Why study Communications skills?

This slide presentation is based on Introductory talks This slide presentation is based on Introductory talks given by Dr Jonathan Silverman from Cambridgegiven by Dr Jonathan Silverman from Cambridge

The controls at the bottom of the slides allow you The controls at the bottom of the slides allow you to change slide - click on the right arrow to change slide - click on the right arrow View or collapse outline on leftView or collapse outline on left View a slide full screen – icon bottom leftView a slide full screen – icon bottom left

Communication skills - why bother?Communication skills - why bother?

Why learn communication skills?Why learn communication skills?

Can you learn communication skills?Can you learn communication skills?

What is there to learn?What is there to learn?

How is it taught?How is it taught?

Where next?Where next?

The ability to integrateThe ability to integrate

- knowledge base- knowledge base

- communication skills- communication skills

- examination skills- examination skills

- problem-solving ability- problem-solving ability

CLINICAL COMPETENCE

Communication is a core clinical skillHow we do things is just as importantas what we doCommunication 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 Are there problems in communication

between doctors and patients?between doctors and patients?

Is there evidence that communication Is there evidence that communication skills can overcome these problems?skills can overcome these problems?

Can these communication skills be Can these communication skills be taught?taught?

Are there problems in communication

between doctors and patients?reasons for the patient's attendancereasons for the patient's attendancegathering informationgathering informationexplanation and planningexplanation and planningadherence to plansadherence to plansmedico-legalmedico-legallack of empathy and understandinglack of empathy and understanding

Is there evidence that communication skills

can be used to overcome these problems?We now have research evidence to validate We now have research evidence to validate the use of specific communication skills:the use of specific communication skills:

process of the interviewprocess of the interviewsatisfactionsatisfactionrecall and understandingrecall and understandingadherenceadherenceoutcome: decreased patient concern outcome: decreased patient concern symptom resolution symptom resolution

physiological outcome physiological outcome

Can communication skills be taught?

communication is a clinical skillcommunication is a clinical skillit is a series of learnt skillsit is a series of learnt skillsexperience is a poor teacherexperience is a poor teacherthere is conclusive evidence that there is conclusive evidence that communication skills can be taughtcommunication skills can be taughtand that communication skills and that communication skills

teaching is retainedteaching is retained

The goals of medical communication

AccuracyAccuracy

EfficiencyEfficiency

SupportivenessSupportiveness

Is the prize on offer worth the effort?Effective communication offers more Effective communication offers more than just good manners or being nicethan just good manners or being nice

Effective communication enables us to Effective communication enables us to become better doctors clinicallybecome better doctors clinically

Effective communication improves Effective communication improves patient care and disease outcomespatient care and disease outcomes

Content: Content: what we do what we doProcess:Process: how we do it how we do itPerceptual:Perceptual: what we're thinking what we're thinking

and and feeling feeling

What is there to learn?

Calgary-Cambridge Observation GuideStructure:Structure:Initiating the sessionInitiating the sessionGathering informationGathering informationBuilding the relationshipBuilding the relationshipExplanation and planningExplanation and planningClosing the sessionClosing the session

Structure:Structure:where am I and what do I want to achieve?where am I and what do I want to achieve?

Specific skills:Specific skills:how do I get there?how do I get there?

Phrasing or behaviour:Phrasing or behaviour:how can I incorporate these skills into my how can I incorporate these skills into my own style and personality?own style and personality?

How do we change our behaviour in the consultation?Knowledge is important but only allows Knowledge is important but only allows

you to know you to know aboutabout communication communication

Experiential teaching is required to Experiential teaching is required to know know howhow to communicate to communicate

How to teach communication skills?How do we change our behaviour in the How do we change our behaviour in the

consultation?consultation?

Where is the block?Where is the block?

Skills or attitudes?Skills or attitudes?

Experiential or didactic teaching?Experiential or didactic teaching?

Know about or know how?Know about or know how?

How to teach communication skills?observationobservation

video or audio playbackvideo or audio playbackwell-intentioned feedback well-intentioned feedback rehearsal rehearsal active small group or 1:1 learning active small group or 1:1 learning

The challenges of experiential learning:The challenges of experiential learning:

opportunisticopportunistic

unstructuredunstructured

potentially unsafepotentially unsafe

it makes things worse before they get it makes things worse before they get better!better!

The challenges of experiential learning: how to provide a supportive environmenthow to provide a supportive environment

how to maximise learning how to maximise learning andand safety safety how to structure sessionshow to structure sessions how to conceptualise learninghow to conceptualise learning how to introduce didactic material such how to introduce didactic material such

as theory and research as theory and research how to structure learning over timehow to structure learning over time

How to teach communication skills?

needs to be on-going, developing needs to be on-going, developing and "helical"and "helical"

cannot be learnt as a a one-off cannot be learnt as a a one-off experienceexperience

The particular problems of teaching

established doctorsMany established doctors have received Many established doctors have received little previous instruction in communicationlittle previous instruction in communication

Their only "training" has been gained from Their only "training" has been gained from their experience in medicinetheir experience in medicine

Experience alone is a poor teacher: need Experience alone is a poor teacher: need observation, well-intentioned feedback and observation, well-intentioned feedback and rehearsalrehearsal

The particular problems of teaching

established doctors further to fallfurther to fallmore unlearningmore unlearning more ingrained habitsmore ingrained habits more threateningmore threatening less aware of needless aware of need

How to teach?You need a methodology that:You need a methodology that:

is based on experiential learning - is based on experiential learning - observation, feedback and rehearsal observation, feedback and rehearsal

tackles the participant's own problemstackles the participant's own problems

BUT ALSOBUT ALSO

extends their understanding of extends their understanding of underlying communication skills and underlying communication skills and principles principles