Why study Communications skills? This slide presentation is based on Introductory talks given by Dr Jonathan Silverman from Cambridge 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 left View or collapse outline on left View a slide full screen – icon bottom left View a slide full screen – icon bottom left

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 integrate - knowledge base - knowledge base - communication skills - examination skills - problem-solving ability CLINICAL COMPETENCE

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? reasons for the patient's attendance reasons for the patient's attendance gathering information gathering information explanation and planning explanation and planning adherence to plans adherence to plans medico-legal medico-legal lack of empathy and understanding 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: process of the interview process of the interview satisfaction satisfaction recall and understanding recall and understanding adherence adherence outcome: decreased patient concern symptom resolution physiological outcome outcome: decreased patient concern symptom resolution physiological outcome

Can communication skills be taught? communication is a clinical skill communication is a clinical skill it is a series of learnt skills it is a series of learnt skills experience is a poor teacher experience is a poor teacher there is conclusive evidence that communication skills can be taught there is conclusive evidence that communication skills can be taught and that communication skills teaching is retained and that communication skills teaching is retained

The goals of medical communication AccuracyEfficiencySupportiveness

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

Content: what we do Process: how we do it Perceptual: what we're thinking and feeling What is there to learn?

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? observation observation video or audio playback video or audio playback well-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: opportunistic opportunistic unstructured unstructured potentially unsafe potentially unsafe it makes things worse before they get better! it makes things worse before they get better!

The challenges of experiential learning: how to provide a supportive environment how to provide a supportive environment how to maximise learning and safety how to maximise learning and safety how to structure sessions how to structure sessions how to conceptualise learning how to conceptualise learning how to introduce didactic material such as theory and research how to introduce didactic material such as theory and research how to structure learning over time how to structure learning over time

How to teach communication skills? needs to be on-going, developing and "helical" needs to be on-going, developing and "helical" cannot be learnt as a a one-off experience 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 further to fall further to fall more unlearning more unlearning more ingrained habits more ingrained habits more threatening more threatening less aware of need less aware of need

How to teach? You need a methodology that: is based on experiential learning - observation, feedback and rehearsal is based on experiential learning - observation, feedback and rehearsal tackles the participant's own problems tackles the participant's own problems BUT ALSO extends their understanding of underlying communication skills and principles extends their understanding of underlying communication skills and principles