In this example you can see the use of the session template to guide students through learning they will need to do before attending the live session.

Look out for the light bulb icon for key standout practices.

Session Outline

Clear expectations for students set and timings given

This session is scheduled for 1 hour. The first 30 minutes are self-directed. You will then join MS Teams for a live, interative session with Angela Kubacki, Head of Clinical Communication and our Peer Tutors, Leo Hudson and Jennifer Collom.

In the first 30 mintues, we will introduce you to the principles and evidence which underpin clinical communication in medicine. Please complete the tasks below.

During the 30 minute live session, you will gain an understanding as to how to start a consultation with a patient by way of your introduction and consent. You will also learn what will be expected of you during your communication skills sessions in year 1.

Learning Objectives

Identify reasons for the importance of effective communication skills in medicine (Canvas)
Identify the elements of obtaining consent from patients and discussing confidentiality (Live)
Learn what is expected of you in Clinical Communication sessions in Year 1 (Live)

What does it mean to communicate effectively?

'Communicate' comes from the Latin 'commūnicāre' which means to impart, make common or share. Communication is an interaction between people and involves both listening and speaking.

If we consider what it means to communicate effectively, it will be a process of both sending and receiving 'messages' in a way that can be understood and retained, however this process is also reliant upon our verbal and non-verbal behaviour.

As doctors effective communication is an integral part of our practice. The GMC 'Outcomes for Graduates' states that you must 'communicate clearly, sensitively and effectively with patients, their relatives and colleagues, and this is inclusive of individuals from different social, cultural or ethnic backgrounds or with disabilities.'

Throughout your training you will be assessed on your clinical competence- this will include your clinical knowledge, clinical skills, problem solving, physical examinations and communication skills.

In terms of your clinical and communication skills, a key aspect in relation to the development of these skills is to practice and practice a lot! You will have the opportunity to revisit these skills in other sessions as many are an integral part of what we do and are inextricably linked.

For example, the skills required when 'Opening up' a consultation are applicable every time you meet a patient whether that is in a clinical environment, classroom or an OSCE situation. We will discuss these skills during the live session.

Clear expectations for students set and timings given

Task 1 (4 mins)

Listen to this short presentation which will introduce you to the concepts and principles of 'Patient Centred Communication'. You will need to identify two models for patient-centred consultations.

Why do we focus on patient-centred communication?

Task 2 (7 mins)

The evidence tells us that when doctors communicate effectively and the interaction is 'patient centred', patients outcomes are improved. We know that up to 80% of our diagnoses are based on taking a history alone, and patients are more likely to adhere to treatment and follow advice related to health behaviour change when consultations are 'patient centred'. Research has also indicated that in adopting this approach, doctors are more satisfied in their work and less likely to face complaints or litigation.

Listen to this brief presentation which outlines the key evidence that supports a patient-centred approach to communicating with patients. List four areas that are improved with a patient-centred approach.

Chunked Panopto content

How will I be taught Clinical Communication?

Our first priority is to provide you with a framework of the medical consulation.

There are many ‘models’ which describe the clinical consultation. As mentioned previously, we use two which have proved particularly useful as a tool for developing clinical communication skills. These models also provide the basis for the way we assess your skills (see the Module OSCE).

Task 3 (5 mins)

Listen to this short presentation which explains the McWhinney "Disease-Illness model". It illustrates how the clinician and the patient both have different perspectives (also called 'agendas'), and that during a consultation both perspectives (or agendas) need to be acknowledged and addressed.

What are the key skills that you will be introduced to in clinical communication sessions this year?

Task 4 (4 mins)

Please listen to this final presentation which introduces the 'Calgary- Cambridge model' which explains the concepts of conducting the medical consultation in a more structured way whilst building the doctor- patient relationship.

What are the key aspects of initiating the consultation?

Clinical communication teaching is an integral part of your learning to become a doctor and although it may be taught formally in the classroom, in many ways it is embedded in all your teaching from PBL , clinical skills, anatomy, lab work, community visits etc. Although some of these sessions are not patient facing, many will still involve communicating professionally with each other and colleagues.

Formal clinical communication teaching usually takes place in a small group setting with role play and simulated or real patients. This is an opportunity for you to practice and build upon your skills in a safe setting with your peers and tutor in addition to receiving constructive feedback from both colleagues and patients.

You will be expected to come prepared for your onsite, face to face sessions having completed the pre-sessional work for the session on CANVAS. To maximise your learning, you must come prepared as we aim to keep our onsite sessions as experiential as possible.

Clinical communication like any other skill you learn in medicine needs to be practised for you to become proficient. This is a core skill that you will be assessed upon and is an integral part of becoming a competent doctor.

I hear and I forget

I see and I remember

I do and I understand

Confucius (551 – 479 BC)

Next, in the live session, we are going to consider how you can prepare for meeting patients - introducing yourself and considering your role as a medical student.

When you meet the patient, you will need to give an appropriate introduction, explain the purpose of the consultation, check the person consents (agrees to this), but you must try and develop a rapport with the patient and ensure they are comfortable to continue.

Take a moment to think about

"What is consent?"

Consent means a voluntary, uncoerced decision, made by a competent person on the basis of adequate information and deliberation, to accept some proposed course of action. In healthcare, consent from patients is necessary before undertaking examinations, investigations, procedures or providing treatment. Consent is also necessary for involving patients in teaching and is often required for research. It is sometimes required for audits too.

"What does the term confidentiality mean?"

It is generally understood and accepted that information about patients must be shared within the healthcare team to provide best care. While patients have a right to expect that information will be kept confidential, it is still important to make patients aware that personal information may be shared. Patients consent for the sharing of personal information is important to obtain if at all possible. It is also vital that patients understand that sometimes confidentiality must be breached whether the patient consents to this breach or not. The GMC provides further guidance in Confidentiality: Protecting and providing information (2004).

Why does gaining consent matter?

Obtaining consent is an ethical, legal, and professional duty. Ethically and professionally it ensures that the patient’s autonomy is respected and legally obtaining consent is necessary to avoid charges of battery or negligence.

Please now join the MS Teams Live session where will we consider the skills for initiating the consultation and gaining consent to interview.

Live session slides

Resources

General Medical Council (2018) Outcomes for graduates (Links to an external site.)

Recommended textbook for Clinical Communication: Silverman, J, Kurtz, S, Draper, J. (2013) Skills for Communicating with Patients. 3rd Edition Radcliffe Publishing

Allowing students to reflect and practice

Additional Practice

Task 5

Take a moment to reflect upon the presentations you have heard and what should be mentioned in your introduction and when obtaining consent?
Practice your introduction with a colleague, member of you family or friend. You may also find it helpful to record a video of yourself on your phone.

After you have practised and viewed your recording, try to reflect upon the process -

Was your introduction clear in terms of who you were and the purpose?
What would you change if anything next time?
Did your patient understand who you were and what you wanted to talk to them about?

Thank you to Karen Lobb-Rossini and Angela Kubacki for this example session how to create a flipped approach to a live session by getting the students to take on new learning and practice before attending a live session.