Introduction to Clinical Skills Module

Communication and Clinical Skills Dr Jane Kidd Associate Professor Clinical Communication

Aims Introduce the Clinical Skills module Raise awareness of some of the communication and clinical challenges you will meet Consider how clinical skills are central to effective practice

Outcomes List components of the clinical skills module List components of effective communication Identify skills to commence a consultation effectively Identify why awareness of feelings is important Identify some barriers to effective clinical communication List some solutions to problems

Clinical Skills Communication Component Dr Jane Kidd Clinical skills component Drs Vinod Patel and Linda Maxwell Inter-professional learning pathway Dr Ann Jackson

Clinical Skills: Communication Phase 1 Introduction Clinical Skills 1 and 2 Inter professional Learning Programme Developing Interview Skills in the Consultation (DISC)

Inter Professional Learning – Why? Communication Collaboration Team working

Inter Professional Learning – How? students 13 professional groups Interwoven online pathway Student discussions in virtual learning sets Patient based journey Weekly episodes and e-activities

How many consultations do you think you will conduct over your professional lives?

Diagnosis from History alone: 85% Diagnosis after Examination only: 5-10% Diagnosis after Investigation: 5-10% So Good Communication Skills are central to Clinical Medicine!

Effective communication: 3 sets of skills Process Content Perceptual Silverman, Kurtz & Draper, 2005

Recommended Reading: Communication Skills Silverman, J, Kurtz, S., and Draper, J. Skills for Communicating with Patients, 2005 Radcliffe Medical Press, Oxford

“I hear and I forget… I see and I remember… I do and I understand…” Chinese Proverb

Structure for next part of session Observe a consultation Discuss the questions with your neighbour Share your ideas with the group

Questions What do you think worked well? Why do you think the student is behaving in this way? What impact does the behaviour have on the patient? What could be done differently? What ethical issues do you think this consultation raises?

Commencing the consultation Prepare Establish initial rapport Identify reasons for the consultation Silverman, Kurtz and Draper 2005

Preparation Environment - location, room, seating, desk Self Activities Emotions Silverman, Kurtz & Draper, 2005

Establish initial rapport Greet patient Check/Obtain patient’s name Introduce self, role, nature of interview Obtain consent Empower patient to ask questions Demonstrate respect and interest Attend to patient’s physical comfort Explain confidentiality Mention note taking Silverman, Kurtz and Draper, 2005

Consider non-verbal aspects Calm approach Tone of voice Use of touch – is a handshake appropriate? Personal space

Identify reasons for the consultation Open questions - allow patient to complete response Listen attentively/use active listening Use “wait” time/silence Confirm list and screen for further problems Negotiate agenda Silverman, Kurtz and Draper, 2005

Awareness of feelings Your own – can impact on your effective behaviours Your patients – differentiate thoughts from feelings - important for empathy

GMC: Clinical and Communication Skills Clinical Skills Interpret the results of commonly used investigations. Communication Skill Explain investigation Explain result Relationship with patient, History, Examination, Problem Solving and Management

Clinical Skills Work out drug dosage and record the outcome accurately. Write safe prescriptions for different types of drugs. Communication Skills Explain drug effects and side effects Write it up effectively GMC: Clinical and Communication Skills Relationship with patient, History, Examination, Problem Solving and Management

Clinical Skills Give intramuscular and subcutaneous injections. Carry out arterial blood sampling. Perform suturing. Communication Skills Explain procedure Respond to patient’s emotions GMC: Clinical and Communication Skills Relationship with patient, History, Examination, Problem Solving and Management

Clinical Skills Perform bladder catheterisation Communication Skills Explain need Explain procedure Be sensitive to patient’s needs GMC: Clinical and Communication Skills Relationship with patient, History, Examination, Problem Solving and Management

Solutions Get to know yourself -prejudices, assumptions, values -Identify your strengths and weaknesses Practice, practice, practice Get feedback on what you do Reflect on – oops! learn from what you do Take every opportunity to learn Be self directed and find more!