Teaching Practical Clinical Skills

Reflections from Communication Skills groups on the Lancaster DClinPsy

Jo Black & Jen DaviesClinical Tutors, Lancaster DClinPsy

Aims• To briefly consider theory relevant to the topic and how it can

inform our teaching

• To describe ways we have taught practical skills, and the conditions necessary to make them effective

• For this to be useful to you in relation to teaching clinical skills in different settings, including in the delivery of formal training and in other contexts, such as within supervisory relationships

What this is and what it’s not….• A place to think about how we as clinicians help others

to develop clinical skills and develop their practice• It’s not a lit review on the topic or an academic take on

teaching and learning

How will this apply to you?

When are you called upon to train someone to develop their practical skills?

What theory is useful?

• AKA old favourites….

What do we know about what helps people to learn and to change?

Kolb’s Experiential Learning Cycle (1984)

Burch, 1970s

Targeted training(Lambert & Ogles, 1997)

This shown to be effective1) focus on a skill - e.g. responding empathetically2) present rationale for this skill3) show audio / videotape examples of presence or

absence of this skill in actual therapy interaction4) trainee practices the skill5) receives feedback from supervisor

What do people need to ‘feel’ in order to be able to change?

As a profession we know what conditions need to be in place to facilitate change…

• Importance of a safe, containing therapeutic relationship

• This applies in one to one settings but also more broadly…eg therapeutic communities, healthy teams, parent-child relationships etc

Our Example Communication Skills Sessions on the Lancaster DClinPsy

Communication Skills Sessions• 7 days through the 1st year of training

• 3 small groups with the same facilitator

• Topics include – listening, exploring another person’s experience, managing the structure/process of a session, exploring ‘difference’, personal boundaries, managing difficult conversations, working with emotion, communicating psychological thinking

• Atheoretical, focus on practical skills

Format of sessions• Discussion, observing own experience• Consider theory or ideas on good practice• Examples – good and bad • Have a go – pairs, threes, wider group, video• Learning by having it ‘done to you’• Feedback – self, peer, facilitator• Reflective practice• Action – taking it forward, personal goals,

what might support this learning

An example – ‘assertive communication’

Exercise

Necessary conditions - Ethos• Lots of ways to get it right – repertoire not robot!

• All are learners and teachers – facilitator has expertise but not ‘THE answer’

• We all have life experience

• Valuing different styles

Necessary conditions - Ethos• Expectation – we will all do it. Conveying firm

compassionate confidence in them! Acceptance it can be exposing, difficult - accepting and welcoming the challenges. Value of ‘training’ arena

• Facilitator – demonstrating imperfection, openness to challenge, feedback, learning

• ‘Failing well’ – hard for our profession?

• Playful approach – giving it a bash

• All requires SAFETY to do this

All of which requires….Safety• Small groups, developing relationships• Attention to beginnings and endings• Contracting• Focus on the process • Time and the conditions to build a relationship• Normalising ‘clunkiness’ (conscious

incompetence?)• Separating person from the action – and

valuing the positives

Techniques around safety• Conversations about the learning relationship from the start-spirit of the relationship-hopes and fears-ways of addressing difficulties-boundaries of the relationship/s, confidentiality-how to review

• Demonstrating fallibility• Moving away from ‘performance of excellence’• Honesty can be feared but brings confidence and trust…

Feedback

“Feedback is the breakfast of champions”.Kenneth Blanchard

“A gem is not polished without rubbing, nor a man perfected without trials”.Chinese Proverb

Giving Feedback – 5 Point Plan(developed by Deb Barnard)

1. Self Assessment - Positive

How do I feel it went? What did I do well? What worked well? 2. Self Assessment - Developmental

What would I do differently next time? What aspect would I like to develop? What aspect would I like to receive comments on? What other options have I considered?

3. Feedback From Other – Positive

What do you think I did well? What did you like? 4. Feedback from Other – Developmental

What do you think could be done differently in future? What could have been tried? What were your reservations and how could they be addressed? What would other good options be?

5. Self – Key Learnings

What do I take form the comments? What might I try in the future? What have been my key learnings?

‘Good’ feedback

• Descriptive Feedback vs personal judgement• Responses that are owned• Specific examples (not personal qualities)• Light touch• Permission asked to feedback or suggest• Constructive in intention

• Attention is also given to helping people give honest, developmental feedback….(not just ‘nice’)

Using the framework

• Think of positive and developmental feedback relating to the following clip…

Practical exercise

Explain the role of a clinical psychologist to a 7 year old child….

Have a try of using the feedback framework with your partner.

How did it go giving feedback?

Overall - ChallengesFacilitator stance• it can be hard to genuinely embrace the ethos• comfort in expert position• exposing ones own practice too• managing authority and facilitation• self doubt• Time demands & hard work!• how to be supportive yet assertive in ensuring all

take part

Challenges• Failing well? Tension with an evaluative role- the need to impress- self doubt- reality of failure

-Relational dynamics - whose voices get heard- how to encourage honest developmental feedback- impact on ongoing relationships- relationship of learner to learning (and to trainer)

-What about when one’s role is less explicitly as a ‘tutor’?

Applying this to your work

• What did you identify at the start as being a ‘skill’ you are called upon to develop in others?

• What can you take from this talk, to inform your practice going forward?

Thanks for listening.

We’d like to acknowledge the work of others who have collaborated with us in developing this work – especially Ben Harper. Some of our material is taken (with permission) from the work of Deb Barnard who heavily influenced our thinking in the early planning stageshttp://relationaldynamics1st.co.uk/index.html.html

If you have any feedback, ideas or suggestions for the communication skills teaching on the Lancaster DClinPsy, please do send us an email j.black@lancaster.ac.uk or j.davies@lancaster.ac.uk