MEDICAL EDUCATION

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Notes for the Primary Care Teachers
TEACHING DOCTOR-PATIENT COMMUNICATION IN FAMILY MEDICINE

Other models include the ILS (Invite-Listen-Summarise), The SEGUE Framework, and the Calgary-Cambridge Observation Guide². All these models promise to be powerful in providing detailed guidance about analysis of consultations. It is advisable that the family medicine teacher selects one model, gets familiar with it, practises it before teaching or even later adds to or alters it according to his or her opinion and experiences.

The medical communication models also have been found to help teachers in the planning of teaching sessions. For example, sessions on building rapport and gathering and giving informationarethe focus in undergraduate teaching, whilst emphasis on ‘reaching agreement on problems and plans’ or more complicated communication such as dealing with angry or emotional patients would be the focusfor postgraduate trainees in family medicine.

DIFFERENT METHODS OF TEACHING COMMUNICATION SKILLS

The principles underlying communication skills teaching should be the same as the principles of teaching other skills in medicine⁴ which can be simplified as the following:

• providing knowledge on what to be covered
• demonstrating the skill
• providing sufficient practice
• giving sufficient feedback and reinforcing learning

Popular methods of teaching communication skills are listed below:

• role-modelling
• observation of learners’ consultations (‘precepting’)
• role-play
• videotaping (or audiotaping) learner’s consultation
• cinemeducation (learning from movie clips or other pre-recorded materials)
• interview practice with standardised patients

In the context of family medicine discipline, all of the methods, except the last one, can be easily incorporated during clinical teaching; for example during a clinical attachment in a family medicine teacher’s clinic. A more formal teaching-learning session may be needed for interview practice with standardised patients.

Whatever method used, the cornerstone of each teaching session is analysis of the interaction, i.e. checking whether skills or tasks described by a chosen model is being covered (quantitative) and if covered, whether the skills are demonstrated competently (qualitative). Normally, communication skills observation tools or checklists are used and these aid both learners and teachers. A convenient example of a communication skills observation tool is the Harvard Medical School Communication Skills Form which is adapted from the Kalamazoo Consensus Statement².

TEACHING DOCTOR-PATIENT COMMUNICATION DURING CLINIC ATTACHMENTS: SOME TIPS

Family medicine teachers usually have busy clinics, and for the untrained, grouses of not having time to teach their students or learners are often heard. A few tips on incorporating communication teaching during busy clinics are described as follows:

• Role-modelling: The teacher provides a printed communication observation tool (preferably after a prior introductory lecture or explanation about the observation tool), then asks the learners to observe his or her consultation, mark observed skills and/or make notes. Discussion on strengths and weaknesses can be done after the clinic session or learners can be encouraged to reflect on their observations in a diary or log. Even though learners would not be able to practise the skills, role-modelling can be a quite powerful way to inculcate positive values in learners. However, while most learners may enjoy watching their teachers in action, this method can appear threatening to new teachers of the discipline.

• Observation of learner’s consultation (‘precepting’): During less busy times, the learner may be allowed to perform the consultation; either the whole consultation or in parts. A common practice is to allow learners to initiate and then gather some information before the teacher takes over the consultation. Learners normally love this ‘hands-on’ opportunity, despite the fact that they are being watched. Communication observation tools may be used by both the teacher and learner (as self-evaluation). Discussion and feedback, based on the observation, need to follow on as far as possible. Giving feedback has been covered in greater depth in another article in this series and readers may want to refer to this⁵.

• Role-play: This simulation technique is widely used normally in formal small group sessions and allows the practise of skills in a safe setting. In a clinic situation, a teacher might grab teaching opportunities ― for example after dealing with breaking bad news ― by role-playing as the patient and asking the learner to role-play being the doctor and simulate what he or she has observed. This gives opportunities for learners to practise a newly-learned skill and reinforce learning.

• Review of pre-recorded consultations: This methodology certainly needs preparation as well as equipment, but can be very effective in changing behaviour. With the progress of technology, portable video cameras (or at least audiotaping facilities) are easily accessible, and viewing them can be done with any standard office computer. Learners can be asked to videotape their consultations in a different room, and view them together with the teacher later. Further details in handling audio and video recording (such as getting consent from the patient) are available^1,2 and can be easily taught to learners.

Note: More information and resources about the topic are available via the author.

References

1. Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. 2nd ed. Oxford: Radcliffe Publishing Ltd; 2005.
2. Accreditation Council for Graduate Medical Education. Advancing education in interpersonal and communication skills. ACGME Outcome Project. Accessed October 6, 2007. Available from: URL: http://www.acgme.org/outcome/implement/interperComSkills.pdf. 
3. Makoul G. Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Acad Med. 2001;76(4): 390-3 [PubMed]
4. George JH, Doto FX. A simple five-step method for teaching clinical skills. Fam Med. 2001;33(8):577-8 [PubMed] [Full text]
5. Khoo SB. Giving feedback. Malaysian Family Physician. 2007;2(1):27-8 [Full text]