Jonathan Silverman

Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides.

Communication skills training is now internationally accepted as an essential component of medical education. However, learners and teachers in communication skills programs continue to experience problems integrating communication with other clinical skills, ensuring that clinical faculty support and teach communication beyond the formal communication course, extending communication training coherently into clerkship and residency, and applying communication skills in medical practice at a professional level of competence. One factor contributing to these problems is that learners confront two apparently conflicting models of the medical interview: a communication model describing the process of the interview and the “traditional medical history” describing the content of the interview. The resulting confusion exacerbates the above dilemmas and interferes with learners using communication skills training to advantage in real-life practice. The authors propose a comprehensive clinical method that explicitly integrates traditional clinical method with effective communication skills. To implement this more comprehensive approach, they have modified their own Calgary–Cambridge guides to the medical interview by developing three diagrams that visually and conceptually improve the way communication skills teaching is introduced and that place communication process skills within a comprehensive clinical method; devising a content guide for medical interviewing that is more closely aligned with the structure and process skills used in communication skills training; and incorporating patient-centered medicine into both process and content aspects of the medical interview. These enhancements help resolve ongoing difficulties associated with both teaching communication skills and applying them effectively in medical practice.

The Calgary–Cambridge Referenced Observation Guides: An aid to defining the curriculum and organizing the teaching in communication training programmes.

Effective communication between doctor and patient is a core clinical skill. It is increasingly recognized that it should and can be taught with the same rigour as other basic medical sciences. To validate this teaching, it is important to define the content of communication training programmes by stating clearly what is to be learnt. We therefore describe a practical teaching tool, the Calgary‐Cambridge Referenced Observation Guides, that delineates and structures the skills which aid doctor‐patient communication. We provide detailed references to substantiate the research and theoretical basis of these individual skills. The guides form the foundation of a sound communication curriculum and are offered as a starting point for programme directors, facilitators and learners at all levels.

UK consensus statement on the content of communication curricula in undergraduate medical education

Context  The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world.

Teaching clinical communication: A mainstream activity or just a minority sport?

This plenary presentation from the EACH International Conference on Communication in Healthcare in Oslo 2008, takes an honest look at the present state of communication teaching and considers how to take the next steps to move communication into the very centre of medical education. Although clinical communication teaching has become increasingly accepted as a formal component of the medical curriculum, there is still a problem to be faced. Communication still often appears in medical education to be a peripheral element rather than a mainstream activity truly perceived by schools and learners as central to all clinical interactions. This presentation explores why clinical communication often appears to be a minority sport in medical education, considers how to overcome this via integration throughout the curriculum, looks at five specific examples of integration in action, presents a new UK consensus statement which helps integrate communication into the mainstream, and finally explores the progression to maturity in communication curricula.

A European consensus on learning objectives for a core communication curriculum in health care professions

OBJECTIVE To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. METHODS Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. RESULTS 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. CONCLUSIONS AND PRACTICE IMPLICATIONS Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process.

Bridging the gap: How is integrating communication skills with medical content throughout the curriculum valued by students

OBJECTIVE To describe a program with integrated learning of communication and consultation skills developed with the intention of preventing deterioration of communication skills, and to present student evaluation data. METHODS Description and evaluation of the program through: (1) monthly student evaluations; (2) questionnaire on student perceptions about the integrated curriculum; (3) a questionnaire about the value of one specific integrated training preceding the pediatric clerkship. RESULTS Key components of training throughout years 3-6 are reinforcement throughout the clinical years, adapting communication training to the clinical context of clerkships using a sandwich model with cycles of preparation, clerkship, and reflection. EVALUATION response rates were 69%, 93% and 93%, respectively. Students value practicing integration of communication and medical content with SPs who represent the population of their next clerkships. They appreciate the multisource feedback during the training, feedback by clerkship specific specialists and SPs is valued most. CONCLUSIONS This description shows an example of an integrated curriculum that helps students to feel well prepared for their communication tasks in subsequent clerkships. PRACTICE IMPLICATIONS Designing and implementing communication curricula to address the issue of integration is feasible. The effects of such integrated programs should be subject to future studies.

Teaching and learning consultation skills for paediatric practice

Effective consultations with patients and their families are important for patient satisfaction, adherence to treatment, and recovery from illness. Communication problems among health professionals are common. Fortunately, the skills of effective communication can be taught and learned. This paper highlights evidence based approaches to teaching these skills with minimal resources.

New approaches to learning clinical skills.

could be challenging. Moreover, it is not clear what portion of the preceptor’s interpersonal characteristics that create the resident’s perception of psychological size and distance represents malleable behaviours. If these characteristics mostly consist of stable and relatively impenetrable personality traits, they might require extensive intervention, a fact that possibly explains the roots of the adage that great teachers are born, not made . 3 It is unclear how psychological size and distance could be used to make a resident)preceptor pairing that would be perceived as a good match as they mainly describe a relationship that is already in existence. It may or may not represent the ideal relationship for either party. One could reframe the question by asking participants to describe their optimum size and distance relationship and use this to make a match. However, what if a resident’s optimum relationship requires the preceptor circle to be a little speck and the resident circle to consume the page, wielding a whip? 4 Does a universally applicable optimum level of size and distance in the resident)preceptor relationship exist? If the optimum varies substantially with the individuals involved, the practical value of the trait will be limited. 5 Do gender or culture differences influence the resident)preceptor relationship? Does the gender or culture of the preceptor interact with that of the resident in this regard? 6 Encouraging psychologically closer relationships between students and instructors can yield unintended consequences. The closer a relationship becomes, the greater the likelihood that it might spill over into the territory of romance. If closer relationships between residents and preceptors are encouraged to improve the instructional experience, clear guidelines are needed to specify their limits. 7 For the sake of generalisability, how does the concept of reducing psychological size and distance relate to an instructor teaching 200 students in an amphitheatre? Is it possible to reduce the psychological size and distance when the instructor is physically distant and sharing his ⁄her presence with 200 others? Some recommendations for giving a good lecture seem directed at reducing the psychological size and distance of the instructor. For example, making one-to-one eye contact with random audience members would seem to be one such strategy.

Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview

Objectives To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor–patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations. Design Multiple ratings of simulated general practitioner (GP)–patient consultations by trained GP evaluators. Setting UK primary care. Participants 21 GPs and six trained GP evaluators. Outcome measures GCRS score. Methods 6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects. Results Assessing the communication quality of individual consultations, GCRS achieved a reliability of 0.73 (95% CI 0.44 to 0.79) for two raters, 0.80 (0.54 to 0.85) for three and 0.85 (0.61 to 0.88) for four. We found an average difference of 1.65 (on a 0–10 scale) in the scores given by the least and most generous raters: adjusting for this evaluator bias increased reliability to 0.78 (0.53 to 0.83) for two raters; 0.85 (0.63 to 0.88) for three and 0.88 (0.69 to 0.91) for four. There were considerable order effects, with later consultations (after 15–20 ratings) receiving, on average, scores more than one point higher on a 0–10 scale. Conclusions GCRS shows good reliability with three raters assessing each consultation. We are currently developing the scale further by assessing a large sample of real-world consultations.

The East Anglia Deanery Communication Skills Teaching Project--six years on

This paper describes the Cascade Communication Skills Teaching Project, which is a programme of facilitator training enabling communication skills teaching in the consultation to general practitioners to be cascaded throughout the former East Anglia Deanery. The paper also explores the projects educational and organizational effectiveness. The programme is based on an ongoing training programme for a cohort of around 30 district-based communication skills facilitators, and was set up in the autumn of 1995. These facilitators are now able to act as a resource to cascade high-quality communication skills teaching into vocational training schemes, trainer education and the continuing professional development of established general practitioners throughout each district in the region. The project has now been extended into medical student teaching, specialist teaching at junior and senior level, and multi-disciplinary teaching.