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Why study Communications skills?
This slide presentation is based on Introductory talks This slide presentation is based on Introductory talks given by Dr Jonathan Silverman from Cambridgegiven by Dr Jonathan Silverman from Cambridge
The controls at the bottom of the slides allow you 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 leftView or collapse outline on left View a slide full screen – icon bottom leftView a slide full screen – icon bottom left
Communication skills - why bother?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 integrateThe ability to integrate
- knowledge base- knowledge base
- communication skills- communication skills
- examination skills- examination skills
- problem-solving ability- problem-solving ability
CLINICAL COMPETENCE
Communication is a core clinical skillHow we do things is just as importantas what we doCommunication 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 Are there problems in communication
between doctors and patients?between doctors and patients?
Is there evidence that communication Is there evidence that communication skills can overcome these problems?skills can overcome these problems?
Can these communication skills be Can these communication skills be taught?taught?
Are there problems in communication
between doctors and patients?reasons for the patient's attendancereasons for the patient's attendance
gathering informationgathering information
explanation and planningexplanation and planning
adherence to plansadherence to plans
medico-legalmedico-legal
lack of empathy and understandinglack of empathy and understanding
Is there evidence that communication skills
can be used to overcome these problems?We now have research evidence to validate We now have research evidence to validate the use of specific communication skills:the use of specific communication skills:
process of the interviewprocess of the interviewsatisfactionsatisfactionrecall and understandingrecall and understandingadherenceadherenceoutcome: decreased patient concern outcome: decreased patient concern symptom resolution symptom resolution
physiological outcome physiological outcome
Can communication skills be taught?
communication is a clinical skillcommunication is a clinical skill
it is a series of learnt skillsit is a series of learnt skills
experience is a poor teacherexperience is a poor teacher
there is conclusive evidence that there is conclusive evidence that communication skills can be taughtcommunication skills can be taught
and that communication skills and that communication skills teaching is retainedteaching is retained
The goals of medical communication
AccuracyAccuracy
EfficiencyEfficiency
SupportivenessSupportiveness
Is the prize on offer worth the effort?Effective communication offers more Effective communication offers more than just good manners or being nicethan just good manners or being nice
Effective communication enables us to Effective communication enables us to become better doctors clinicallybecome better doctors clinically
Effective communication improves Effective communication improves patient care and disease outcomespatient care and disease outcomes
Content: Content: what we do what we do
Process:Process: how we do it how we do it
Perceptual:Perceptual: what we're thinking what we're thinking and and
feeling feeling
What is there to learn?
Calgary-Cambridge Observation GuideStructure:Structure:
Initiating the sessionInitiating the session
Gathering informationGathering information
Building the relationshipBuilding the relationship
Explanation and planningExplanation and planning
Closing the sessionClosing the session
Structure:Structure:
where am I and what do I want to achieve?where am I and what do I want to achieve?
Specific skills:Specific skills:
how do I get there?how do I get there?
Phrasing or behaviour:Phrasing or behaviour:
how can I incorporate these skills into my how can I incorporate these skills into my own style and personality?own style and personality?
How do we change our behaviour in the consultation?Knowledge is important but only allows Knowledge is important but only allows
you to know you to know aboutabout communication communication
Experiential teaching is required to Experiential teaching is required to know know howhow to communicate to communicate
How to teach communication skills?How do we change our behaviour in the How do we change our behaviour in the
consultation?consultation?
Where is the block?Where is the block?
Skills or attitudes?Skills or attitudes?
Experiential or didactic teaching?Experiential or didactic teaching?
Know about or know how?Know about or know how?
How to teach communication skills?observationobservation
video or audio playbackvideo 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:The challenges of experiential learning:
opportunisticopportunistic
unstructuredunstructured
potentially unsafepotentially unsafe
it makes things worse before they get it makes things worse before they get better!better!
The challenges of experiential learning: how to provide a supportive environmenthow to provide a supportive environment
how to maximise learning how to maximise learning andand safety safety
how to structure sessionshow to structure sessions
how to conceptualise learninghow to conceptualise learning
how to introduce didactic material such how to introduce didactic material such as theory and research as theory and research
how to structure learning over timehow to structure learning over time
How to teach communication skills?
needs to be on-going, developing needs to be on-going, developing and "helical"and "helical"
cannot be learnt as a a one-off cannot be learnt as a a one-off experienceexperience
The particular problems of teaching
established doctorsMany established doctors have received Many established doctors have received little previous instruction in communicationlittle previous instruction in communication
Their only "training" has been gained from Their only "training" has been gained from their experience in medicinetheir experience in medicine
Experience alone is a poor teacher: need Experience alone is a poor teacher: need observation, well-intentioned feedback and observation, well-intentioned feedback and rehearsalrehearsal
The particular problems of teaching
established doctors further to fallfurther to fall
more unlearningmore unlearning
more ingrained habitsmore ingrained habits
more threateningmore threatening
less aware of needless aware of need
How to teach?You need a methodology that:You need a methodology that:
is based on experiential learning - is based on experiential learning - observation, feedback and rehearsal observation, feedback and rehearsal
tackles the participant's own problemstackles the participant's own problems
BUT ALSOBUT ALSO
extends their understanding of extends their understanding of underlying communication skills and underlying communication skills and principles principles
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