Manchester Medical School Clinical Communication in the Undergrad Programme Dr N Barr Co-Lead for Clincial 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 CONTENT Patient’s perspective? Communication skills Building rapport Listening skills Open questions Body language Empathy PROCESS

Calgary-Cambridge framework Initiating Gathering information Physical exam Explanation & planning Closing Build relationship Provide structure

Adapted Calgary Cambridge framework Initiating the session Gathering Information Physical examination Share/explain and planning Closing the session Providing structure Building the relationship Providing structure Making the organisation overt Attending to flow Building the relationship Using appropriate non verbal behaviour Developing rapport Involving the patient Initiating the session Preparation Establishing initial rapport Identifying the reason for the consultation 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 Closing the session Ensuring appropriate point of closure Forward planning

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:

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?