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

Table 1: Communication Skills and Medical Interviewing

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 interviewAs aboveAs above
2. Establishes and maintains relationshipsApproaches such as PEARLS: (Partnership, Empathy, Apology, Respect, Legitimization, Support)As aboveAs above
3. Manages time and flow of interactionAs aboveEnhanced
4. Opens discussionAs aboveAs above
5. Gathers informationInitiation by open-ended questions followed by clarifying questions utilizing appropriate transitionsAs above

Develops as system based knowledge increases
As above

6. Explores patient’s perspectiveApproaches such as FIFE: (Feelings/fears, ideas, function, expectations)As aboveAs above
7. Shares information/provides educationApproaches such as ISDM: (informed shared decision making).Partial/limitedEnhanced
8. Reaches agreement/establishes consensus for management planPartial/limitedEnhanced
9. Summarizes and closes interactionAs aboveAs above
II. Components of the health history
A. Screening health historyComprehensive clinical methodKurtz, 2003.As aboveAs above
B. Focused health history
a) System specific
b) Psychosocial For all:
a) initial screen questions
b) follow-up detailed screen
1. alcoholKern, 2005.As aboveAs above
2. anxietyKern, 2005.As aboveAs above
3. depressionKern, 2005.As aboveAs above
4. domestic violenceKern, 2005. also Chang, 2005. As aboveAs above
5. health-related behavioursKern, 2005.As aboveAs above
6. low health literacyKern, 2005.As aboveAs above
7. post-traumatic stressKern, 2005.As aboveAs above
8. sexual historyKern, 2005.As aboveAs above
9. somatiform disordersKern, 2005.As aboveAs above
III. Advanced Communication and Medical Interviewing SkillsComprehensive clinical methodKurtz, 2003.
1. Advanced DirectiveTulsky, 2005.As above
2. Communicating RiskEdwards, 2002.As above
3. Medical ErrorHebert, 2001.As above
4. Challenging physician-patient relationship – boundary issuesWhite, 2004.As above
5. Culturally-safe communicationUlrey, 2001.As above
6. Breaking bad newsBuckman, 1992.As aboveAs above
7. Health promotionKurtz, 2003.As aboveAs above
8. Language barrierPutsch, 1985.
IV. Medical Recording and Reporting
A. Oral case presentationAs above
Develops as system based knowledge increases
B. Written medical recordProblem-oriented medical record
Weed, 1968.
As above
Develops as system based knowledge increases
Enhanced by comprehensive management plans
V. Interprofessional CommunicationIntroduction to, and awareness of collaborative practice and necessary interprofessional communication skillsEnhanced through exposure to, and participation with interprofessional and collaborative practice