Educational Solutions for Workforce Development East Deanery General Practice ST1 – GP Placement Introduction

Educational Solutions for Workforce Development East Deanery GP SPECIALTY TRAINING THREE or FOUR YEARS YEAR ONE – 6 months medical specialties, 6 months GP YEAR TWO – other specialties YEAR THREE – Final GP year [or higher level specialty post(s) then final 4 th year GP]

Educational Solutions for Workforce Development East Deanery GP SPECIALTY TRAINING FIRST SIX MONTHS IN GENERAL PRACTICE – THE BASICS 1.CONSULTATION + COMMUNICATION SKILLS 2.INFORMATION HANDLING & INFORMATION TECHNOLOGY 3.“DOING THE JOB”

Educational Solutions for Workforce Development East Deanery Communication Skills Doctor –patient communication is central to clinical practice Doctors perform consultations in a professional lifetime There are major problems in communication between doctors and patients Effective communication is essential to high quality medicine

Educational Solutions for Workforce Development East Deanery Consultation Consultation Models + understanding Videos – Analysis & C.O.T. Role Play Learning as an Expert

Educational Solutions for Workforce Development East Deanery Communication Do doctors actually want to improve their consultation skills? How would you define, communication skills & consultation skills? How do they differ? What factors make a successful consultation? – list What are the barriers to effective consultation?

Educational Solutions for Workforce Development East Deanery Communication Need for extra effort, time and emotional commitment Clinical skills – examination & practical procedures only Communication skills – non-clinical aspect Consultation skills = Clinical skills + Communication skills

Educational Solutions for Workforce Development East Deanery Communication - What you need to achieve in a consultation? Discover the reasons for a patients attendance Define the clinical problems Address the patients problems Explain the problems to the patient Make effective use of the consultation “The Doctor’s Communication Handbook” - Peter Tait

Educational Solutions for Workforce Development East Deanery Communication CONTACT COMPLAINT CONTEXT CONCERNS CONSENSUS “The 5 Cs” Donald Gemmell

Educational Solutions for Workforce Development East Deanery COMMUNICATION 4 E ’s & 2 F ’s Critical communication tasks E NGAGE E MPATHISE E DUCATE E NLIST Biomedical tasks F IND the problem F IX it “Bayer educational model”

Educational Solutions for Workforce Development East Deanery Communication Skills Calgary/Cambridge Model – Tasks 1.Initiating the session 2.Gathering information 3.Building the relationship 4.Explanation and planning 5.Closing the session

Educational Solutions for Workforce Development East Deanery Communication Skills “Pendleton’s Rules” Briefly clarify any matters of fact Encourage the learner to go first Consider what has been done well first Make recommendations rather than state weaknesses

Educational Solutions for Workforce Development East Deanery Communication Skills “ALOBA” – agenda led outcome based analysis Discover and record the learner’s agenda before looking at consultation Look at consultation Self-assessment by learner according to stated agenda Group is invited to add ideas Range of suggestions of ways to improve created Learner selects from range what they would like to try next time

Educational Solutions for Workforce Development East Deanery Communication 2 dimensional - doctor centred v. patient centred 3 dimensional – physical, psychological, social 4 dimensional – presenting problem, continuing problems, modifying health-seeking behaviour, health promotion 5 dimensional – connecting, summarising, hand-over, safety-netting, housekeeping (& 5 Cs)

Educational Solutions for Workforce Development East Deanery Communication 6 dimensional – PHASES > relationship, agenda, examination, consideration, treatment, closure; HEALTH BELIEFS > What? Why? Why me? Why now? What if? What next? 7 dimensional – agenda, other problems, choice of action, shared understanding, involvement, use of resources, maintaining relationships.

Educational Solutions for Workforce Development East Deanery Communication Skills Miller (1990) – Pyramid of clinical competence DOES SHOWS HOW KNOWS HOW KNOWS

Educational Solutions for Workforce Development East Deanery Communication Skills DOES – sit in or video – real patients, role play or simulated patients SHOWS HOW KNOWS HOW – face to face tutorial (formative) oral exam (regulative) KNOWS – questionnaire or rating scales

Educational Solutions for Workforce Development East Deanery Communication Skills COMPETENCE  knows how to do (can do) PERFORMANCE  actually puts into practice (does)

Educational Solutions for Workforce Development East Deanery Communication Skills QUALITY IMPROVEMENT Peer review Self assessment (Teacher/Trainer feedback)

Educational Solutions for Workforce Development East Deanery Communication Skills Communication is a core clinical skill – an essential component of clinical confidence Knowledge, communication skills, physical examination and problem solving are the four essential components of clinical competence Without appropriate communication skills, our knowledge and intellectual efforts are wasted Communication turns theory into practice

Educational Solutions for Workforce Development East Deanery Communication Defining the broad type of communication skills CONTENT SKILLS PROCESS SKILLS PERCEPTUAL SKILLS

Educational Solutions for Workforce Development East Deanery Communication CONTENT SKILLS What doctors communicate – the substance of their questions and responses; the information they gather and give; the treatments they discuss.

Educational Solutions for Workforce Development East Deanery Communication PROCESS SKILLS How they do it – the ways they communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; how they develop the relationship with the patient; the way they organise and structure communication

Educational Solutions for Workforce Development East Deanery Communication PERCEPTUAL SKILLS What they are thinking and feeling – their internal decision making, clinical reasoning and problem solving; their awareness of feelings and thoughts about the patient, the illness and other issues that may be concerning them; aware of their own self- concept and confidence, of their own biases, attitudes, intentions, and distractions

Educational Solutions for Workforce Development East Deanery Communication Skills - Video

Educational Solutions for Workforce Development East Deanery Communication Skills - Video Patient Centred Clinical Method

Educational Solutions for Workforce Development East Deanery THE GP CURRICULUM You can only remember three things….. 3 core domains 3 other domains 3 bits you need to apply the domains

Educational Solutions for Workforce Development East Deanery 1. Primary care management To provide quality care – access good clinical care – organised and evidence based good communication To act in - diagnosis and management coordinate PHCT refer – secondary care / voluntary services / family be an advocate

Educational Solutions for Workforce Development East Deanery 2. Person centred care Patients want - a competent doctor an active role to be listened to a caring doctor We want - to be effective Why has this patient with this problem come to see me today? What does this problem mean to this patient?

Educational Solutions for Workforce Development East Deanery 3. Specific problem solving skills Tolerate uncertainty vs reduce uncertainty Explore probability vs explore possibility Marginalise danger vs marginalise error You need - knowledge of natural history of illness range of skills stepwise plan of action use time – both urgent and at leisure likelihood information

Educational Solutions for Workforce Development East Deanery A comprehensive approachCoping with multiple complaints Dealing with co-morbidity Balancing treatment / symptom relief / prevention Working the system Community orientation Public health Justice Prioritisation / resource allocation / rationing A holistic approach Triple diagnosis Health beliefs Cultural and existential

Educational Solutions for Workforce Development East Deanery 3 “essential features” that will impact on your ability to apply the competencies Contextual The working environment The practice demography Pressures you are under Home and personal circumstances Attitudinal Belief and values Regulatory framework Legal framework Ethical principals Scientific Knowledge Basic understanding of medical science Evidence based medicine Ability to critically analyse information

Educational Solutions for Workforce Development East Deanery Agendas Doctors agenda To make a diagnosis To initiate management To practice safely To get through our surgeries efficiently Patients agenda To find out what has happened To be able to fit this into their personal circumstances (knowledge & beliefs) To understand and agree what needs done

Educational Solutions for Workforce Development East Deanery What do patients want? Clear information Mutually agreed goals An active role Positive empathy and support Sensitivity and support Involvement Explanations

Educational Solutions for Workforce Development East Deanery What are the benefits? Patient satisfaction Compliance Better health outcomes

Educational Solutions for Workforce Development East Deanery Doctors agenda Patients Agenda Effective Consulting What are we trying to achieve? MERGING AGENDAS