Clinical Skills

1

• Clinical Skills

2
Clinical skills assessment framework

• gathers information
• identify problem or drug-related issue
• option and management strategies
• provide appropriate follow-up

3
Gathering Information

• Opening
• Systematic but flexible approach
• Begin with open ended questions
• Use close ended questions to narrow down
• Cast your net wide
• Stay organized, aware of time

4
Identifying Patients Needs

• Differentiate between
• patients needs and wants
• caregivers needs and wants
• health care providers needs and wants
• Establish urgency of situation - do not expect to
  solve all problems now!

5
Identify Management Options

• Use references to confirm knowledge base
• Identify all relevant options, including status
  quo
• Identify pros and cons for each option
  objectively, so patient can make own, informed
  decision
• Refer to patients specific circumstances

6
Communicate/Negotiate

• Be clear as to what YOU think is the best option
  and WHY
• Do not pressure, but educate
• Apply your therapeutic knowledge
• Use persuasive communications techniques where
  appropriate

7
Implementing Plan/Follow-Up

• By the end of the interview, there should be a
  decision of some sort.
• If the Rx is appropriate, counsel on it.
• If the Rx is inappropriate, clearly explain to
  patient why, what you will do and how it will be
  done.
• Do not let interview digress into a chit-chat

8
II. Physical Evaluation

• Observe patients affect
• Note physical changes (e.g. tremor, shortness of
  breath, sweating, tics)
• Confirm laboratory tests (e.g. blood pressure,
  glucometer, peak flow meter)

9
III. Provisional Assessment

• Do not stop once youve identified one problem
  - there may be others
• Identify steps for confirming or disconfirming
  your assessment

10
IV. Final Assessment

• Need to be able to make a decision based on
  evidence, rather than just have a chat and offer
  advice
• Verbalize your thinking - important for patient,
  important for assessor