General Practice ST1 – GP Placement Introduction

1. General Practice ST1 – GP Placement Introduction

2. GP SPECIALTY TRAINING • THREE or FOUR YEARS • YEAR ONE – 6 months medical specialties, 6 months GP • YEAR TWO – other specialties • YEAR THREE – Final GP year [or higher level specialty post(s) then final 4th year GP]

3. GP SPECIALTY TRAINING • FIRST SIX MONTHS IN GENERAL PRACTICE – THE BASICS • CONSULTATION + COMMUNICATION SKILLS • INFORMATION HANDLING & INFORMATION TECHNOLOGY • “DOING THE JOB”

4. Communication Skills • Doctor –patient communication is central to clinical practice • Doctors perform consultations • in a professional lifetime • There are major problems in communication between doctors and patients • Effective communication is essential to high quality medicine 200 000

5. Consultation • Consultation Models + understanding • Videos – Analysis & C.O.T. • Role Play • Learning as an Expert

6. Communication • Do doctors actually want to improve their consultation skills? • How would you define, communication skills & consultation skills? How do they differ? • What factors make a successful consultation? – list • What are the barriers to effective consultation?

7. Communication • Need for extra effort, time and emotional commitment • Clinical skills – examination & practical procedures only • Communication skills – non-clinical aspect • Consultation skills = Clinical skills + Communication skills

8. Communication - What you need to achieve in a consultation? • Discover the reasons for a patients attendance • Define the clinical problems • Address the patients problems • Explain the problems to the patient • Make effective use of the consultation • “The Doctor’s Communication Handbook” -Peter Tait

9. Communication • CONTACT • COMPLAINT • CONTEXT • CONCERNS • CONSENSUS • “The 5 Cs” Donald Gemmell

10. COMMUNICATION • 4 E’s & 2 F’s • Critical communication tasks • ENGAGE • EMPATHISE • EDUCATE • ENLIST • Biomedical tasks • FIND the problem • FIX it • “Bayer educational model”

11. Communication Skills • Calgary/Cambridge Model – Tasks • Initiating the session • Gathering information • Building the relationship • Explanation and planning • Closing the session

12. Communication Skills • “Pendleton’s Rules” • Briefly clarify any matters of fact • Encourage the learner to go first • Consider what has been done well first • Make recommendations rather than state weaknesses

13. Communication Skills • “ALOBA” – agenda led outcome based analysis • Discover and record the learner’s agenda before looking at consultation • Look at consultation • Self-assessment by learner according to stated agenda • Group is invited to add ideas • Range of suggestions of ways to improve created • Learner selects from range what they would like to try next time

14. Communication • 2 dimensional - doctor centred v. patient centred • 3 dimensional – physical, psychological, social • 4 dimensional – presenting problem, continuing problems, modifying health-seeking behaviour, health promotion • 5 dimensional – connecting, summarising, hand-over, safety-netting, housekeeping (& 5 Cs)

15. Communication • 6 dimensional – PHASES > relationship, agenda, examination, consideration, treatment, closure; HEALTH BELIEFS > What? Why? Why me? Why now? What if? What next? • 7 dimensional – agenda, other problems, choice of action, shared understanding, involvement, use of resources, maintaining relationships.

16. Miller (1990) – Pyramid of clinical competence Communication Skills

17. Communication Skills

18. Communication Skills • COMPETENCE  knows how to do (can do) • PERFORMANCE  actually puts into practice (does)

19. Communication Skills • QUALITY IMPROVEMENT • Peer review • Self assessment • (Teacher/Trainer feedback)

20. Communication Skills • Communication is a core clinical skill – an essential component of clinical confidence • Knowledge, communication skills, physical examination and problem solving are the four essential components of clinical competence • Without appropriate communication skills, our knowledge and intellectual efforts are wasted • Communication turns theory into practice

21. Communication • Defining the broad type of communication skills • CONTENT SKILLS • PROCESS SKILLS • PERCEPTUAL SKILLS

22. Communication • CONTENT SKILLS • What doctors communicate – the substance of their questions and responses; the information they gather and give; the treatments they discuss.

23. Communication • PROCESS SKILLS • How they do it – the ways they communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; how they develop the relationship with the patient; the way they organise and structure communication

24. Communication • PERCEPTUAL SKILLS • What they are thinking and feeling – their internal decision making, clinical reasoning and problem solving; their awareness of feelings and thoughts about the patient, the illness and other issues that may be concerning them; aware of their own self-concept and confidence, of their own biases, attitudes, intentions, and distractions

25. Communication Skills - Video

26. Communication Skills - Video Patient Centred Clinical Method

27. THE GP CURRICULUM • You can only remember three things….. • 3 core domains • 3 other domains • 3 bits you need to apply the domains

28. 1. Primary care management • To provide quality care – • access • good clinical care – organised and evidence based • good communication • To act in - • diagnosis and management • coordinate PHCT • refer – secondary care / voluntary services / family • be an advocate

29. 2. Person centred care • Patients want - • a competent doctor • an active role • to be listened to • a caring doctor • We want - • to be effective • Why has this patient with this problem come to see me today? • What does this problem mean to this patient?

30. 3. Specific problem solving skills • Tolerate uncertainty vs reduce uncertainty • Explore probability vs explore possibility • Marginalise danger vs marginalise error • You need - • knowledge of natural history of illness • range of skills • stepwise plan of action • use time – both urgent and at leisure • likelihood information

32. 3 “essential features” that will impact on your ability to apply the competencies

33. Agendas Doctors agenda To make a diagnosis To initiate management To practice safely To get through our surgeries efficiently Patients agenda To find out what has happened To be able to fit this into their personal circumstances (knowledge & beliefs) To understand and agree what needs done

34. Clear information Mutually agreed goals An active role Positive empathy and support Sensitivity and support Involvement Explanations What do patients want?

35. What are the benefits? • Patient satisfaction • Compliance • Better health outcomes

36. What are we trying to achieve? Doctors agenda Effective Consulting Patients Agenda MERGING AGENDAS