Teaching communication skills to practicing family doctors: Bringing lessons from academia to the co

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Teaching communication skills to practicing
family doctors Bringing lessons from academia to
the community

• Dr. Yonah Yaphe
• Dept. of Family Medicine
• Rabin Medical Centre and
• Sackler Faculty of Medicicne
• Tel Aviv University, Israel

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Objectives

• After this lecture the you will
• Know the basic prinicples of teaching
  communication skills in medicine
• Understand the differences between teaching
  methods using simulated and real patients
• Appreciate the value of using a variety of
  methods to reach your goals
• (yaphe.esmartweb.com)

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Background

• Good communication skills are the basis of
  medical practice.
• They increase diagnostic accuracy, therapeutic
  outcomes and patient satisfaction.
• They decrease litigation.

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Educational background

• Communication skills can be taught.
• Our students have a natural ability to
  communicate.
• Understanding patient needs can enhance skills
  teaching.
• Patient-centred care provides a useful model for
  teaching consultation skills.

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Learners needs

• Pre-clinical students Patients as people, what
  is medicine, future needs
• Introductory clinical Basic history taking
  skills, physical examination
• Clinical Diagnosis and therapeutics
• Vocational training Developing skills
• CME Perfecting skills, problem-solving,
  preventing burnout

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Patient-centred care

• Understanding patients, their health beliefs,
  needs and wants as well as biomedical factors.
• Based on the work on Ian McWhinney, Moira Stewart
  and others from London, Ontario, Canada.

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Elements of patient-centred care

• Disease-illness
• Whole person medicine
• Finding common ground
• Use of resources
• Prevention
• Enhancing the doctor-patient relationship

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Patient explanatory models FIFE

• Fears and feelings
• Ideas
• Function
• Expectations

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Teaching methods

• Lectures
• Small group discussion
• Reading
• Simulation
• Observation and feedback
• Case supervision

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Simulated vs. Real patientsAdvantages

• Simulated
• Variety of cases
• Safe
• Instant replay
• Change in intensity
• Feedback
• Many approaches
• Defined objectives
• Assessment
• Consistent

• Real
• Immediate utility
• Natural, credible
• Demonstrate abnormal findings
• Available
• Low cost
• Acceptable

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Disadvantages

• Simulated
• Cost
• Development time
• Artificial
• No physical signs
• Resistance of staff and students

• Real
• Time
• Consent
• Limited case mix
• Distressed by exam
• Unpredictable
• Not standardized
• Less flexible

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Case number 1 Patient M.

• 60 year old woman
• Diffuse pain, insomnia, tearful
• Family history of osteoporosis
• Referred by orthopedic surgeon for bone density
  measurement
• Test not covered by national insurance

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Case Example 2 - Simulation

• 75 year old man with low back pain
• Requests MRI
• Previous experience and fears

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Research model
Patients

Resources Demands and Capability
System
Doctors
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Research findings

• Conflict is an unavoidable feature of primary
  care consultations.
• Insurance-related conflicts are common.
• Passive acceptance of limitations is common.
• Reflection is the basis for improvement.

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Conclusions

• A mix of methods for teaching and learning
  communication skills makes for a stimulating and
  enjoyable experience that has the power to change
  practice and improve outcomes of care.