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Teaching consultation skills

Teaching consultation skills. Linda Gask University of Manchester. Problem-Based interviewing a model. Development by Art Lesser in Canada in 1980s. One of several models!. Key features. Simple- minimal theory! Active- videofeedback Based on real material ‘Problems’ not symptoms.

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Teaching consultation skills

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  1. Teaching consultation skills Linda Gask University of Manchester

  2. Problem-Based interviewinga model • Development by Art Lesser in Canada in 1980s. • One of several models!

  3. Key features • Simple- minimal theory! • Active- videofeedback • Based on real material • ‘Problems’ not symptoms. • Process not outcome. • Extensively evaluated.

  4. Three key sources of information • What the patient says: the ‘History’- but also verbal cues • What the doctor ‘sees’ and ‘hears’: nonverbal and vocal cues. • What the doctor feels.

  5. Problem detection skills • Beginning the interview • Picking up/responding to verbal cues • Picking up/responding to non-verbal cues • Demonstrating empathy • Asking about health beliefs/concerns • Controlling the interview

  6. Picking up/responding to verbal cues • Open question • Clarification • Example

  7. Problem Management skills • Ventilating feelings • Information/education • Making links • Negotiation • Motivating change/promoting self-management • Conjoint interviewing

  8. Skills needed in training • Putting trainee at ease • Selection of material • Setting the agenda • Stopping tape to teach: ‘decision points’

  9. Skills needed in training • Focus on skills • Constructive criticism • Hierarchy of prompts

  10. Difficult patients or difficult consultations?

  11. Impossible patients? • Much of the published literature is about problem patients. • Is the problem really one of problematic interactions rather than problem patients?

  12. Complex interactions • Demanding problems? • Multiple problems • Social difficulties ‘not medical’ • ‘Medically unexplained symptoms’ • Unmet emotional needs

  13. Complex interactions • Complex communication • Physical barriers (eg. deafness) • Communication style • Linguistic barriers • Cultural barriers • Emotional tone • Atypical balance of power • ‘Expert’ patients • Consulting with fellow professionals

  14. Complex interactions • Potential for disagreement • Physical or psychological? • Having treatment or not? • Changing behaviour or not? • Complex dynamics • Couples • Families • Parents and children

  15. I came to medical school with the idea that really got reinforced in my training, that if you really learn everything and you really do care about your patients, if you really are a great doctor then you can take care of it all….. (From Gerber 1983)

  16. Factors that predict our resistance to stress • Character • Challenge • Commitment • Control • What do you get out of your work? • What does your work get out of you?

  17. Recognising and tackling problems • Reflection- awareness of our thoughts, feelings, reactions • Acknowledgement • Ownership • Motivation to change • Action

  18. Breaking the problem down • Helps with clearer definition • Enables sense of control and achievement earlier • Fact or assumption? • What, when, where, who and how?

  19. Establish achievable goals • What are the key sources of support that I have? • Can I make use of them? • If not, why not? • What sources of relevant training do I have access to? • Can I make use of them? • If not, why not?

  20. Establish achievable goals • Are the expectations that I have of myself realistic or unrealistic in this case? • Am I guilty of undervaluing what I have achieved so far?

  21. Generating solutions to problems • ‘Brainstorming’ • The more the merrier • Mix and combine • Avoid judgement

  22. Challenging the way we think about complex interactions with our patients • Share your difficulties • Challenge your attitudes but Also be prepared to • Be clear about your boundaries • Confront hopelessness in yourself but also be prepared to • Accept your own powerlessness when necessary • (Getting the balance right between the two) KEY SLIDE

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