1. Teaching Practical Clinical Skills Reflections from Communication Skills groups on the Lancaster DClinPsy Jo Black & Jen Davies Clinical Tutors, Lancaster DClinPsy

2. 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

3. 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

4. How will this apply to you? When are you called upon to train someone to develop their practical skills?

5. What theory is useful? AKA old favourites…. What do we know about what helps people to learn and to change?

6. Kolb’s Experiential Learning Cycle (1984)

7. Burch, 1970s

8. Targeted training (Lambert & Ogles, 1997) This shown to be effective 1) focus on a skill - e.g. responding empathetically 2) present rationale for this skill 3) show audio / videotape examples of presence or absence of this skill in actual therapy interaction 4) trainee practices the skill 5) receives feedback from supervisor

9. 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

10. Our Example Communication Skills Sessions on the Lancaster DClinPsy

11. Communication Skills Sessions 7 days through the 1 st 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

12. 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

13. An example – ‘assertive communication’

14. Exercise

15. 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

16. 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

17. 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

18. 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…

19. Feedback “Feedback is the breakfast of champions”. Kenneth Blanchard “A gem is not polished without rubbing, nor a man perfected without trials”. Chinese Proverb

20. 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?

21. ‘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’)

22. Using the framework Think of positive and developmental feedback relating to the following clip…

23. 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.

24. How did it go giving feedback?

25. Overall - Challenges Facilitator 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

26. 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’?

27. 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?

28. 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 stages http://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.ukj.black@lancaster.ac.uk