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Developing Consulting Skills: some ideas

Here are a few ideas and tools which we can use to develop our skills of consulting with patients. They may be useful for GP Registrars, medical students, GPs and health care workers who wish to improve their consulting.

I have made a few suggestions for how these tools can be used, but individual Educators and learners may find other ways of using them to enhance their consultation skills. You can view and download each file by clicking on the hyperlink, and then edit and modify as needed according to the particular learning needs of individual learners.

I have used gender-neutral pronouns ‘ze, zir, zirs, zirself’ rather than ‘he/she, him/her, etc.’

Consultation Navigation Tool 1

Consultation Navigation Tool This is a tool for helping Registrars to consult in a structured way. It shows a navigation path for the consultation, emphasising the importance of gathering all relevant information first, before 'crossing the bridge' and discussing management. By following this consultation structure, the doctor avoids looping back and forth between gathering data and discussing management. The consultation is more focussed, the patient is more involved, and it is quicker. Note that in the first half of the consultation, the information can be gathered in whatever order seems appropriate, and not necessarily in the order written. For example, if a patient has a rash it may be appropriate to examine first and then ask questions.

Some GP Registrars have found it helpful to laminate this Navigation Tool and place it on zir consulting desk as an aide-memoir during consultations.

It can also be used to facilitate analysis of consultations on video, and aid discussion of alternative pathways through a particular consultation.

Here is a version in Chinese

Consultation Analysis Tool This is a tool which we can use to analyse parts of the consultation. In the first column, write down some actual words that we hear the doctor say, for example. “How are you sleeping?”

In the second column, write an analysis, for example, ‘history, explanation, open question, closed question, statement, verbal echo, summarising, discussing options, etc’.

In the third column, write I if the comment relates to Information Gathering.

In the fourth column, write M if it relates to Management and Planning.

We can then note the structure of the consultation, whether it moves smoothly from 'Gathering Information' to 'Management Planning' or whether there is looping back and forth. We can discuss with the Registrar what happened, and consider alternative phrases for any areas that ze wishes to develop.

Some Consultation Microskills This is a list of microskills that GP Educators may wish to discuss with Registrars and students to help them enhance their consultation skills, particularly during the stage of Gathering Information. Perhaps start by identifying which skills the learner already uses, then discuss which one ze would like to learn. It is useful to practise the skill during a tutorial, with the Educator being the 'patient' and enabling the Registrar or student to do a 'mini-skills practice' using the chosen microskill. Such 'mini-practice' may last only 10 seconds, and enables the student to feel confident about using the new technique during a real consultation.

Prezi presentation of Consultation Navigation Tool and Microskills This presentation shows each part of the Consultation Navigation Tool, and then describes several microskills.

List of Phrases during Consultations If the learner has difficulty with a particular part of the consultation, ze may wish to consider using one of these phrases. Each person can find a phrase that ze feels comfortable using, perhaps by trying out a few of the phrases on the list with zir Educational Supervisor or clinical teacher, then with patients.

Some Ideas about Active Listening This is a list of some ideas which enhance active listening during consultations. There is also a list of some common reasons which reduce active listening. GP Edcuators may wish to discuss these with their Registrar or student, perhaps trying some of the ideas during a tutorial, then with patients.

Some Ideas about Consulting This collates some ideas about consulting, and developing personal consulting skills. There are some suggestions about aspects of language and word order.

Consulting Cycle

The Consulting Cycle is a graphical representation of the cyclical nature of consulting, showing how the patient processes what occurred during the consultation, decides what to do in zir own context, and starts from a different viewpoint during the next consultation. The doctor, too, has learned something about the patient, zirself and about consulting, so has the opportunity to consult differently next time.

Consulting Cycle

The table mirrors the graphical representation, and has more details, whilst the diagram more clearly shows the cyclical process.

Prezi presentation of Consultation Models This maps various Consultation Models onto a grid which describes each model according to its degree of doctor/patient centeredness, and according to whether it describes mainly tasks or behaviours. An example model from each quadrant is described in more detail. (Based on an original idea on the website of The Essential Handbook for GP Training and Education).

Damian Kenny is a Community Education Advisor for Gloucestershire, part of the team of GP Educators of the Severn School of Primary Care.

This Website is to offer ideas only, and has no official standing. It is continually updated, and I welcome comments, corrections and ideas for future development.

Please contact me via email Damian Kenny