1. Why study Communications skills?
This slide presentation is based on Introductory talks given by Dr Jonathan Silverman from Cambridge
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2. Communication skills - why bother?
l Why learn communication skills?
l Can you learn communication skills?
l What is there to learn?
l How is it taught?
l Where next?

3. CLINICAL COMPETENCE The ability to integrate - knowledge base
- communication skills
- examination skills
- problem-solving ability

4. 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!

5. Effective communication is essential to the practice of high quality medicine

6. 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?

7. Are there problems in communication between doctors and patients?
l reasons for the patient's attendance
l gathering information
l explanation and planning
l adherence to plans
l medico-legal
l lack of empathy and understanding

8. 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:
l process of the interview
l satisfaction
l recall and understanding
l adherence
l outcome: decreased patient concern symptom resolution physiological outcome

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

10. The goals of medical communication
Accuracy
Efficiency
Supportiveness

11. 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

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

13. Calgary-Cambridge Observation Guide
Structure:
Initiating the session
Gathering information
Building the relationship
Explanation and planning
Closing the session

14. Phrasing or behaviour:
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?

15. 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

16. 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?

17. How to teach communication skills?
l observation
l video or audio playback
l well-intentioned feedback
l rehearsal
l active small group or 1:1 learning

18. The challenges of experiential learning:
l opportunistic
l unstructured
l potentially unsafe
l it makes things worse before they get better!

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

20. How to teach communication skills?
l needs to be on-going, developing and "helical"
l cannot be learnt as a a one-off experience

21. 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

22. The particular problems of teaching established doctors
l further to fall
l more unlearning
l more ingrained habits
l more threatening
l less aware of need

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