Manchester Medical School
Clinical Communication in the
Undergrad Programme
Dr N Barr
Co-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
Communication skills
• Building rapport
• Listening skills
• Open questions
• Body language
• Empathy
CONTENT
Patient’s perspective?
PROCESS
Calgary-Cambridge framework
Initiating
Provide
structure
Gathering information
Physical exam
Explanation & planning
Closing
Build
relationship
Adapted Calgary Cambridge
Initiating theframework
session
Preparation
Establishing initial
Initiating
rapport the session
Identifying the reason for the consultation
Providing
Providing
structure
structure
Making the
organisation overt
Attending to flow
Gathering information
Exploration ofGathering
the patients problems
to discover the
Information
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
Physical examination
Share/explain and planning
Closing the session
Closing the session
Ensuring appropriate point of closure
Forward planning
Building the
Building
relationship
the
Using appropriate
relationship
non
verbal
behaviour
Developing rapport
Involving the
patient
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
S
P
I
K
E
S
Setting
Patient’s perception
Invitation
Knowledge
Explore emotions and empathise
Strategy and summary
Baile, Buckman et al
The 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 3
Life 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?