Table 1: Communication Skills and Medical Interviewing

Element	Technique(s)	Evidence	Pre-Clerkship	Clerkship
I. Foundational Skills for Effective Physician-Patient Communication and Clinical Interviewing:	As described by a variety of models of effective patient-physician communication including: Bayer, Calgary Cambridge, Macy Model, The Kalamazoo Consensus Statement.	Kalamazoo Consensus Statement; Patient-centred Method literature.	All elements with exception of 7 and 8 are preclerkship skills.	Enhancement of all foundational skills and development of 7 and 8.
1. Prepares for interview			As above	As above
2. Establishes and maintains relationships	Approaches such as PEARLS: (Partnership, Empathy, Apology, Respect, Legitimization, Support)		As above	As above
3. Manages time and flow of interaction			As above	Enhanced
4. Opens discussion			As above	As above
5. Gathers information	Initiation by open-ended questions followed by clarifying questions utilizing appropriate transitions		As above Develops as system based knowledge increases	As above Enhanced
6. Explores patient’s perspective	Approaches such as FIFE: (Feelings/fears, ideas, function, expectations)		As above	As above
7. Shares information/provides education	Approaches such as ISDM: (informed shared decision making).		Partial/limited	Enhanced
8. Reaches agreement/establishes consensus for management plan			Partial/limited	Enhanced
9. Summarizes and closes interaction			As above	As above
II. Components of the health history
A. Screening health history	Comprehensive clinical method	Kurtz, 2003.	As above	As above
B. Focused health history
a) System specific
b) Psychosocial	For all: a) initial screen questions b) follow-up detailed screen
1. alcohol		Kern, 2005.	As above	As above
2. anxiety		Kern, 2005.	As above	As above
3. depression		Kern, 2005.	As above	As above
4. domestic violence		Kern, 2005. also Chang, 2005.	As above	As above
5. health-related behaviours		Kern, 2005.	As above	As above
6. low health literacy		Kern, 2005.	As above	As above
7. post-traumatic stress		Kern, 2005.	As above	As above
8. sexual history		Kern, 2005.	As above	As above
9. somatiform disorders		Kern, 2005.	As above	As above
III. Advanced Communication and Medical Interviewing Skills	Comprehensive clinical method	Kurtz, 2003.
1. Advanced Directive		Tulsky, 2005.		As above
2. Communicating Risk		Edwards, 2002.		As above
3. Medical Error		Hebert, 2001.		As above
4. Challenging physician-patient relationship – boundary issues		White, 2004.		As above
5. Culturally-safe communication		Ulrey, 2001.		As above
6. Breaking bad news		Buckman, 1992.	As above	As above
7. Health promotion		Kurtz, 2003.	As above	As above
8. Language barrier		Putsch, 1985.
IV. Medical Recording and Reporting
A. Oral case presentation			As above Develops as system based knowledge increases	Enhanced
B. Written medical record	Problem-oriented medical record Weed, 1968.		As above Develops as system based knowledge increases	Enhanced by comprehensive management plans
V. Interprofessional Communication			Introduction to, and awareness of collaborative practice and necessary interprofessional communication skills	Enhanced through exposure to, and participation with interprofessional and collaborative practice

References

Buckman R, Kason Y. How to break bad news : a guide for health-care professionals. London: Papermac; 1992.
Chang JC, et al. Asking about intimate partner violence: advice from female survivors to health care providers. Patient Educ.Couns. 2005 Nov;59(2):141-147.
Edwards A, et al. Explaining risks: turning numerical data into meaningful pictures. BMJ 2002 Apr 6;324(7341):827-830.
Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad.Med. 2001 Apr;76(4):390-393.
Hebert PC, et al. Bioethics for clinicians: 23. Disclosure of medical error. CMAJ 2001 Feb 20;164(4):509-513.
Hurst JW, Walker HK. The problem-oriented system. New York: Medcom; 1972.
Kern DE, et al. Teaching the psychosocial aspects of care in the clinical setting: practical recommendations. Acad.Med. 2005 Jan;80(1):8-20.
Kurtz S, et al. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad.Med. 2003 Aug;78(8):802-809.
Putsch RW,3rd. Cross-cultural communication. The special case of interpreters in health care. JAMA 1985 Dec 20;254(23):3344-3348.
Tulsky JA. Beyond advance directives: importance of communication skills at the end of life. JAMA 2005 Jul 20;294(3):359-365.
Ulrey KL, Amason P. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. Health Commun. 2001;13(4):449-463.
Weed LL. Medical records that guide and teach. N.Engl.J.Med. 1968 Mar 14;278(11):593-600.
White GE. Setting and maintaining professional role boundaries: an educational strategy. Med.Educ. 2004 Aug;38(8):903-910.

AFMC National Clinical Skills Working Group Evidence-Based Clinical Skills Document

Table 1: Communication Skills and Medical Interviewing