General Practice ST1

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General Practice ST1 GP Placement Introduction
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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

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GP SPECIALTY TRAINING

• FIRST SIX MONTHS IN GENERAL PRACTICE THE BASICS
• CONSULTATION COMMUNICATION SKILLS
• INFORMATION HANDLING INFORMATION TECHNOLOGY
• DOING THE JOB

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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
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Consultation

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

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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?

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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

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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 Doctors Communication Handbook -Peter
  Tait

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Communication

• CONTACT
• COMPLAINT
• CONTEXT
• CONCERNS
• CONSENSUS
• The 5 Cs
  Donald Gemmell

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COMMUNICATION

• 4 Es 2 Fs
• Critical communication tasks
• ENGAGE
• EMPATHISE
• EDUCATE
• ENLIST
• Biomedical tasks
• FIND the problem
• FIX it
• Bayer educational model

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Communication Skills

• Calgary/Cambridge Model Tasks
• Initiating the session
• Gathering information
• Building the relationship
• Explanation and planning
• Closing the session

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Communication Skills

• Pendletons 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

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Communication Skills

• ALOBA agenda led outcome based analysis
• Discover and record the learners 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

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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)

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Communication

• 6 dimensional PHASES gt relationship, agenda,
  examination, consideration, treatment, closure
  HEALTH BELIEFS gt 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.

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Communication Skills

• Miller (1990) Pyramid of clinical competence

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Communication Skills
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Communication Skills

• COMPETENCE ? knows how to do (can do)
• PERFORMANCE ? actually puts into practice
  (does)

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Communication Skills

• QUALITY IMPROVEMENT
• Peer review
• Self assessment
• (Teacher/Trainer feedback)

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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

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Communication

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

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Communication

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

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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

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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

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Communication Skills - Video
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Communication Skills - Video
Patient Centred Clinical Method
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THE GP CURRICULUM

• You can only remember three things..
• 3 core domains
• 3 other domains
• 3 bits you need to apply the domains

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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

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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?

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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

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A comprehensive approach Coping with multiple complaints Dealing with co-morbidity Balancing treatment / symptom relief / prevention Working the system
Community orientation Public health Justice Prioritisation / resource allocation / rationing
A holistic approach Triple diagnosis Health beliefs Cultural and existential
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3 essential features that will impact on your
ability to apply the competencies
Contextual The working environment The practice demography Pressures you are under Home and personal circumstances
Attitudinal Belief and values Regulatory framework Legal framework Ethical principals
Scientific Knowledge Basic understanding of medical science Evidence based medicine Ability to critically analyse information
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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
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What do patients want?

• Clear information
• Mutually agreed goals
• An active role
• Positive empathy and support

• Sensitivity and support
• Involvement
• Explanations

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What are the benefits?

• Patient satisfaction
• Compliance
• Better health outcomes

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