Action Points: Communication & Consultation Skills

 Action Points for the Competency Rating Scales

  • Write entries having decided which competence(s) you are intending to cover and looked at the relevant word pictures so that you can enable your ES or CS to validate the entries easily and provide evidence for you.
  • Need to review in detail consultations, on your own, and / or with a peer to identify missed cues, (and what to do about these) missed opportunities to explore background and context (and suggest ways / words to discuss these) and episodes when consultation is circling, and ways to address / prevent this practice common disease explanations to non-medical friends primed to challenge the wording/ tone etc. These can be written up as professional conversations or clinical encounters depending whether you do these with others or alone.
  • You need to demonstrate you are consistently able to communicate verbally and in writing in patient computer records and your e-portfolio so that other people are very clear what you are thinking and planning. Take two patient records that you have made and reflect on how you have kept these useable for others and how they reflect your verbal communication skills.
  • Develop skills to really determine the impact of illness on the patient and their carers and finding out about the patient’s health beliefs. You need to consider how you can do all this in ten minutes. Strive to achieve excellent in this competence. Reflect on achievement of this against the excellent word picture on two occasions.
  • Consider how you have adjusted your communication skills to make patients, especially teenagers, feel more at ease when you are taking a sexual history and consider steps you could take to improve this further  (on at least 1 LLE).
  • Before the next ES meeting there should be three examples of learning log entries where communication with the patient of carers and 1-2 LLE with the team or other professionals) was highlighted. (Think  how you did this and what worked well as well as what you might change to improve this further)
  • You need to consider trying to speak more slowly. This will be important for the CSA exam. When you are practising for CSA ask the group members/facilitators specifically about the rate of your speech. Collect their feedback and include it as a LLE with your reflection on it. You are likely to benefit from doing this several times.
  • You need to ensure you are talking in English as much as possible throughout the day. Try to speak English at home, watch English television programmes, and speak to your children in English. Consider writing things in Word so that you can spell check and correct grammatical errors. The evidence for this will be in the quality of your written English on all your entries.
  • You need to look at time management within the consultation and aim to complete consultations in ten minutes. Look at video consultations with your trainer and on your own reflect on the learning from these (as well as the times it took for you to do the consultations. Identify what parts of the consultation you especially need to work on.
  • Join a CSA preparation group to help with communication and consultation skills.  You will then be able to write 2-3 LLE relating to the learning from these sessions in relation to consultation skills.
  • Consider role play during tutorials, joint surgeries, de-briefs to gain and own phrases you can use with patients to ensure you are understood. Reflect on this process in LLEs.
  • If you do not already have then get the RCGP Case Cards and practice explaining common diseases, conditions, investigations and procedures. You could try this with your CSA preparation group and in tutorials and with your Clinical Supervisor. Or with non-medical friends. Write some LLEs on their feedback about this.
  • Repeat PSQ in ST3 – 2 review period. Repeat MSF in ST2 – 3 review period.
  • You will be able to put consultations skills into practice with GP consultations again soon so you need to continue to reflect on this and the process of establishing concerns as part of helping people to clarify their needs. Will need further work on GP consultation timescales (though working on 15 at this stage is good)
  • Consider how to develop this skill in hospital posts and apply them to the particular patient populations in each post. Even though not part of the hospital routine it will help your patients if you understand their ICE ( and help you if you reflect on this in you LLEs)
  • Develop GP relevant consultation skills including exploration of ICE. Shared decision making and. Providing structure will be important. You will be able to demonstrate this through COT, but also in LLEs
  • Paediatrics next and you need to develop a strategy for communicating effectively with children. Please use the learning log to document how this goes initially and your plans to develop your skills.
  • You need to get Mini CEX done spaced over the post but otherwise continue this good progress. Don’t forget to keep your GP hat on whilst you are in hospital posts and keep thinking and documenting in your log how you will apply your skills in GP in the future.
  • You need to remember to use joint surgeries for CSA practice as well as COTs as COTS are quite proscriptive in their scoring and you need to develop ‘soft’ skills. You should document at least 3 joint surgeries through COT or as LLEs
  • Need to develop skills in identifying cues and sharing information and management plans, these are vital to develop into a rounded GP. You can reflect on this in  your clinical encounters as well as having this demonstrated in COTs
  • As in your PDP, you now need to focus on explanations, don’t spend too long on the patients agenda as though this is important, it is important to get to the end of the case and be able to show of the explanation and negotiation skills! Practice your explanations in front of a mirror or with non-medical friends. Document your learning from this as a LLE.
  • Be inquisitive, imagine a friend is telling you something – ask spontaneous questions to find out more, don’t just move on to the next question on your “medical” list – asking questions shows empathy and builds rapport especially if you use information you have heard earlier on.
  • Move things forward towards 10 minute consultations and their limitations and with a view to CSA – learn to mix ICE with more Doctor centred approach in this area for CSA;  a difficult balance.
  • Move to now look at more advanced techniques such as dealing with different sorts of patients and changing consultation  styles as appropriate, reflect on this at  least once in your e-P. We can discuss different ones and sources at your review
  • PSQ needs to be done in the next post please and reflect on patients’ feedback.
  • Need to further develop skills to be able to clearly explain to the patient the diagnosis/ likely nature of the problem and be clear when explaining the management (evidence this with LLE or COT or professional conversations.
  • Last review we looked at shared decision making and different forms of communication in GP e.g. triage – as moving to paediatrics think about how you communicate with children – body language as well as phrases- do an entry around this and think about 3 way conversations plan to the patient. Reflect ion these in your e-P
  • Add log entries that describe and discuss specific consultation skills used in real life consultations (as well as practice CSA cases).

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