Tierney communication 2011
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Transcript of Tierney communication 2011
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Examiners Training CourseCommunications
Sean Tierney
Lusaka December 2011
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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
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Communication skills
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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
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Why bother with communication skills?
• Effective communication is essential to the practice of high quality medicine
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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
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Assessment of communication skills
• Should be included at MCS level
• Separate & distinct– Busy clinical agenda– Language issues
• Structured– ?OSCE– global rating
• Information giving & gathering
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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
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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
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Providing structure
Building the relationship
Initiating the session
Gathering information
Physical examination
Explanation & Planning
Closing the session
Model of the consultation
Calgary Cambridge model
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Providing structure
Building the relationship
Initiating the session
Gathering information
Physical examination
Explanation & Planning
Closing the session
Calgary Cambridge model
Information gathering
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Providing structure
Building the relationship
Initiating the session
Gathering information
Physical examination
Explanation & Planning
Closing the session
Calgary Cambridge model
Information giving
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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
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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
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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
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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
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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
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Providing structure
Building the relationship
Initiating the session
Gathering information
Physical examination
Explanation & Planning
Closing the session
Model of the consultation
Calgary Cambridge model
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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
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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
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Human Factors
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Human Factors
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Human Factors
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Teaching communications skills
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Human Factors training RCSI
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Review
• communication skills can be taught• best model is experiential• all levels (up to senior clinicians) benefit
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School for Surgeons
UK Council of Clinical Communication in Undergraduate Medical Education
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Communications skills for surgeons