Introduction to Clinical Skills Module

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Introduction to Clinical Skills Module
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Communication and Clinical Skills

• Dr Jane Kidd
• Associate Professor
• Clinical Communication
• j.m.kidd_at_warwick.ac.uk

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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

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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

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Clinical Skills

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

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Clinical Skills Communication

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

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Inter Professional Learning Why?

• Communication
• Collaboration
• Team working

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Inter Professional Learning How?

• 1000 students
• 13 professional groups
• Interwoven online pathway
• Student discussions in virtual learning sets
• Patient based journey
• Weekly episodes and e-activities

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

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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!
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Effective communication 3 sets of skills

• Process
• Content
• Perceptual
• Silverman , Kurtz Draper, 2005

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Recommended ReadingCommunication Skills

• Silverman, J, Kurtz, S., and Draper, J.
• Skills for Communicating with Patients, 2005
• Radcliffe Medical Press, Oxford

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• I hear and I forget
• I see and I remember
• I do and I understand
• Chinese Proverb

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Structure for next part of session

• Observe a consultation
• Discuss the questions with your neighbour
• Share your ideas with the group

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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?

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Commencing the consultation

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

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Preparation

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

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Establish initial rapport

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

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Consider non-verbal aspects

• Calm approach
• Tone of voice
• Use of touch
• is a handshake appropriate?
• Personal space

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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

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Awareness of feelings

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

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GMC Clinical and Communication Skills
Relationship with patient, History, Examination,
Problem Solving and Management

• Clinical Skills
• Interpret the results of commonly used
  investigations.
• Communication Skill
• Explain investigation
• Explain result

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GMC Clinical and Communication Skills
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

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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 patients emotions

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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 patients needs

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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!