Manchester Medical School

Clinical Communication in the Undergrad Programme

Dr N BarrCo-Lead for Clincial Communication

Why teach communication?

Why teach communication?

• More effective consultations for both parties

• Improves: accuracy, efficiency, supportiveness; health outcomes for pts; satisfaction rates better; better therapeutic relationship

• Bridges gap between evidence-based med and individual pt choice

• Less complaints/litigation

The official context

Graduates must Communicate effectively with patients

and colleagues in a medical context Tomorrow’s Doctors GMC 2009 Sec 15, Outcomes 2: Doctor as practitioner

Models/Frameworks

• What models or frameworks of Communication do you know about?

• What do you use?

• How would a learner know you were using a model?

She’s competent but can’t communicate

If she can’t communicate, how can she be competent?

He’s nice and friendly but wouldn’t recognise a

diagnosis if it hit him in the face

Is that really the type of doctor we want to produce?

Traditional approaches

History-taking• Presenting complaint• Past medical history• Drug history• Family history• Social history• Systems review

CONTENTPatient’s perspective?

Communication skills• Building rapport• Listening skills• Open questions• Body language• Empathy

PROCESS

Calgary-Cambridge framework

Initiating

Gathering information

Physical exam

Explanation & planning

Closing

Buildrelationship

Providestructure

Adapted Calgary Cambridge frameworkInitiating the session

Gathering Information

Physical examination

Share/explain and planning

Closing the session

Providing structure

Building the relationship

Providing structure

Making the organisation overt

Attending to flow

Building the relationship

Using appropriate non verbal behaviour

Developing rapport

Involving the patient

Initiating the sessionPreparationEstablishing initial rapportIdentifying the reason for the consultation

Gathering informationExploration of the patients problems to discover theBiomedical perspective –

Sequence of events, Symptom analysisRelevant systems reviewPC/HPC, PM/SH, FH, DH, SR

Patients’ perspective ICE or FIFEBackground Information SH

Closing the session

Ensuring appropriate point of closure

Forward planning

Communication curriculum

• Cues to communication learning in PBL cases

• Reflection in portfolio

• Teaching across all 5 years of the undergraduate curriculum

• Summative and formative assessment

Underpinning principles

• Active, experiential learning• Reflection in-built with feedback• Patient-centred approach• Credible scenarios – in context• Use of input & evidence; frameworks

SPIKES

SPIKES

SettingPatient’s perceptionInvitationKnowledgeExplore emotions and empathiseStrategy and summary

Baile, Buckman et alThe Oncologist 2000, 5:302-311.

Phase 1- Years 1 & 2

Early clinical experience•Starts week one•further sessions each year – gathering information, advanced listening, responding to cues, patient’s view•Integrated with PBL, pharmacy, anatomy, consultation skills•Hospital & community visits with patients

Phase II – Year 3

• Consultation skills – taking a history and recording content

• Cultural diversity and disability• Handling own emotions• Video fback session – history taking• Audio fback session – presenting

history• Sharing information and planning

Phase II – Year 4

• Transferring interviewing to Mental health

• Breaking bad news x 3Life changing, life threatening, working

with relatives and high emotion

Phase III - Year 5

Pre exemption exam• Ethics in action • Preparation for practice as a

Foundationer Post exemption exam• End of life care

What students need

• Opportunity• Feedback on information gathering

skills, problem solving (and diagnostic thinking)

• Endorsement of the importance of the patient’s perspective

• Help to understand the psychosocial aspects of doctors role

• Consciously competent role models

How can you help?

In twos/threes

What can you do to assist the students’ learning of clinical communication in the workplace?What support would you need?