tierney communication 2011
DESCRIPTION
for COSECSA exam course, Lusaka, Zambia, 2011TRANSCRIPT
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