Breaking bad news. ⢠Low literacy. ⢠Poverty... CONTEXTS OF CARE: ⢠Emergency room. ⢠Intensive care. ⢠Hospital short, long term. ⢠Outpatient clinic. ⢠Home.
Competence in professional communication: a developmental approach C Richard, M-T Lussier, O Jamoulle, S Galarneau, J Ayoub, J Dubois, F Lagarde, M Lefebvre, M-J Dupuis, A Boucher. Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Introduction: It is now widely accepted
that medical communication training should be rooted in clinical practice. Still, too many medical education initiatives in this domain remain theoretical and isolated from clinical activities. The objective of the University of Montreal Faculty of Medicine Communication Competency Working Group (CCWG) was to • Define the content of medical communication training during undergraduate and graduate medical studies • Determine the progression of communication skills and competencies from the start of medical school to the end of residency training
Methods: A group of medical educators from Results: The CCWG inspired by the “Communica-
tion Curriculum Wheel”6 representation developed by the UK Council produced a curricular map of all the possible forms and expressions of Health Communication as they occur during clinical activities. Our proposition builds on four metacategories: 1) Generic functions and dimensions of Health Communication 2) Medical interview fundamentals highlighting the Calgary-Cambridge Guides 3) Medical interviews covering the spectrum of clinical practice 4) Health Communication in its many forms and expressions We have enhanced our wheel by the addition of a suggested repertoire of doctor-patient relationships that take into account important clinical dimensions and contexts of care5. The wheel becomes a practical tool to create clinical cases that cover the communication metacategories.
family medicine/general practice, medical and surgical specialties (Radiology, Gynecology, Pediatrics, Oncology, Genetics, Community Health), communication experts, as well as a student representative, met regularly since 2007. Together, they developed a broad model of medical communication. To ensure coherence throughout the medical curriculum, the committee based their work on published research in the fields of communication as well as pedagogy, particularly on the publications of Kurtz, Silverman and Draper 1,2,3, Richard and Lussier 4,5 and von Fragstein et al.6 for the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education.
The possible transformations in the doctor-patient relationship: Type of relationship is influenced by problem characteristics A graphic representation of the possible transformations in the doctor-patient relationship along a “taking charge/collaboration” continuum. We associate the different relationships to two characteristics of the patient problem: the nature of the problem (acute versus chronic: the X axis) and the degree of severity (serious versus minor: the Y axis). The nature of the problem and its severity allows us to group together categories of problems and the care contexts in which they are most likely to be encountered (emergency room, hospitalization, appointment or walk-in clinic) and this permits us to suggest a dominant relationship.
INITIATING THE session
A PL
NN ING
CO S K NT INUOUS TAS SE S QU E K S NTIAL TA
OM IN M G UNIC PH YSI ATING CAL E XA M
PR O STR VID UC T
CLOS THE s ING e ss i on G& ININ EXPLA
Its Functions and Dimensions
RE BU LA
NG ERI TH TION GA M A
HEALTH Communication
R FO IN ING HIP ILD ONS TI
G IN RE U
C R U D
MEDICAL INTERVIEW FUNDAMENTALS: The CalGary-Cambridge guide
TERVI EW FUNDA
ALS
L IN
T N ME
MEDI CAL INTERVIEWS
OT HE R INT
S R O T ER L O C U
MEDIA HEALTH COMMUNICATION:
ITS MANY FORMS AND EXPRESSIONS
Discussion: This model has been approved by
our Faculty. It will serve both as a theoretical framework and a practical tool to guide undergraduate and residency program directors in the development of communication training programs. The flexibility of the model will allow
MEDIA • Face to face • Written (charts, reports) • Phone • Electronic (mail, internet,...) • Dictation • Public speaking • Videoconference
AG
SITUATIONS
DI ME CA
PRO BL E
IC AT
HEALTH COMMUNICATION
s n o i t a l u p
• Infant, parents • Preschool • School age • Adolescent • Young adult • Middle age • Old age
M
Other interlocutors • Family, caregivers • Legal tutors • Interpreters • Medical colleagues • Other professionals • Support staff • Students, Residents, Teachers • Legal and Administrative representative
IC patien F I C E tp P S o
Age and GENDER:
EA
SEN
R E N D GE N D
SITIVE TOPICS
CON TEXTS OF CARE
MEDICAL INTERVIEWS:
Specific patient populations:
• Mental health • Cognitive impairement • Pregnancy • HIV, STD • Terminal disease...
SENSITIVE TOPICS:
• Alcohol, drug abuse • Physical, psychological abuse • Sexual behavior • Sexual orientation ...
PROBLEMATIC SITUATIONS:
• Intense emotions • Uncertainty THE SPECTRUM OF • Risk CLINICAL PRACTICE • Breaking bad news • Low literacy • Poverty...
Contexts OF CARE:
• Emergency room • Intensive care • Hospital short, long term • Outpatient clinic • Home...
adaptation for each stage of training and the specific needs of medecine and surgery. The CCWG’s work will now focus on the communication skills competencies expected at different levels of medical training, the elaboration of educational activities and appropriate evaluation strategies.
References: 1. Kurtz, S, Silverman, J, Benson, J, Draper, J, Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary-Cambridge Guides, Academic Medicine: August 2003, Volume 78 (8) p 802809 2. Silverman J, Kurtz S, Draper J. Skills for communication with patients. 2e éd. Abingdon (U-K) : Éditions Radcliffe, 2005. 3. Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. 2e éd. Abingdon (U-K) : Éditions Radcliffe, 2005.
4. Lussier MT, Richard C. En l’absence de panacée universelle. Répertoire des relations médecin-patient. Canadian Family Physician 2008;54:1096-9. 5. von Fragstein M, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C, On behalf of the UK Council for Clinical Communication Skills Teaching in Undergraduate Medical Education. UK consensus statement on the content of communication curricula in undergraduate medical education. Medical Education 2008;42: 1100-7.
