FINAL YEAR OSCE REVIEW

SESSION
“COMMUNICATION SKILLS”
BY Dr. Hazel Laws & Community Health Team
 OBJECTIVES

By the end of this session you would

have:
1. Revised the correct approach to the
communication skills station of the
OSCE
2. Practiced / honed your own
communication skills
 METHODOLOGY
PART 1
Discussion about the communication skills station of the
OSCE

PART 2

Practical session using triads to hone your

communication skills
 COMMUNICATION SKILLS
 Your communication skills are basic skills that are
important
 They are important because they help you conduct
successful medical interviews
 This improves patient satisfaction & outcome
 CONSULTATION MODELS

 Differentmodels have been developed and used to aid

doctor – patient communication
CONSULTATION MODEL OF INTEREST

The model of interest:

1. The Calgary- Cambridge model/ approach to
communication skills teaching; By Kurtz & Silverman
(1996)
The Calgary Cambridge Framework- the structural elements /parts
of the medical interview include:

1. Initiating the Session

2. Gathering Information–[ This depends on the task]
3. (Physical examination)
4. Explanation & Planning- [This depends on the task]
5. Closing the Session
Running throughout the interview
6. Building of the doctor - patient relationship
7. Providing Structure to the interview
 COMMUNICATION SKILLS

The outlined framework may be modified

by the particular

“communication task”
 COMMUNICATION SKILLS
At the communication skills station you will be provided
with the following:

1. Instructions / “Communication Task”

to be completed in

 7 minutes
 (There is usually a bell at the 5 minutes mark – indicating that you
have two minutes remaining)
 OSCE – Seven possible types of
“Communication Tasks”

1. Conduct a focused history and physical exam

2. Provide patient information/ counsel patient

3. Break bad news

 OSCE – Seven possible types of
“Communication Tasks”

4. Obtain informed consent

5. Communicate with a difficult patient

( Communicate with difficult colleagues)

6. Obtain advanced directives

7. Discuss medical error

 Communication Skills Station
 Read the instructions / communication task carefully

 Modify your approach accordingly – decide what points

you must cover as you interact with patient

 Complete task in 7 minutes

 You will hear a bell at the five (5) minutes mark to

indicate that you have two (2)minutes remaining
 Communication Skills Station

Pay particular attention to the following

elements of the interview:

 The start of the interview / Initiating the Session

- Start well !

 The end of the interview / Closing the Session

- End well !
 Communication Skills Station
 Communication Tasks:

1. Breaking bad news

2. Counseling

(Always read the OCSE question /

communication task carefully! )
 Communication task:
“Breaking Bad News”
“Bad news is any news that drastically and
negatively affects the patient’s view of his or her future .” (
R. Buckman)
 Ptacek and Ederhardt defined bad news as information
that, “........ results in a cognitive, behavioural or emotional
deficit in the person receiving the news that persists for
sometime after the news is received.”

(Lancet 2004; 363: 312-319)

 What is “bad news” ?
Bad news is stereotypically associated with
terminal diagnoses :
o Diagnosis of cancer or its recurrence (stated
by patients as the most likely example of bad
news)
o HIV/ AIDS when the test is +
o Traumatic deaths
Other diseases that fall in the ‘bad news’ category

o Chronic diseases – arthritis, DM, heart disease

o Psychiatric illnesses – schizophrenia, bipolar disorder

o Paediatrics- congenital deafness or heart disease

o Ophthalmology – iritis, glaucoma, blindness

o Cardiology – coronary artery disease, CCF

o And the list continues............

 Breaking Bad News

 Is an unpleasant task

 We are often fearful of patients’ / relatives’ reaction to

the news

 We are often uncertain about dealing with the intense

emotions that may be triggered by the news

 Your patients will always judge your performance

 How to break bad news –
Preparation for the Consultation
 Bad news must be transmitted in person, not over
the phone; schedule an appointment
 Ensure protected time, turn off all telephones; do not
appear to be rushed
 The setting must be private and comfortable
 Prepare emotionally
 Be conversant with all the relevant facts pertaining to
the case/ disease; read the notes; get all the facts
before you start
BBN Consultation – Communication Process

Introduction
 Greet patient appropriately, ensure comfort

 Enquire if patient would like spouse, relative or friend to

participate to provide support

 Establish and maintain rapport

 How to break bad news –
The consultation Process

1. Find the patient’s starting point:

 Ask what they know already

o Ask about the tests / investigations that were done –

elicit patient’s understanding of the reason for the tests

o Explain the significance of the tests

NB: Ask ….before you tell

 How to break bad news –
The consultation Process
2. Provide structure to the consultation: as you gently
break the news:
 Break the news in stages – diagnosis, implications,
treatment options, prognosis and if appropriate be
reassuring
3. A warning shot is sometimes helpful: “ The results are
not as good as we would like…..”
 How to break bad news –
The consultation Process
4. Through observation/ enquiry, find out how much
details the patient wants
o look for all the cues (body language)
o “Do you want to leave it for now?”

5. Use simple language; try to avoid / explain medical

jargon
6. Allow for silence, tears and other emotional reactions
 How to break bad news –
The consultation Process
7. Explore patient’s response to the results :

o Ask about/ explore the fears, the concerns and

emotions and deal with them appropriately

8. Be empathetic, display empathy;

9. Provide opportunities for questions – discuss the

patient’s concerns
 How to break bad news –
The consultation Process
10. Observe patient and see how he/she

is coping

11. Discuss the management / way forward ( if appropriate

at this time) or schedule follow up

12. Summarize the main points & remember ‘safety-netting’

13. The patient may need further counseling

14. Follow up appointment

 Breaking Bad News (BBN)

 As you prepare for this exam develop a mental

check- list of the points that you must cover when
“breaking bad news” to a patient

 What will this mental check-list look like?

Develop a Mental Checklist for BBN

 1.
 2.
 3.
 4.
 5.
 6.
 7.
8
 Communication task:
“Counseling”
 You can be given a patient who has:

 An unhealthy lifestyle - (diet rich with refined sugars)

 An unhealthy habit - like smoking, drinking too much
alcohol.

 Diabetes and needs to know more about ‘self management’ &

compliance

 You can be asked to counsel such patients !

 Communication task:
“Counseling”

1. You may be asked to counsel a patient

regarding behavior change /modification

2. You may be asked to counsel a patient / give

advice about a particular medical condition
or lifestyle practice
 Communication task:
“Counseling”

 Howdo you approach the task

of counseling?
 Communication task: Counseling
Introduction
 Greet the patient politely, introduce self
& establish rapport

 Confirm reason for the visit; and

ascertain data regarding patient’s
problems and concerns
Communication task: Counseling
Gathering Information
 Find out what the patient knows or does not know
about the health issue/ disease of concern
 Enquire about previous medical history
 Enquire about self management practices & lifestyle
practices (explore patient’s compliance)
 Discuss current behaviors that facilitate poor health
outcomes (unhealthy habits)
 Communication task: Counseling
Explore the following (if applicable):

 Determine patient’s attitude regarding disease (nonchalant,

focused, or disciplined)

 Enquire and explore the patient’s concerns, fears, feelings

 Discuss previous behavior change attempts

 Give accurate and appropriate (technical) information

 Use simple language

Communication task: Counseling
Behavior Change
 Find out how committed the individual is to
change : is the patient ready to address the health issue
now or some time in the future

 Design with the client, a plan for change/

addressing the health issue including:
 Time frame: when will patient start ?
 How to replace the undesirable behavior with a healthier
alternative? (Discuss & negotiate with patient)
 How to deal with possible barriers to change?
 Communication task: Counseling
Behavior Change

 Agree on strategies to support the required

behavior change including:
 Rewards?

 possible support mechanisms or people and support

groups

 ways of dealing with lapses

Communication task: Counseling
 Discuss the next step – consider the patient’s opinions &
negotiate the plan of action

 Get patient’s feedback

 Confirm action plan with patient

 Summarize
 Schedule appropriate follow up visit
 Counseling

 As you prepare for this exam develop a mental check- list

with the points that you must cover when counseling a
patient

 What will this mental check-list look like?

 Develop a Mental Checklist for Counseling
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Practice / Practice/Practice
 You can excel in your
communication skills station by
practicing
 GOOD LUCK!!
 “You may never know what results come of
your action, but if you do nothing, there will be
no result.”

By Mahatma Gandhi
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“Success is the sum of small efforts repeated day in and
day out.”

By Robert Collier
Part 2 - Practical Session
 Part 2 - Practical Session
Divide into groups of three (triads) whereby:
 One student will be the candidate/ student

 One student will act out the patient role

 One student will be the observer providing feedback

 (Students will switch roles each round)

 Part 2 - Practical Session

 We are asking your cooperation in

returning all the material we are
going to use for this practical session.
 We utilize these case scenarios twice
per year
 References
1. Breitsameter C. Medical decision –making and
communication of risks: an ethical perspective. J Med Ethics
2010;36:349- 352
 Recommended Reading
1. Gordon Geoffrey. Defining the Skills Underlying
Communication Competence. Seminars in Medical Practice;
Vol. 5, No. 3 september 2002