Examiners Training CourseCommunications

Sean Tierney

Lusaka December 2011

MSC format (2010)

• Clinical Bays (*5 in duplicate)– Thyroglossal cyst– Abdominal mass– Jaundice– Penile carcinoma– Soft tissue sarcoma– Paget’s disease of nipple

• Operative skills (*1)– Bowel anastomosis

• Communications skills (*2)– Giving (consent)– Getting (history taking)

8 bays in total

Communication skills

Communication skills

• Do we need to assess communication skills separately – why bother?

• What is to be assessed and How

• Can communication skills be taught and/or learned?

Credit: Richard Young, Consultation Skills and Curriculum Development Tutor, UEA

Why bother with communication skills?

• Effective communication is essential to the practice of high quality medicine

Why bother …

• Ensuring more effective interviews accuracy efficiency supportiveness

• Enhancing patient and doctor satisfaction

• Improving health outcomes for patients

The average doctor undertakes 200,000 consultations in a professional lifetime!

• Promoting collaboration and partnership

• Managing expectations

Assessment of communication skills

• Should be included at MCS level

• Separate & distinct– Busy clinical agenda– Language issues

• Structured– ?OSCE– global rating

• Information giving & gathering

A model of assessment

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.

Knows

Shows how

Knows how

Does

Pro

fess

ion

al au

then

tici

ty

Cognition

Behaviour

How can we assess ?

Knows

Shows how

Knows how

Does

Knows Factual tests: MCQ, essay type, oral…..

Knows how(Clinical) Context based tests:EMQ, essay type, oral…..

Shows howPerformance assessment in vitro:OSCE, SP-based test, long/short cases…..

DoesPerformance assessment in vivo: Masked simulated patients, Video

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Model of the consultation

Calgary Cambridge model

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Calgary Cambridge model

Information gathering

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Calgary Cambridge model

Information giving

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Initiation

Calgary Cambridge model

• Preparation

• reading of the brief

• establishing initial rapport

• Introductions

• identifying the reasons for the consultation

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Gathering Information

Calgary Cambridge model

• exploration of the patient’s problems to discover the:

• biomedical perspective

• the patient’s perspective

• background information - context

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Explanation & Planning

Calgary Cambridge model

• providing the correct type and amount of information

• aiding accurate recall and understanding

• achieving a shared understanding: incorporating the patient’s illness framework

• planning: shared decision making

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Providing structure

Calgary Cambridge model

Making organisation overt

Attending to flow

Time keeping

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Building the relationship

Calgary Cambridge model

using appropriate non-verbal behaviour

developing rapport

involving the patient

Providing structure

Building the relationship

Initiating the session

Gathering information

Physical examination

Explanation & Planning

Closing the session

Model of the consultation

Calgary Cambridge model

Gathering information

Information gathering

• patient’s narrative• question style

– open vs closed

• attentive listening• establish baseline• picking up cues• clarification

– check back

• Chunks & checks• internal summary• appropriate use of language

Process

Gathering information

Information gathering

• patient’s narrative• question style

– open vs closed

• attentive listening• establish baseline• picking up cues• clarification

– check back

• Chunks & checks• internal summary• appropriate use of language

• History– Sequence of events– Symptom analysis– Systems review

• Patients perspective– ideas & beliefs– concerns– Expectations

• Background & context– medical/surgical history– social history (occupation)

Process Content

Human Factors

Human Factors

Human Factors

Teaching communications skills

Human Factors training RCSI

Review

• communication skills can be taught• best model is experiential• all levels (up to senior clinicians) benefit

School for Surgeons

UK Council of Clinical Communication in Undergraduate Medical Education

Communications skills for surgeons