Did you know DYK 1

what consultation skills the ELM (Year 2/3)

students have learnt?

Communication and consultation skills are a crucial aspect of patient care, and they, like other clinical
skills, need to be learned. Students who will be moving into Year Four in the ALM course in 2010 began
2008 with communication skills teaching which more closely resembled the teaching of previous years,
but with the introduction of considering the patients perspective in gathering a history. The Calgary-
Cambridge model has been used to base the learning of consultation.

Thus, the consultation is broken down into five separate and sequential steps, each of which requires
particular skills to successfully move through them. Alongside these steps are the tasks of Building
the Relationship and Providing Structure. These are continuous threads which run throughout the
consultation.

The Calgary-Cambridge Model

(From: Kurtz S, Silverman J, Benson J, Draper J. Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary-
Cambridge Guides. Academic Med. 2003;78: p806)

Please note that the students opportunities to practise these skills have been limited almost entirely to
simulated situations, either with actors or with peers role-playing scenarios. They will benefit enormously
from being able to revisit and practise these skills with the patients they meet in the ALM programme.
Furthermore, such experiences will be highlighted when teaching staff are able to observe a proportion
of these interactions, and to provide feed-back to students as a consequence.

Component Level of Attainment by end of Year Three

Initiating the Session Should show competence

Gathering Information Should show competence
Physical Examination Should show competence at basic systems examination
Explanation and Planning Students have been exposed, however because clinical reasoning has
yet to be introduced specifically in the course (in 2010), competence
should not be expected.
Closing the Session Should show competence

Providing Structure Should show competence

Building the Relationship Should show competence

There are many similarities between the skills laid out in the Calgary-Cambridge Guide and what
medical students have been taught in the past at Otago as Communication Skills. Thus they are still
expected to be able to engage with the patient such that they can successfully gather information from
them, and attend to their feelings with appropriate empathy.

By the end of ELM 3, students should be competent to engage with a patient to determine the reasons
for their presentation, and having due regard for the patients perspective of their illness.

They will have attempted to gather information about key symptoms of cardiovascular, respiratory,
gastrointestinal, musculoskeletal and neurological diseases

They will have attempted to interview someone who is angry, or anxious or embarrassed

They will have been exposed to taking an obstetric history, a sexual history and a history from
someone who is depressed

Where there are differences from earlier Communication Skills learning, they will be (i) in the
structure of the consultation, and (ii) in some of the terminology used. In addition to this, the
framework encompasses the entire medical consultation. The model also makes it clear that patients
are to be encouraged to express their ideas, concerns and feelings.

Note: For the new cohort of students moving up through the Advanced Learning in Medicine programme, the
Year 5 OSCE stations relating to elements of the clinical consultation
will be based on the Calgary-Cambridge Model.

Did you know

For more information:
The Faculty Education Units website has more information about the Consultation model used:
http://tinyurl.com/ydbahnm DYK 1