Download Communication skills for OSCE - the Royal College of Obstetricians

Communication Skills for the
OSCE
J. A. Mark Broadbent
RCOG Revision Course
January 2012
© Royal College of Obstetricians and Gynaecologists
Communication:
• Is the activity of conveying meaningful
information
• Requires:
– a sender – you
– a message – the clinical scenario
– an intended recipient – the examiner/role
player
Why Is Communication Important?
• At Work
– Effective communication is essential in caring for patients
– However, continues to be problematic
– Majority of complaints/litigation reflect failure of effective
communication
• During Examinations
– If you cannot communicate you will not pass the exam
Barriers to Effective Communication
in Clinical Practice
• Patients disclose only 40% of
concerns due to:
Fears
Beliefs
Difficulties
Barriers to Effective Communication
in Exams
Fear
Lack of knowledge
Communication:
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Non-verbal
Visual
Oral
Written
Communication Comprise
• 55%
• 38%
• 7%
body language
tone of voice
content of word
Mehrabian, (1971), Silent Messages
Communication
“…when conveying emotion, if body language,
tone of voice, and words disagree,then body
language and tone of voice will be believed
more than words…”
Debunking the 55%, 38%, 7% rule, Judith
Pearson (2006)
Non-verbal Communication
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Eye contact
Gesture
Touch
Body language
Facial Expression
Posture
Personal Space
Dress Code
At Each OSCE Station
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Be confident
Don’t hesitate
Be assured
Smile
Introduce yourself by number to examiner
Introduce yourself by name to role player
Practice with friends/colleagues
Visual Communication
• Primarily associated with two dimensional
images:
• Signs
• Drawings
• Illustrations
During OSCE
• Use pad of paper to draw diagrams/visual
illustrations
• This can break tension if stalling verbally
• Mimics performance in clinical practice that
might help to get you back on track
Oral Communication
• Primarily relates to spoken verbal
communication
• Typically relies on:
– Words
– Visual aids
– Non-verbal elements
Oral Communication:
Speech (Para-language)
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•
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•
Voice quality
Emotion
Speaking style
Prosodic features
– Rhythm
– Intonation
– Stress
During OSCE Exam
• Speak clearly
• Speak slowly
• Examiner and role player must be able to hear
and understand you
• Body language must be appropriate to
situation
Preparation for OSCE Exam
• Make use of observer stations and note good
and poor practice
• Practice with friends/colleagues
• You will be videoed during one of the OSCE
stations
Examiner Stations
• Candidate number
• Examiner usually leads not you
• Examiner will ask you structured
questions
• Examiner will not enter into a
discussion
Role Player Stations
• Why is the role player important?
• Ignore the examiner
– They are instructed not to communicate
• There may be a male role player
Role Player Stations
• Remember you are leading the clinical
scenario
– Introduce yourself
– Check the correct patient/name
– A good lead in is to enquire as to what they
know of the clinical scenario
– Sympathy/Empathy and pitfalls
Definition of Sympathy
• “an emotional affinity in which whatever
affects one correspondingly affects another” –
synonym is pity
• Translation from Greek – “to suffer together”
Definition of Empathy
• From Greek – “to suffer with”
• Often characterised as the ability to “put
oneself into another’s shoes”
• Or experiencing the outlook or emotions of
another being within oneself
• “the imaginative, intellectual and emotional
participation in another person’s experience”
(Bennett, 1972)
Difference Between
Sympathy and Empathy
• Sympathy: I am sorry for your loss.What can I do to
help you during this difficult time?
• Sympathy: A doctor may feel sympathy and
understand a patient’s illness and try to alleviate the
pain, but they may not feel his/her distress and pain.
Difference Between
Sympathy and Empathy
• Empathy: I feel and understand your pain; my
grandmother passed away last year as well.
• Empathy: A cancer support group can
empathise with the radiation therapy of a
member and understand his/her fear because
they have experienced the procedure as well.
Difference Between
Sympathy and Empathy
• “In empathy, one attends to the feelings of
another; in sympathy one attends to the
suffering of another, but the feeling’s are one’s
own”
• The difference is neither the degree nor the
subject of concern: it is whose perspective
that is being assumed
Disadvantages of Sympathy
• Sympathy is insensitive to difference therefore can
be inaccurate and may impede effective
communication
• In the face of difference sympathy can be patronising
– people with different thoughts and views from you
may feel they are being disvalued
• This can breed defensiveness
• Sympathy helps perpetuate the assumption of
similarity
Relevance to OSCE
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Be caring
Listen
Offer support
Offer reassurance
Body language
Eye contact
Dress Code:
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First impressions
Professional
Smart
Comfortable
Labels on sleeves
Honeymonster syndrome
Dress Code
X
Dress Code
X
Dress Code
X
Dress Code
X
Dress Code:
• Smart
• Professional
• Comfortable
Practice in Front of a
Mirror or Colleague
Clinical Knowledge
• No substitute for clinical knowledge
• Up to date with guidelines
– Royal College
– National (NICE)
Answer
The
Question