Communicators in war-torn and developing settings must go beyond basic information exchange. They are responsible for building trust in environments where healthcare systems may be fragile, misinformation may be common, and cultural, religious, and social factors strongly influence patient decisions. Communication becomes a tool for education, advocacy, de-escalation, and community engagement, especially in managing conditions like tuberculosis, mental health disorders, and trauma-related illnesses.
1. Develop and recognize the essential skills of a communicator #
1.1 Engage in patient-centred care that supports autonomy in decision-making and establishes trust while demonstrating empathy, respect and compassion #
Students must actively build trust with patients who may have fear, mistrust, or limited prior interaction with formal healthcare systems. This involves listening carefully, acknowledging concerns, and showing genuine compassion—especially for patients affected by trauma, displacement, or poverty. Supporting autonomy may require navigating family-dominated decision-making structures while still ensuring the patient’s voice is heard. In many cases, trust-building is the first and most critical step before any medical intervention is accepted.
1.2 Demonstrate effective verbal and non-verbal communication in all contexts of care #
Students must communicate clearly using simple, non-technical language, especially when patients have limited health literacy. Non-verbal communication becomes equally important—respectful posture, appropriate eye contact (within cultural norms), and calm demeanor can help reduce anxiety and build rapport. In high-stress environments such as emergency care or conflict zones, clear and calm communication is essential for maintaining order and ensuring patient cooperation.
1.3 Demonstrate effective communication to optimize care outcomes and minimize errors #
Students must ensure that instructions, diagnoses, and treatment plans are clearly understood, as misunderstandings can lead to serious harm—especially when follow-up is uncertain. This includes confirming understanding by asking patients to repeat instructions and simplifying care plans where possible. Clear communication is also critical within healthcare teams to avoid errors in environments where systems and documentation may be inconsistent.
1.4 Effectively communicate respecting the diversity and background of patients, families, communities and colleagues #
Students must adapt communication based on cultural, religious, and social contexts. This includes understanding gender roles, family hierarchies, and community norms that influence healthcare decisions. For example, mental health conditions like PTSD may be stigmatized, requiring sensitive and indirect communication approaches. Respecting diversity is essential for gaining acceptance and ensuring adherence to care.
1.5 Ensure an appropriate physical location for all discussions while understanding the context and supporting patient safety, comfort, dignity, privacy and diversity #
In settings where infrastructure is limited, students must still strive to maintain patient dignity and privacy. This may involve finding quieter or more private areas for sensitive discussions, especially for topics like mental health, reproductive health, or trauma. Even small efforts to create a respectful environment can significantly improve patient trust and openness.
1.6 Deliver information to the patient and family in a humane manner that is clearly understood, encourages discussion and supports full participation in decision-making #
Students should provide information in a compassionate and structured way, avoiding overwhelming patients with complex medical details. Encouraging questions and involving family members—when appropriate—helps ensure understanding and shared decision-making. This is particularly important when explaining long-term treatments like TB therapy or managing chronic conditions.
1.7 Demonstrate skills and methods in the disclosure of adverse outcomes in a timely and complete manner #
Students must communicate adverse events honestly and sensitively, even in systems where formal processes may not exist. This includes explaining what happened, addressing concerns, and maintaining empathy. Transparency is essential for maintaining trust, especially in communities where healthcare systems may already face skepticism.
2. Develop a common understanding on issues, problems and plans with patients, families, colleagues and other professionals to develop a shared plan of care #
2.1 Develop rapport, trust and ethical relationships with patients, families, communities, colleagues and healthcare providers #
Students must build strong relationships not only with patients but also with families, community leaders, and other healthcare workers. In many settings, collaboration with religious or local leaders is essential, particularly for addressing mental health issues or encouraging public health measures. Trust is built through consistency, respect, and reliability.
2.2 Enable patient-centered active communication in exploring patient symptoms and experience #
Students should encourage patients to share their experiences in their own words, as symptoms may be described differently based on cultural understanding. Active listening helps uncover important details that may not be immediately obvious and allows students to better understand the patient’s perspective.
2.3 Understand the patient and family’s beliefs, values, gender, culture, knowledge, preferences and perspective on care #
Students must explore how cultural beliefs and traditions influence health behaviors. For example, some patients may prefer traditional remedies or delay seeking care due to stigma. Understanding these perspectives allows students to provide recommendations that are more acceptable and realistic.
2.4 Integrate social, economic, medical, family, life stage, demographic, work/school, and other relevant history factors in the clinical encounter #
Students should consider the full context of a patient’s life when making decisions. This includes factors such as financial limitations, displacement, family responsibilities, and access to transportation. These factors directly impact the feasibility of treatment plans and must be integrated into care.
2.5 Participate in shared decision-making through common ground for diverse patient and community values including, but not limited to gender, religion and cultural beliefs to address patient health goals #
Students should work collaboratively with patients and families to find acceptable solutions that align medical recommendations with cultural and personal values. This may involve negotiation and compromise while ensuring patient safety is not compromised.
2.6 Participate in obtaining informed patient consent #
Students must ensure that patients understand the purpose, risks, and benefits of treatments or procedures, even when literacy levels are low. This may require using simple language, visual aids, or involving trusted family members. Consent must be voluntary and based on understanding.
2.7 Demonstrate an approach to managing physical, verbal and emotionally challenging scenarios #
Students will encounter patients and families under significant stress, including grief, anger, or fear. They must remain calm, use de-escalation techniques, and respond with empathy while maintaining professional boundaries. This is especially important in conflict-affected settings where emotional distress is common.
3. Develop practices for documenting and sharing written and electronic information on the encounter to optimize clinical decision-making, patient safety, confidentiality and privacy #
3.1 Document clear, accurate and appropriate written and/or electronic records #
Students should maintain clear and organized records, even in paper-based systems. Accurate documentation is critical for continuity of care, especially when patients may see different providers or move between locations.
3.2 Effectively report clinical encounters and treatment plans to patients, families, and health professionals #
Students must ensure that all relevant parties understand the patient’s condition and management plan. Clear communication reduces errors and ensures coordinated care across teams.
3.3 Demonstrate effective reporting of encounters and treatment during transitions of care #
Students should provide structured handovers when transferring care, highlighting key information such as diagnosis, treatment, and pending issues. This is essential in settings where continuity of care is often disrupted.
3.4 Demonstrate professionalism in all communication #
Students must maintain respectful and appropriate communication at all times, regardless of stress or workload. Professional behavior builds trust and reflects the values of the medical profession.
3.5 Demonstrate privacy, data security and confidentiality in written, verbal, social media and electronic communication #
Students must protect patient information, even in environments with limited data security systems. This includes being cautious when using mobile devices or social media and ensuring that patient details are only shared when necessary for care.