Amsterdam anglais 13 septembre

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Brief model presentation. • Exercise #1: Building a clinical scenario. • Exercise #2: Teaching from a video. • Implementation and use of the communication wheel ...


Sophie Galarneau MD, CCMF Olivier Jamoulle, MD, FRCP M-Thérèse Lussier, MD, BSc, MSc, FCMFC Claude Richard, PhD, MA September 29th 2014, Amsterdam

•  We do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.

•  Marie-­‐Thérèse  Lussier  and  Claude  Richard  have  received  honorary,   outside  of  this  workshop,  for  their  work  on  health  communica?on   from  Astra  Zeneca  and  Merck.   Sophie Galarneau MD, CCMF Olivier Jamoulle, MD, FRCP M-Thérèse Lussier, MD, BSc, MSc, FCMFC Claude Richard, PhD, MA September 29th 2014, Amsterdam

The  Professional  Health  Communica4on  Wheel  


Workshop objectives   At  the  end  of  the  workshop,  the  par?cipant  will  have:   •  Familiarized  herself/himself  to  the  wider  conceptual  model  of   professional  health  communica?on  and  its  components     •  Experimented  the  use  of  the  “Professional  Health   Communica?on  Wheel”  in  different  teaching  ac?vi?es     •  Discussed  the  applicability  of  the  “Professional  Health   Communica?on  Wheel”  in  their  own  teaching  seRng  

Workshop structure                                  

•  Welcome and presentation of participants •  Brief model presentation •  Exercise #1: Building a clinical scenario •  Exercise #2: Teaching from a video •  Implementation and use of the communication wheel in teaching activities •  Conclusion


•  •  •  •  •  •  •  • 

Residents ? Students ? Physicians ? Nurses ? Social workers ? Other professions ? Communication skills teachers ? Program directors ? Others ?

Professional Health Communication Wheel

Generic functions and dimensions of communication


Medical interview fundamentals: the Calgary-Cambridge Guides

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Medical interviews across the spectrum of clinical practices

Medical communication: its many forms and expressions

Claude Richard1, Marie-Thérèse Lussier1,2, Sophie Galarneau2 et Olivier Jamoulle3 1 2


Équipe de recherche en soins de première ligne, CSSS Laval, Laval, Canada Family medicine and Emergency department, Faculty of Medicine, Université de Montréal, Montreal, Canada Pediatric department, CHU Sainte-Justine, Université de Montréal, Montreal, Canada

* Drawing on the work by Von Fragstein M, Silverman J, Cushing A et al. UK Consensus Statement on the content of communication curricula in undergraduate medical education. Medical Education 2008; 42: 1100-1107.


•  First  aim  of  the  tool   –  To  represent  (gather  in  one  tool/piece/glance?)  all   aspects  of  health  communica?on  in  the  medical   prac?ce   •  Not  only  the  doctor-­‐pa?ent  medical  encounter  

–  To  show  «  as  simply  as  possible  »  the  complexity   of  communica?on  issues  for  the  clinician  

The model: 4 Meta-categories   1.  Generic functions and dimensions of communication 2.  Medical interview fundamentals: • 

The Calgary-Cambridge Guides

3.  Medical interviews across the spectrum of clinical practices 4.  Medical communication: its many forms and expressions

Building  (crea?ng?)  a  case-­‐scenario  


Situation/Context •  Your Program Director asks you to prepare a communication skills teaching session for residents. •  During a recent survey, the residents from your program have identified they needed more training on breaking bad news.

Task You have decided to work on the (announcement?) diagnosis of genital herpes. Use the wheel to create: 1)  A simple case (medical student/clerk or junior resident) 2)  A complex case (senior resident) SPIN THE WHEEL 2X2!

Group Discussion   •  Sharing examples? •  Which part of the wheel did you change to raise the level of difficulty of the case? •  What is the utility of the wheel to create scenarios?


Teaching from a video


Wheel Use during Direct Observation •  Melissa is a resident in pediatrics (R4) at the ambulatory clinic of a pediatric university hospital. She is seeing a 5 year old boy with asthma for a follow-up visit after a ER visit. Compliance to treatment at home is an issue. •  You will watch the last part of the encounter with the mother to give Melissa feedback on her communication skills when explaining and planning the treatment and follow-up.      

Task 1)  Observe the interview 2) Use the communication wheel to structure/ prioritize your feedback to Melissa


Feedback to Melissa •  What  will  you  say  to  Melissa?     •  How  did  the  wheel  help  you?  Or  didn’t  help?  

Feedback to Melissa

Video Feedback  example  to  Melissa  

Context of care •  Relationship is influenced by: –  The nature of the problem and the chronicity –  The setting and the type of the consultation

•  Exemple: –  Acute and severe problem = « Expert-in-charge » –  Chronic and simple problem = « Facilitator »

Another Use of the Wheel •  To build a communication skills teaching curriculum for any residency program •  To follow the progress of the communication competency during the residency (from junior to senior) –  To define milestones (the expected ability in communication skills at each stage of expertise)

•  Appropriate tool to fit with new CanMEDS roles 2015 from the Royal College of Physicians and Surgeons of Canada

Communication Curriculum in a Pediatric Program •  R1 –  Calgary-Cambridge model and approach –  Children 0-5 years old and 6-12 years old –  ER, hospitalization unit

•  R2 –  Adolescents –  Specific populations –  IC unit

•  R3 –  Problematic situations (dealing with emotions…) –  Sensitive topics (intimacy issues…)

•  R4 –  Disclosing unexpected complications and errors

Integrating the communication wheel to teaching

Advantages and Limitations  

Use and Advantages   1.  Supervisor and learner Supervision tool !  Analysis grid ??? !  Shared vocabulary and conceptual framework !  Overlapping of different variables (age, gender, context of care...) !  Explicit curriculum for the learner !  Useful tool for the resident to prepare a teaching session with a video

Use and advantages 2.  Faculty Teaching tool !  Helps to create scenarios for teaching sessions and role plays !  Maps the communication skills

3.  Program director Curriculum guide !  Supports the development of a program curriculum for the communication competency !  Adjusts the communication skills to the program specificity

Limitations •  Descriptive model –  Doesn’t tell you how or what to teach

•  Easier to use in a clinical setting than to teach communication challenges between health professionals •  Doesn’t give justice to the complexity of all interactions a clinician faces –  But does do justice to a multitude of communication situations in practice

Conclusion   •  The communication wheel gives a structure for professional health communication teaching •  The wheel may helpful to build teaching session on communication skills •  The wheel helps to structure but doesn’t tell how to teach •  The wheel may hone intervention on communication feedback •  It allow to “play” with the different aspects of a case, it is a game changing tool.