Transcript Communication Skills for CASC

Communication Skills for
CASC
Meinou Simmons
ST5 Child and Adolescent Psychiatry
Facilitator in Communication Skills,
Cambridge Clinical School
Summary
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Theoretical model
Structuring the interview
Specific skills-verbal and non verbal
Practical tips and exercises
Theoretical model
 Calgary--Cambridge model.
Reference: Skills for Communicating
with patients 2nd edn. (2005) J
Silverman, S Kurtz, J Draper.
Structuring the interview
Initiating the Session
• preparation
• establishing initial rapport
• identifying the reason(s) for the consultation
Gathering information
Providing
• exploration of the patient’s problems to discover the:
Structure
 biomedical perspective
• making
organisation
overt
Building the
relationship
 the patient’s perspective
 background information - context
•
using
appropriate
non-verbal
behaviour
•
developing
rapport
•
involving
the patient
Physical examination
• attending to
flow
Explanation and planning
• providing the correct amount and type of information
• aiding accurate recall and understanding
• achieving a shared understanding: incorporating the patient’s
illness framework
• planning: shared decision making
Closing the Session
• ensuring appropriate point of closure
• forward planning
Structuring
 Forward planning and timing
 What do I need to cover i.e. Pass/fail
items e.g. risk
 How much time for each section?
‘Impressionist’ not perfectionist
approach
Example
 Gather the history of this 17 year old
girl who has missed 5 periods and
has lost weight recently.
 Jot down key structuring areas
Structuring skills:
Initiating an interview
 Preparation. Names: yours and
theirs (plan intro statement)
 First impressions = most marks!
 Establishment initial rapport: respect,
role explanation, listening to
opening statement…
 Negotiates parallel agendas. What
takes precedence?...in dementia...in
mania..
Structuring skills
 Active use of signposting. ‘We have just
talked about mood, I would now like to talk
about your eating if that’s ok with you.’
 Use of ‘chunking and checking’ to break
up. ‘Can I just check the details about your
sleep before we move on.’
 Negotiating timings. There’s a lot to get
through now. Do you mind if we just
concentrate on…
Structuring skills
 Use of summarising. ‘Can I check
I’ve got what you’ve told me is right
now. Stop me if I don’t get it right..’
 Use of screening. ‘You’ve told me
about your recent low mood. Has
anything else been bothering you?
Practice structuring skills with
example
 Interview a 25 year old mother with
low mood following birth of new baby.
Baby now 3/12 old.
Communication skills-non verbal
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Eye contact
Facial expression
Posture: crossed arms, writing
Position, movement
Vocal cues: rate, volume, intonation
Communication Skills-verbal
 Open questions.. ‘Tell me about…your
mood.’ (What
about...mania...cognitive impairment)
 Open to closed CONES
 Sequencing of questions
Communication skills-facilitative
response
Encouragement ‘yes’ ‘I see’
Use of silence
Repetition or echoing
Paraphrasing ‘it sounds as if you’re
very worried about letting him down’
 Sharing your thoughts. ‘Sometimes
depression can be brought on by
stress. I wondered if you felt this may
be true for you.’ (depersonalise)
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Closing
 Forward planning: Contracting and
safety netting (how to seek help if
needed)
 End summary and final checking.
 Avoid final panics and ‘everything in
kitchen sink’ approach..
 Remember final impression important
too!
How can I improve?
 Practice, practice, practice.
 As many observed interviews. Use
Consultants, nurses, SpRs. Ask them
for feedback.
 Work in pairs/3s on CASC scenarios
 Watch video clips
 Read about skills
 Use WPBAs. Focus on PROCESS
rather than content.