting expectations (Fig. 1h).

Fig. 1.

Result of the evaluation of the development of soft skills among undergraduate medical students through participation in a socio-educational project during the coronavirus disease (COVID)-19 pandemic. The figure presents comparative data on student responses in the pre-action and post-action moments for the following conditions: a Ability to deal with adverse situations (P-value = 0.657). b Decision-making. c Prioritization of activities (P-value = 0.543). d Communication skills. e Teamwork (P-value = 0.392). f Ability to recognize limits (P-value = 0.211). g Receptivity to external assistance (P-value = 0.518). h Ability to deal with the fear of not meeting expectations (P-value = 0.502). It was not possible to calculate the P-values to two markers (Decision-making and communication skills). The exploratory statistical analysis (pilot study) was performed to compare responses to pre-action and post-action questionnaires using the McNemar Bowker test with an alpha error of 0.05

The ability to deal with adverse situations had an increase in the number of individuals who indicated “totally agree” when comparing the pre-action and post-action moments, as the choice of this item on the scale doubled.

Decision-making also showed an increase in positive responses, seeing a 200% increase in the number of people who said “I completely agree” when comparing the pre-action and post-action moments. Furthermore, the number of negative responses (“Disagree” and “Strongly disagree”) decreased to zero when comparing the pre-action and post-action questionnaires.

The analysis of the ability to deal with the fear of not meeting expectations proved to be interesting given the high number of negative responses (“Disagree” and “Totally disagree”) in the pre-action moment, which corresponded to half of the responses described in the questionnaire. However, in the post-action questionnaire, an important redistribution of responses was demonstrated, so this rate was reduced when comparing the pre-action and post-action questionnaires.

The other soft skills presented less expressive results, but it is still possible to notice an increase in positive responses (“I agree” and “I totally agree”) when comparing the pre-action and post-action moments. Therefore, an aspect of improvement in the feeling about participation in the proposed activities in the context of the development of soft skills can be inferred.

Discussion

As the field of medicine evolves rapidly, it is essential to reevaluate the skills required to train competent doctors. Modern physicians must also effectively handle the intricacies of their relationships with patients. Recent educational discussions have highlighted the importance of soft skills, which are increasingly recognized as a vital component of medical training. Additionally, a historical analysis reveals that the integration of technical knowledge with interpersonal and relational skills has long been a topic of conversation in the medical profession [1, 2, 17]. In our data, it was observed that the participation of medical students in a voluntary socio-educational project in the context of the COVID-19 pandemic, through the impacts they brought to medical education, contributed significantly to the development of soft skills with a clear positive impact on medical training. There is a change in students' perception regarding most of these skills, based on participation in the proposed activities. Therefore, the soft skills most affected in the project were the ability to deal with adverse situations, decision-making, and the ability to deal with the fear of not meeting expectations.

In the healthcare environment, both hard skills and soft skills are essential for providing exceptional patient care. A key distinction between these two types of skills lies in how they are acquired and applied daily [18]. Hard skills are typically developed through education or specialized training. Important hard skills in healthcare include knowledge of regulatory standards, documentation requirements, preparation for state surveys, familiarity with healthcare software and databases, data analysis, and monitoring vital signs and behaviors [18]. These skills are easily taught, clearly defined, and readily measurable by employers, making them critical to meeting the expected standards of care in any healthcare organization [18]. In contrast, soft skills focus on personal habits, strengths, and perspectives that influence workplace performance. Often referred to as "people skills" or "interpersonal skills", soft skills are subjective and harder to quantify [52]. They encompass abilities that are often learned through life experience, such as effective communication, teamwork, compassion for patients, conflict resolution, and stress management. In healthcare, soft skills are as vital as hard skills. At their core, healthcare professionals must possess a genuine passion to positively impact others' lives [18]. These soft skills facilitate the building of relationships with patients and their families, effective communication with colleagues and supervisors, and the ability to remain composed and professional in challenging situations [18].

First, there is the ability to deal with adverse situations, with an increase in the number of students who indicated positive responses. It should be noted that this soft skill is also defined by the concept of resilience, that is, a dynamic capacity that can allow people to thrive in challenges in appropriate social and personal contexts [19]. In this context, it is important to highlight the participation of medical students in volunteer activities as an important enhancer of the development of resilience in medical education [20]. In addition, resilience has been widely studied in medical education, and several authors have emphasized its importance for medical practice [21]. Therefore, the active participation of medical students in a voluntary socio-educational project was able to induce a positive impact on the development of the ability to deal with adverse situations, revealing the contribution to implementing soft skills. In summary, the literature agrees that medical education programs that expose students to controlled adverse situations, such as voluntary activities or simulations, tend to strengthen this ability [22, 23]. However, some studies disagree on the effectiveness of voluntary activities, arguing that lack of adequate supervision can generate more stress than benefits, particularly in crisis contexts such as the COVID-19 pandemic [24].

Decision-making was a key process that also stands out, with an increase in positive responses when comparing the pre-action and post-action moments. In the context of these soft skills, it is important to highlight the demand for this skill, also considering the context of the COVID-19 pandemic, which caused difficulties in medical decision-making, with a lack of resources and limited knowledge about the disease, often with several guidelines to deal with the evolution of the disease including diagnosis, treatment, and measures to contain disease progression [25–33]. All the issues related to the COVID-19 pandemic influenced medical education worldwide, especially, highlighting the importance of a critical point of view, including those associated with the scientific literature that suffered a paperpandemic process with numerous studies being retracted [34–37]. A study carried out at the Medical University of Vienna demonstrated that students' perception of teaching soft decision-making skills was that the skill would not be sufficiently taught in medical school [38]. This finding is supported by other studies that suggest that medical curriculums often neglect the practice of complex decision-making in uncertain situations, which could be improved through activities such as voluntary projects or simulations [39, 40]. However, some authors argue that decision-making needs a stronger technical foundation before being practiced in voluntary contexts, suggesting that a lack of technical knowledge can create insecurity rather than improve this skill [41]. Therefore, the need to expand and improve this teaching among students stands out. The participation of students in a social project would serve as an instrument for enhancing decision-making capacity in medical education.

Another aspect analyzed that had an interesting positive impact in the context of the activities developed was the ability to deal with the fear of not meeting expectations. It is known that this skill has been evaluated as an important challenge in medical education – this feeling is a common challenge in medical education, generating uncertainties among students about their knowledge, emotional management when interacting with patients, and their role within teams [42]. In this sense, there are feelings of uncertainty among students about their knowledge and skills, the management of emotions in encounters with patients, the culture and values ​​of health professionals, and their position within teams [42]. Therefore, students begin to harbor a feeling of uncertainty about what is expected of them in their role as students in their future professional roles [42]. The culture and professional values, as well as the fear of not living up to expectations, create a constant pressure-filled environment. The literature recognizes this fear as a significant barrier to professional development [43, 44]. Studies suggest that coping strategies, such as those developed in social and voluntary projects, can help students overcome this fear and increase self-confidence [45]. However, there are also studies that indicate that without adequate psychological support, this approach can be counterproductive, exacerbating stress among students [46]. Therefore, the demonstration of a strategy capable of assisting in the development of this soft skill among medical students has a relevant potential to contribute to the medical practice of these students, so participation in a social and voluntary project proved to be a prominent tool for this.

However, the study has some limitations. The observational study was carried out on a small scale, with a limited number of participants and within an activity in a specific context. In fact, this is a pilot study. Therefore, the similarity of the results (replication of results) in other studies also depends on the similarities of the activities. Another potential limitation of the study is the lack of generalization, since it was carried out in groups of students from the same student association and in a single college (medical school). Larger studies with more diverse samples could provide more generalizable results [47]. Also, we conducted a pilot study with a low number of questions and a low number of participants, and, in this context, we were unable to evaluate the account for self-reporting bias. Moreover, several factors such as sociocultural context could biased our findings; however, due to the nature of the study, it was not possible to analyze these markers, which should be considered in future studies. However, to deal with this problem, our sample was to quickly analyze the impact of the absence of these important markers in a paired way. It is important to note that the COVID-19 pandemic caused an intense impact in Brazil [5, 6], which was an epicenter of the disease—this fact may possibly be related to some findings described in our data. However, even though it was an epicenter of the disease, Brazil experienced some social and cultural irregularities in dealing with the COVID-19 pandemic [7, 48], including the quick forgetfulness of the pandemic moment that we have experienced in recent times [49], which was linked to millions of cases and thousands of deaths in Brazil.

In conclusion, undergraduate medical students demonstrated the existence of difficulties regarding the development of soft skills, revealing, through pre-action questionnaires, some insecurities regarding their perception of themselves with the skills presented. The COVID-19 pandemic brought with it challenges in medical education and highlighted the need to improve tools to strengthen non-technical skills in medical training. This study suggests that participation in a voluntary socio-educational project during the COVID-19 pandemic can be an effective strategy to enhance the teaching of these competencies, offering a practical approach adapted to the socio-cultural and professional context.

Authors’contributions

[MMM, MAA, FB] Data collection. [CVCP, FALM, AMAF] Data validation and statistical analysis. [MMM, MAA, FB, CVCP, FALM, AMAF] All authors wrote the manuscript, approved it, and agreed with its submission to the journal.

Authors information

Not applicable.

Funding

MAA received a scholarship from the Institutional Program of Scientific Initiation Scholarships – National Council for Scientific and Technological Development (PIBIC/CNPq, Programa Institucional de Bolsas de Iniciação Científica – Conselho Nacional de Desenvolvimento Científico e Tecnológico).

Data availability

The material used to carry out the study will be available upon request to the corresponding researcher.

Declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the University of Campinas (no 58322622.9.0000.5404). Informed consent to participate was obtained from all participants in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.