Cross Curriculum Communication Skills Training
Communication skills comprise one component of the Clinical Skills Unit, Med 1 and 2. In Med 1, they are taught in dedicated
communication skills activities with simulated patients and then fully integrated across the unit as students learn/practice medical history taking and physical examination skills with volunteer patients. In Med 2, communication skills are fully integrated into case practice with students performing focused patient histories and physical examinations.
Med 1: Clinical Skills Unit
Dedicated Communications Skills Training
Clinical Skills are allotted two sessions per week: Tuesday afternoon and Thursday morning
Please note: SP=simulated patient
|#2||Establishing the Foundation for Effective Patient-Doctor Communication: |
A) Calgary Cambridge Guide (CCG)
Patient-Centred Clinical Method
B) The Teaching/Learning Process: Patient Interviewing
and Giving/Receiving Feedback
B) Tutorial (2 hours)
Groups of 8 with
1 SP and Tutor
|#3||Skills Practice: Applying Communication Process Skills|
of the Interview
Practice with SPs, session facilitated by tutors
|Practice Session #1|
|#4||Combining Communication Process Skills with Basic |
Content of the Medical History
Communicating across cultural differences
Groups of 4
|#5||Skills Practice: Combining Communication Process |
Skills with Basic Content of the Medical History
Practice with SPs, facilitated by tutors
|Practice Session #2|
|#15||Emotions in the Medical Interview||Plenary|
| 2.5 hours
|#16||Skills Practice and Recording: Emotions in the|
Practice with SPs, session facilitated by tutors
|Practice Session #3|
|#17||Recording Review: Emotions in the Medical |
Discussion facilitated by tutors
Groups of 4
Med 3 - Communication Skills Curriculum
In clerkship, learners consolidate and continue to build on their communication skills as they engage in patient-doctor interactions characterized by greater intensity and intentionality and broaden their interactions to include members of the health care team.
This begins with communication skills training during an Introduction to Clerkship Orientation Week.
During Med 3, clerks also participate in three physician-facilitated, small group skills practice sessions with simulated patients.
These sessions use the Agenda-Led Outcome-Based Analysis (ALOBA) method which enables clerks to identify and practice a variety of challenging
patient-doctor and intra- and inter-professional interactions chosen by them and directly relevant to their clinical experience. In this way,
ALOBA sessions, as the name implies, are grounded in the learners’ agenda and based on the outcomes the learners want to achieve. Rotations in
which ALOBAs are conducted include: Medicine, Pediatrics and Surgery.
Communication Skills Training in Med 3 During Introduction to Clerkship Orientation
|Large group interactive sessions (3 hours)|
- "Breaking Bad News" and "The Angry Patient"
- Empathic Communication
|Small group skills practice session (3 hours)|
Each practice session features role play with simulated patients and are facilitated by a physician, nurse and social worker to demonstrate interprofessional collaboration.
|By the end of the Introduction to Clerkship, learners will be able to:
- Apply a framework for breaking bad news to patients and families
- Apply a framework for responding to an angry patient
- Demonstrate empathy and support for grieving patients/families
- Identify communication skills for effective patient-centred collaboration among members of the health care team
- Recognize the role of nurses and social workers when breaking bad news and interacting with patients experiencing strong emotion
At the postgraduate and faculty level, communication skills teaching/learning extends beyond the patient-doctor focus to
include communication skills specific to the physician’s expanding role as teacher and collaborator. Workshops are subsequently
related to the CANMEDS’ roles of Communicator (patient-doctor communication); Collaborator (team dynamics and conflict
management); and, Scholar (feedback, challenging learner, qualitative research.
In the Postgraduate Program, two annual communication skills teaching activities on patient-doctor communication are delivered by the CSP and coordinated through the postgraduate medical education office. They are:
1. Orientation for International Medical Graduates (IMGs):
Patient-doctor communication is the focus of two full days in the two week IMG orientation. Teaching/learning activities include: a full group interactive session: Agenda-Led Outcome-Based Analysis (ALOBA) sessions with simulated patients;
and, a four station OSCE-like experience with verbal feedback being provided by simulated patients.
2. Communication Skills Workshop for First Year Residents:
This is a mandatory four hour communication workshop for all first year residents. It consists of a 3 station OSCE and follow-up tutor facilitated workshop on patient-doctor communication. Simulated patients provide verbal and written feedback on
resident OSCE communication strengths and skill deficits as part of a formative assessment given to residents, program directors and the PGME office.
III. Continuing Medical Education:
Our history of offering continuing medical education in patient doctor communication skills has encompassed a number of strategies to enhance the skills of practicing physicians. They have included:
- Offering the CME workshop Talking With Patients: Sharing Stories and Strategies in association with the College of Physicians and Surgeons of Nova Scotia, to physicians seeking to enhance their communication skills with patients.
- Incorporating communication skills instruction into existing CME programs
- Communication skills sessions have been integrated into the Dalhousie CME Annual Refresher programs, including online programs
- Designing workshops programs on topics of physician interest.
- A needs assessment of the NS Physician Communication Skills Planning Committee, identified 5 priority topics of interest for CME workshops: 1) the patient who brings a list, and 2) the patient whose first complaint is not the main reason for the visit, 3) lifestyle counselling, 4) talking with teens and 5) boundaries in practice.
- As a result, three workshops were developed on: 1) "The Doorknob Visit" (the patient whose first complaint is not the main reason for the visit); 2) "Patient with a List"; and 3) Lifestyle Counselling Strategies To Talk to Patients About Weight loss.
Workshop materials were developed with content experts and included video-taped scenarios, facilitator and participant manuals including questions for discussion, summary of evidence, references, presentation slides, and facilitation tips. These workshops were presented at numerous CME refreshers programs and community hospitals.
- Working with a network of physicians throughout the province who are interested in communication skills in medicine. Resources and training were provided to physicians who practice in small towns. These physicians subsequently led communication skills workshops for colleagues in their communities.
IV. Faculty Development:
Faculty members often desire support and guidance on how to better teach and assess their learners' communication skills. The Communication Skills Program goals are to:
- Provide faculty training on effective strategies for teaching and assessing communication skills to adequately prepare medical learners for the CANMED’s roles of ‘Communicator’(patient-doctor communication) and ‘Collaborator’ (team dynamics and conflict management) and ‘Scholar’(providing feedback, dealing with the challenging learner).
- Provide faculty training in feedback and evaluation skills
- Identify and work with faculty role models and "champions" of communication skills in medicine
Faculty Development workshops occur on a regular basis. They have also included workshops led by Dr. Jonathan Silverman, Associate Clinical Dean and Director of Communication Studies at the School of Clinical Medicine, University of Cambridge, and Dr. Suzanne Kurtz, formerly of the University of Calgary’s Faculty of Medicine.