Masters in Medical Education in Clinical Contexts Learning Communication Skills Annie Cushing, Adrienne Kirk Monday 6th February 2017 13.00-17.00 Robin Brook Centre Learning Outcomes:  Understand educational theory and consensus for methods. Identify challenges to effective teaching in clinical settings & devise strategies to overcome them. Best Practice in setting up a teaching session & negotiating learning outcomes with students Appreciate the importance of preparation, debriefing, feedback, reflection and planning any changes as a result Set an action plan for practice Translate principles to learning in clinical settings

The Learning Process Experiential Learning: KOLB D. 2005

The Medical Interview: Three Function Approach Cole S. and Bird J The Medical Interview: Three Function Approach Cole S. and Bird J. 2014 3rd Edition Elsevier Saunders Gathering of data to understand the patient's problems. Development of doctor-patient rapport and the appropriate physician response to a patient's emotions. Educating patients about their illness and motivating them to adhere to treatment.

Communication and Interpersonal Skills Duffy et al Communication and Interpersonal Skills Duffy et al. Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II Report. Academic Medicine 2004. 79;6: 495-507   Tasks: Obtain a Medical History Explain a diagnosis and prognosis Shared Decision-Making Giving therapeutic instructions Counselling Relational and Process: Establishing a Trusting Relationship Managing anxiety and uncertainty Structuring and time-management

1. Build the Doctor-Patient Relationship 2. Open the Discussion Back to Top Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement Makoul G. 2001 1. Build the Doctor-Patient Relationship 2. Open the Discussion 3. Gather Information 4. Understand the Patient's Perspective 5. Share Information 6. Reach Agreement on Problems and Plans 7. Provide Closure * Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status, spirituality) * Actively listen using nonverbal (e.g., eye contact) and verbal (e.g., words of encouragement) techniques Share Information * Check for understanding Reach Agreement on Problems and Plans * Encourage questions * Acknowledge and respond to the patient's ideas, feelings, and values * Use language the patient can understand Understand the Patient's Perspective * Elicit the patient's full set of concerns * Allow the patient to complete his or her opening statement Open the Discussion * Establish/maintain a personal connection Gather Information * Structure, clarify, and summarize information * Use open-ended and closed-ended questions appropriately * Explore beliefs, concerns, and expectations about health and illness

Figure 3. Disease-Illness Framework and Patient-Centred Communication McWhinney et al 1989 Content - Disease: Bio-medical Perspective Content - Illness: Patient Perspective Skills Listening Rapport Empathy Question style Clarifying Signposting Summarising Explaining Negotiating Shared decision making Integration Management Plan History Physical Examination Investigations Differential Diagnosis Ideas Concerns Expectations (ICE) Feelings Effects on life Understanding the patient Timeline Pattern Signs 6

The Calgary-Cambridge Guide Silverman J et al 2008

The Learning Process Zone of proximal development: Vygotsky 1978

How to Teach or Facilitate Learning Observation of real encounters in clinic Live or Video/audio review Report Back Refs: Dent and Harden 2001 Four Skills Teaching and Learning Methods.

Teaching and Learning with Patients 2017 Tutor Coach Tutor Demonstrator Student Tutor Student Student Student Observer Report Back Student Student Demonstrator: Students watch clinician and debrief afterwards Coach: Tutor stands to side and comments to each student in turn as they enquire into aspects of the history and carry out aspects of physical examination. May intervene. Observer: Tutor distances him/herself from student-interaction, observes a single or pair of students for longer portion of history-taking or examination, giving feedback to both at end. Conducts feedback – with patient/ away from patient. Report Back: Working in pairs, students do a history and examination, without supervision. They subsequently report back to tutor, present case and receive feedback on content and delivery. Tutor Tutor Student Student Teaching and Learning with Patients 2017

Steps in Experiential Learning Preparation - Students & Patient Action Feedback & Debrief Consolidation & New learning goals Simulation of a teaching/learning opportunity Teaching and Learning with Patients CILT 2013

Patient-Centred Model Working Effectively and Ethically with Patients Ask the Patient for Feedback? http://dx.doi.org/10.1136/bmj.i6190 Teaching and Learning with Patients CILT 2013

FEEDBACK CONVERSATION Link to goals for consultation Student first (Actor ‘in role’ then ‘out of role’) ‘Colleagues’ ‘Tutor’ What I noticed observation not judgement What I thought/felt subjective view What do you think? encourage learner thinking What I would suggest alternative if learner stuck