1. Masters in Medical Education in Clinical Contexts
Learning Communication Skills
Annie Cushing, Adrienne Kirk
Monday 6th February 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

2. The Learning Process Experiential Learning: KOLB D. 2005

3. The Medical Interview: Three Function Approach Cole S. and Bird J
The Medical Interview: Three Function Approach Cole S. and Bird J rd 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.

4. 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 ;6:  
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

5. 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

6. 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

7. The Calgary-Cambridge Guide Silverman J et al 2008

8. The Learning Process Zone of proximal development: Vygotsky 1978

9. 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.

10. 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

11. 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

12. Patient-Centred Model
Working Effectively and Ethically with Patients
Ask the Patient for Feedback?
Teaching and Learning with Patients CILT 2013

13. 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