Why study Communications skills?
This slide presentation is based on Introductory talks
given by Dr Jonathan Silverman from Cambridge
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Communication skills - why bother?
l Why learn communication skills?
l Can you learn communication skills?
l What is there to learn?
l How is it taught?
l Where next?
CLINICAL COMPETENCE
The ability to integrate
- knowledge base
- communication skills
- examination skills
- problem-solving ability
Communication is a core clinical skill
How we do things is just as important
as what we do
Communication skills turn theory
into practice
The average GP undertakes 200,000
consultations in a professional lifetime!
Effective communication
is essential to the practice of
high quality medicine
Why learn communication skills?
Are there problems in communication
between doctors and patients?
Is there evidence that communication
skills can overcome these problems?
Can these communication skills be
taught?
Are there problems in communication
between doctors and patients?
l reasons for the patient's attendance
l gathering information
l explanation and planning
l adherence to plans
l medico-legal
l lack of empathy and understanding
Is there evidence that communication skills
can be used to overcome these problems?
We now have research evidence to validate
the use of specific communication skills:
l
l
l
l
l
process of the interview
satisfaction
recall and understanding
adherence
outcome: decreased patient concern
symptom resolution
physiological outcome
Can communication skills be taught?
l communication is a clinical skill
l it is a series of learnt skills
l experience is a poor teacher
l there is conclusive evidence that
communication skills can be taught
l and that communication skills
teaching is retained
The goals of medical communication
Accuracy
Efficiency
Supportiveness
Is the prize on offer worth the effort?
Effective communication offers more
than just good manners or being nice
Effective communication enables us to
become better doctors clinically
Effective communication improves
patient care and disease outcomes
What is there to learn?
Content:
what we do
Process:
how we do it
Perceptual:
what we're thinking
and feeling
Calgary-Cambridge Observation Guide
Structure:
Initiating the session
Gathering information
Building the relationship
Explanation and planning
Closing the session
Structure:
where am I and what do I want to achieve?
Specific skills:
how do I get there?
Phrasing or behaviour:
how can I incorporate these skills into my
own style and personality?
How do we change our behaviour
in the consultation?
Knowledge is important but only allows
you to know about communication
Experiential teaching is required to
know how to communicate
How to teach communication skills?
How do we change our behaviour in the
consultation?
Where is the block?
Skills or attitudes?
Experiential or didactic teaching?
Know about or know how?
How to teach communication skills?
l observation
l
video or audio playback
l well-intentioned feedback
l
rehearsal
l active small group or 1:1 learning
The challenges of experiential learning:
l opportunistic
l unstructured
l potentially unsafe
l it makes things worse before they get
better!
The challenges of experiential learning:
l how to provide a supportive environment
l how to maximise learning and safety
l how to structure sessions
l how to conceptualise learning
l how to introduce didactic material such
as theory and research
l how to structure learning over time
How to teach communication skills?
l needs to be on-going, developing
and "helical"
l cannot be learnt as a a one-off
experience
The particular problems of teaching
established doctors
Many established doctors have received
little previous instruction in communication
Their only "training" has been gained from
their experience in medicine
Experience alone is a poor teacher: need
observation, well-intentioned feedback and
rehearsal
The particular problems of teaching
established doctors
l further to fall
l
more unlearning
l more ingrained habits
l more threatening
l less aware of need
How to teach?
You need a methodology that:
l is based on experiential learning observation, feedback and rehearsal
l tackles the participant's own problems
BUT ALSO
l extends their understanding of
underlying communication skills and
principles