Manchester Medical School

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Manchester Medical School

• Clinical Communication in the Undergrad Programme
• Dr N Barr
• Co-Lead for Clincial Communication

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Why teach communication?
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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

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The official context

• Graduates must
• Communicate effectively with patients and
  colleagues in a medical context Tomorrows
  Doctors GMC 2009 Sec 15, Outcomes 2 Doctor as
  practitioner

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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?

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Shes competent but cant communicate

• If she cant communicate, how can she be
  competent?

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Hes nice and friendly but wouldnt recognise a
diagnosis if it hit him in the face

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

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Traditional approaches

• History-taking
• Presenting complaint
• Past medical history
• Drug history
• Family history
• Social history
• Systems review
• CONTENT
• Patients perspective?

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

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Calgary-Cambridge framework
Build relationship
Provide structure
Initiating
Gathering information
Physical exam
Explanation planning
Closing
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Adapted Calgary Cambridge framework
Initiating the session Preparation Establishing
initial rapport Identifying the reason for the
consultation
Initiating the session
Gathering information Exploration of the patients
problems to discover the Biomedical perspective
Sequence of events, Symptom analysis Relevant
systems review PC/HPC, PM/SH, FH, DH,
SR Patients perspective ICE or FIFE Background
Information SH
Gathering Information
Building the relationship Using appropriate non
verbal behaviour Developing rapport Involving the
patient
Providing structure Making the organisation
overt Attending to flow
Providing structure
Building the relationship
Physical examination
Share/explain and planning
Closing the session Ensuring appropriate point of
closure Forward planning
Closing the session
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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

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Underpinning principles

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

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SPIKES

• S
• P
• I
• K
• E
• S

• Setting
• Patients perception
• Invitation
• Knowledge
• Explore emotions and empathise
• Strategy and summary
• Baile, Buckman et al
• The Oncologist 2000, 5302-311.

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Phase 1- Years 1 2

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

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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

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Phase II Year 4

• Transferring interviewing to Mental health
• Breaking bad news x 3
• Life changing, life threatening, working with
  relatives and high emotion

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Phase III - Year 5

• Pre exemption exam
• Ethics in action
• Preparation for practice as a Foundationer
• Post exemption exam
• End of life care

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What students need

• Opportunity
• Feedback on information gathering skills, problem
  solving (and diagnostic thinking)
• Endorsement of the importance of the patients
  perspective
• Help to understand the psychosocial aspects of
  doctors role
• Consciously competent role models

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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?