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Why study Communications skills?

This slide presentation is based on Introductory talks

given by Dr Jonathan Silverman from Cambridge
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Communication skills - why bother?

 Why learn communication skills?

 Can you learn communication skills?

 What is there to learn?

 How is it taught?

 Where next?

The ability to integrate

- knowledge base

- communication skills

- examination skills

- problem-solving ability
Communication is a core clinical skill
How we do things is just as important
as what we do
Communication skills turn theory
into practice
The average GP undertakes 200,000
consultations in a professional
Effective communication
is essential to the practice of
high quality medicine
Why learn communication
Are there problems in communication
between doctors and patients?

Is there evidence that communication

skills can overcome these problems?

Can these communication skills be

Are there problems in communication

 doctors
reasons for theand patients?
patient's attendance
 gathering information
 explanation and planning
 adherence to plans
 medico-legal
 lack of empathy and understanding
Is there evidence that communication skills

We be used
haveto overcome
research these problems?
evidence to validate
the use of specific communication skills:

 process of the interview

 satisfaction
 recall and understanding
 adherence
 outcome: decreased patient concern
symptom resolution
physiological outcome
Can communication skills be
 communication is a clinical skill
 it is a series of learnt skills
 experience is a poor teacher
 there is conclusive evidence that
communication skills can be taught
 and that communication skills
teaching is retained
The goals of medical


Is the prize on offer worth the effort?
Effective communication offers more
than just good manners or being nice

Effective communication enables us to

become better doctors clinically

Effective communication improves

patient care and disease outcomes
What is there to learn?

Content: what we do
Process: how we do it
Perceptual: what we're thinking
and feeling
Calgary-Cambridge Observation
Initiating the session
Gathering information
Building the relationship
Explanation and planning
Closing the session
where am I and what do I want to achieve?

Specific skills:
how do I get there?

Phrasing or behaviour:
how can I incorporate these skills into my
own style and personality?
How do we change our
in the consultation?
Knowledge is important but only allows
you to know about communication

Experiential teaching is required to

know how to communicate
How to teach communication
How do we change our behaviour in the
Where is the block?
Skills or attitudes?
Experiential or didactic teaching?
Know about or know how?
How to teach communication
 observation
 video or audio playback
 well-intentioned feedback
 rehearsal
 active small group or 1:1 learning
The challenges of experiential learning:

 opportunistic

 unstructured

 potentially unsafe

 it makes things worse before they get

The challenges of experiential
how to provide a supportive environment
 how to maximise learning and safety
 how to structure sessions
 how to conceptualise learning
 how to introduce didactic material such
as theory and research
 how to structure learning over time
How to teach communication
 needs to be on-going, developing
and "helical"

 cannot be learnt as a a one-off

The particular problems of teaching

Many established
established doctors have received
little previous instruction in communication

Their only "training" has been gained from

their experience in medicine

Experience alone is a poor teacher: need

observation, well-intentioned feedback and
The particular problems of teaching

established doctors
further to fall
  more unlearning
 more ingrained habits
 more threatening
 less aware of need
How to
You need a methodology that:
 is based on experiential learning -
observation, feedback and rehearsal
 tackles the participant's own problems
 extends their understanding of
underlying communication skills and