Key communication skills and how to acquire them
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7366.697 (Published 28 September 2002) Cite this as: BMJ 2002;325:697
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Evidence and the self-evident
After ten years working in medical communication, the banality of
much of the research still stops me in my tracks. Maguire and
Pitceathly's list of "key skills"1, for all the lucidity with which it is
set forward, and for all the research effort that has generated it over
the years, has more than a hint of bathos about it.
So then: eye contact matters. Also summarising information,
prioritising it, checking understanding, clarifying, exploring, not
interrupting... All true, but no more than the stuff of basic teacher-
training, for generations past. In my experience, most doctors have no
problem in recognising it as obvious. Just think of the opportunity costs
of demonstrating the common-sensical in this way.
But I should declare an interest, or at least a set of
preconceptions. The facts-taken-for-granted at the outset of any research
endeavour vary from discipline to discipline: I have originally a
Humanities background, and in my research world, this kind of thing is now
familiar beyond the point of cliche. Most of the advice we associate
today with "patient-centredness", or the very similar "student
centredness" has its origins in, for example, the progressivist2 movement
of the early 1900s, and is implicit in Rousseau3. And after all, when it
comes to the question of analysing the effects of communication on an
audience, we all sound like pale echoes of Aristotle, Cicero, Quintilian.
Incidentally, Maguire and Pitceathly concentrate explicitly on
results from process/outcome research, though much of this is narrowly
behaviourist. The limitations of this kind of skills-based approach to
communication, and the need rather to call on deeper parts of our being,
are well-enough set out by Aristotle4:
It is not true....that the personal goodness revealed by the speaker
contributes nothing to his powers of persuasion; on the contrary, his
character may almost be called the most effective means of persuasion he
possesses.
Quintilian too talks of "a good man skilled at speaking"5. This is
something which doctors, like everyone else, might remember.
1 Maguire P, Pitceathly C. Key communication skills and how to
acquire them. BMJ 2002: 325; 697-700.
2 Dewey J. The child and the curriculum (1902), in Boydston, JA ed. The
collected works of John Dewey, 1882-1953. Carbondale and Edmondsville:
Southern Illinois University Press. 1969-1991, Middle works 2:273-291.
3 Rousseau JJ. Emile (1762), Bloom A tr. London: Penguin 1991.
4 Aristotle. Rhetoric (350BCE), Roberts, WR tr. In The works of Aristotle
Ross WD ed. Oxford: Clarendon. 1924
5 Quintilian The education of the orator (Institutio oratoria) (c90CE),
Russell DA ed. and tr. Cambridge, Mass: Harvard University Press. 2001.
Competing interests: No competing interests
Dear Editor,
It is indeed timely that you devote a whole issue, and this article
in particular, to the key communication skills that have actually been
shown to make a difference in patient outcomes. Whilst much is known about
"what" skills are required and "why" this is so, there is far less
material on the "how to's", the actual underlying processes that excellent
communicators utilise daily.
The field of Neuro-linguistic Programming (NLP)has long had a
pragmatic approach to modelling and teaching the structure (i.e. the how
to's) of effective communication. Building on the evidence base of the
Calgary-Cambridge Model (1), I have mapped across the key NLP skills to
each of the five phases of the consultation. The resulting book,
Consulting with NLP (2), was recently published by Radcliffe Medical Press
in August. Filled with practical skills based exercises I believe
(naturally!) that it provides an additional, complementary approach to the
acquisition of the kind of "bread and butter" skills referred to in this
article. Many of the approaches can be easily utilised by an individual
studying on their own, and equally well in small and larger groups.
NLP has modelled skills such as empathy, showing not only their
underlying structure, but also how, in a series of fairly simple
exercises, it is a highly teachable and learnable skill. Beliefs and
expectations also have both a cognitive stucture and a non-verbal
behavioural expression, the understanding of which will allow you to more
easily elicit your patients concerns, and to frame your responses and
information giving in a way that fits their perspective. Both patient AND
doctor satisfaction are eminently worthwhile goals to aim for.
Good, clear communication, within a climate of rapport-building
skills and empathy, underpinned by attention to beliefs and expectations
is a sine-qua-non of the effective doctor, regardless of clinical
specialty.
Lewis Walker.
(1) Silverman J, Kurtz S, and Draper J (1998) Skills for
Communicating with Patients. Radcliffe Medical Press
(2) Walker L (2002) Consulting with NLP : neuro-linguistic programming in
the medical consultation. Radcliffe Medical Press
Competing interests: No competing interests
Teaching communication skills in small groups
Editor-Maguire and Pitceathly described a range of methods for
delivering effective training in communication skills. By coincidence we
ran the first in a series of workshops "Communication Skills for
Established GP Principals" seven days after publication, employing similar
techniques.
Provision of training in communication skills is well established for
General Practice Registrars and General Practice Vocational Trainers in
the West of Scotland. However as Continuing Professional Development
advisers in the West of Scotland we were aware that there was no formal
training in communication and consultation skills for General
Practitioners outwith these groups. Interest in this area has increased
through the impending introduction of the appraisal process in Scotland,
which will assess communication skills as a key competency of general
practice.Our aim for the course was to improve communication and
consulting skills, and it was designed to give participants the
opportunity to examine these skills in a facilitated small group of their
peers.
Some pre-course reading was required. The group meets for two full day
sessions, two months apart, with a final session three months later. They
are asked to prepare a video of a single consultation prior to session two
and a tape with five consultations prior to the final meeting.
Session one was spent establishing small groups, discussing communication
skills, initially in general, then specifically in the general practice
consultation. Time was spent discussing the importance of feedback and how
this should be delivered, and feedback techniques were practiced looking
at the tutor's video. At session two participants showed the video they
had prepared and received feedback from the group, the tutor facilitating
this process and acting as a resource to ensure that essential educational
messages are covered. The final session will allow participants to receive
feedback either individually or in the the group depending on their
preference.
Sessions one and two have already taken place. Evaluation has been
positive, in particular participants have enjoyed learning as part of a
cohesive small group.
Maguire and Pitceathly questioned whether residential courses teaching
consultation skills were more effective than a series of workshops.
Evaluation of this initiative may offer some clarification.
Competing interests:
None declared
Competing interests: No competing interests