Teaching Tips & Tools - Communicator Strategies

Communicator

Issues with this CanMEDS role centre around challenges with communication with patients and, for the purposes of this guide, communication skills in general.  Some FLAGS to be aware of include:

  • Frequent misunderstandings or miscommunications noted
  • Missed information during patient encounters
  • Trouble expressing thoughts and ideas, apparent knowledge deficits
  • Lack of expression or improper use of tone
  • Strained relationships (with patients/with colleagues)
  • Poor written communications

CanMEDS Coaching

A number of non-medical expert CanMEDS roles can be addressed through one of our qualified CanMEDS coaches, who specialize in one-on-one consulting with resident around issues in communication, collaboration, and professionalism. To request access to a CanMEDS coach, contact the PGME office. Learners on formal remediation have priority access to coaching. 

Strategies

In addition to coaching, click on the below topics for some strategies in addressing the following:

  1. General Presentation Skills

    Harvard Manage Mentor: Through the AHS Insite portal under My Learning, learners have access to a number of online modules called the “Harvard Manage Mentor”, one of which is on general “Presentation Skills”. Learners can access any of these e-learning modules at any time.

    ToastMasters Club: The Toastmasters is a not-for profit organization aimed at helping people practice their public speaking skills, and could help with developing confidence. The generally meet weekly. Visit the Toastmaters site to find events in Calgary.

    VIDEO/AUDIO Recording: It is often difficult for a learner to observe oneself, and understand feedback around communication, while in action so there is great value in video or audio recording interactions for later review and discussion. The Medical Skills Centre has access to training spaces and can arrange standardized patient sessions.

    VIDEO/AUDIO Recording Extension: To foster insight, the resident can do and initial self-assessment analysis first prior to reviewing with the preceptor. Then, preceptor can add input afterwards and stimulate discussion around the differences in their perceptions on the interaction. Consider using an assessment tool such as a Mini-CEX to guide self-assessment and discussion around communication skills, then the learner and preceptor can compare their ratings and discuss differences in ratings.

  1. Patient-Centred Communication

    CMPA Good Practices Guide: The Good Practices Guide are a series on online modules covering a wide variety of CanMEDS topics. Under the “Communication” module, there is a section on patient-centred communication. That the learner could review.

    Calgary-Cambridge Guide: Have the learner reviewing the Calgary-Cambridge guide in advance and then schedule a time to discuss/review the guide with a mentor or coach. The learner will identify their own strengths and weaknesses with respect to the guide in their own patient encounters and identify areas for improvement. Have then, based on areas needing improvement, have the learner create their own “cheat sheet” or “checklist” for themselves in how to approach patient encounters.

  1. Conciseness, Appropriateness, and Accuracy of Information

    Framework-based Communication: Learners should be given, identify, or find a communication framework to follow (i.e. SOAP). When gathering patient information, the learners should get in the habit of writing down gathered information and organizing it in a structured way for presentation. Then, when presenting, practice framework to communication about patients in an organized manner.

    “In Your Own Words” and “Highlighter” Exercise: Learners should review of old patient notes and identify/highlight pertinent positives (i.e. in yellow) and negatives (i.e. in blue) and develop their own written summary of the note within a short paragraph. Upon follow-up, the resident should add succinctly to the patient note with a plan.

    Modifying Case Presentations: Have the learner practice (with a coach or mentor) two presentations regarding the same patient. One presentation should consider the TEAM as the audience, while the other should consider the PATIENT and FAMILY as the audience. Discuses and reflect on how the information shared and how it is conveyed changes when communicating to different audiences.

    Timed Case Summaries: The purpose of this activity is to promote efficiency in delivering patient information during hand-over and admissions and focus on the prioritization of patients when delivering patient information. Focus on prioritizing patients – i.e. critical first, complex second, simple last and timing of the hand-over: time spent on the patient indicates their level of criticality/complexity (i.e. give rough times for presenting cases for each category – i.e. 1-2 minutes critical/complex, 30 seconds for simple cases.

  1. Breaking Bad News and Empathy

    Reading and Reflective Assignment: Review a relevant article or module in communicating difficult news (such as the SPIKES framework). Then, take a moment to consider a previous challenging encounter in delivering difficult news and then try to re-write a dialogue following a recommended framework or advice from the literature. Take the time to anticipate future conversations and consider writing short notes or a script for yourself in how to approach this situation. Anticipate the patients and family’s reactions and how you would respond.

    Reverse Observation Exercise: Watch a role-modeled demonstration of delivering news & identify characteristics of the conversation that make this an example of good compassionate communication. Maintain a “communication log” or “field note” around your own patient communication/interactions and try to highlight strengths and challenges with the interaction. Compare and contrast observed communication practices to your own style.

    Write a Patient Story: Have the learner develop their own case or story around a patient, and write the story from the perspective and voice of the patient themselves to stimulate empathy and understanding.

  1. Dictations

    “Mock Dictation” Case review:  Residents will review a case with their preceptor however report the case like a mock dictation. The resident can be asked to create, or be provided with, a standard dictation protocol. The preceptor will not interrupt during the “dictation” but will ask for clarifying questions afterwards should any important information have been missed. Once these are identified, the resident will attempt the dictation again, incorporating the new information into their summary.

  1. Written Communications

    AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops through My Learning Link related to the roles and responsibilities of a healthcare professional. Through this, an online course called “Business Communication” focuses on clear and concise written communication such as e-mail communication.

    CMPA eLearning: The CMPA offers a number of e-learning modules focusing on appropriate documentation, confidentiality and consent, and negligence. These would be good modules for the learner to review.

    Writing Support: The University of Calgary offers a number of workshops around writing support through the student success centre. Residents are able to access workshops and seminars, for a listing visit the Writing Support website.

  1. Non-Verbal Communication Skills

    AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops through My Learning Link related to the roles and responsibilities of a healthcare professional. A workshop called “Communication Cornerstone – Back to Basics” focuses on interpersonal communication skills as well as being more clear and concise.

    Video Review Exercise: The resident could be asked to find and review some clinical teaching videos online demonstrating good and exaggerations of bad communication, taking particular note of the body language used during strained communication. They could then write comparison assignment noting which characteristics they might demonstrate in their own communication, which can be previewed with a coach or mentor, and reflect on how this communication style can be perceived negatively by others. Check the resource page for a list of video resources.

    VIDEO/AUDIO Recording: It is often difficult for a learner to observe oneself, and understand feedback around communication, while in action so there is great value in video or audio recording interactions for later review and discussion. The Medical Skills Centre has access to training spaces and can arrange standardized patient sessions.

  1. Effective Handovers, Organized Clinical Presentation Skills

    CMPA Good Practices Guide: The Good Practices Guide are a series on online modules covering a wide variety of CanMEDS topics. Under the “Teams” module has a number of sections focusing on teamwork. Additionally, the “Communication” module has a section on “Team Communication”.

    Framework-based Communication: Learners should be given, identify, or find a communication framework to follow (i.e. SOAP). When gathering patient information, the learners should get in the habit of writing down gathered information and organizing it in a structured way for presentation. Then, when presenting, practice framework to communication about patients in an organized manner.

    “Highlighter” Exercise: Before handovers, learners should review patient notes with a highlighter identify/highlight pertinent information to disclose. The learner will develop from scratch their own written summary of the note within a short paragraph to use to guide their handover presentation.

    Timed Case Summaries: The purpose of this activity is to promote efficiency in delivering patient information during hand-over and admissions and focus on the prioritization of patients when delivering patient information. Focus on prioritizing patients – i.e. critical first, complex second, simple last and timing of the hand-over: time spent on the patient indicates their level of criticality/complexity (i.e. give rough times for presenting cases for each category – i.e. 1-2 minutes critical/complex, 30 seconds for simple cases.

Assessment

There are a number of tools available for the assessment of the Medical Expert Competency such as:

  • Field notes or Encounter Cards
  • Consultation Letter Rating Scale
  • OSCE (Observed Structured Clinical Examinations) & Simulated Patients
  • ITERs (In-Training Evaluation Reports)
  • Multisource Feedback (i.e. 360-Evaluations, Patient Surveys)
  • Structured Oral Examinations (SOEs)
  • Communications Checklist (like the Calgary-Cambridge Guide)
  • The Mini-CEX (Clinical Evaluation Exercise)

Please refer to the “CanMEDS Teaching and Assessment Tools Guide” and the “CanMEDS Assessment Tools Handbook” for a comprehensive list, as well as access to tools. A sample of some of the guide is available online. A full copy of the guide can be obtained here.

Resources

The following are some specific resources that have been helpful in the remediation of Communication Skills:

  1. The Calgary-Cambridge Guide to the Medical Interview
  2. DocCom Healthcare Communication Videos
  3. The “SHARED” Communication Framework
  4. The UK Foundation Program Mini-CEX Guidance for Assessors
  5. CMPA Good Practices Guide Modules
  6. The Mind-Tools Toolkit features a number of useful resources
  7. Hofstede’s Cultural Dimensions

***To contribute ideas and grow this resource, PLEASE CONSIDER MAKING SUGGESTIONS pdassist@ucalgary.ca***