Damian Kenny's Web Site: Consulting

Developing Consulting Skills, Facilitating and Teaching Skills: some ideas

Here are a few ideas and tools which we can use to develop our skills of consulting with patients. They may be useful for GP Registrars, GPs and health care workers who wish to improve their consulting skills.

I have assumed some knowledge and experience of consulting, and these ideas build on standard principles. For those new to consulting, the COG-Connect model developed by Bristol Medical School effectively and beautifully describes the sequence of stages of a typical consultation.

Included here are also ideas which may be useful for GP Educational Supervisors and other Educationalists who are facilitating groups or teaching consulting skills, either face-to-face or remotely.

I have made a few suggestions for how these tools can be used, but individual Educators and learners may find other ways of using them to enhance their consulting skills. You can view and download each file by clicking on the hyperlink, and then edit and modify as needed according to the particular learning needs of individual learners.

I have used gender-neutral pronouns ‘ze, zir, zirs, zirself’ rather than ‘he/she, him/her, etc.’

Some Ideas for Developing Consulting Skills

Consultation Navigation Tool Page 1

Consultation Navigation Tool This is a tool for helping clinicians to consult in a structured way. It shows a navigation path for the consultation, emphasizing the importance of gathering all relevant information first, before 'crossing the bridge' and discussing management. By following this consultation structure, the clinician avoids looping back and forth between gathering information and discussing management. The consultation is more focused, the patient is more involved, and it is quicker. Note that in the first half of the consultation, the information can be gathered in whatever order seems appropriate, and not necessarily in the order written. For example, if a patient has a rash it may be appropriate to examine first and then ask questions.

Some GP Registrars have found it helpful to laminate this Navigation Tool and place it on the desk or wall as an aide-memoir while consulting.

It can also be used to facilitate analysis of consultations on video, and aid discussion of alternative pathways through a particular consultation.

Here is a version in Chinese

Consultation Analysis Tool This is a tool which we can use to analyze parts of the consultation. In the first column, write down some actual words that we hear the clinician say, for example. “How are you sleeping?”

In the second column, write an analysis, for example, ‘history, explanation, open question, closed question, statement, verbal echo, summarizing, discussing options, etc’.

In the third column, write I if the comment relates to Information Gathering.

In the fourth column, write M if it relates to Management and Planning.

We can then note the structure of the consultation, whether it moves smoothly from 'Gathering Information' to 'Discussing Management' or whether there is looping back and forth. We can discuss with the consulter what happened, and consider alternative phrases for any areas that we wish to develop.

Some Consultation Micro-skills This is a list of Micro-skills that GP Educators may wish to discuss with Registrars and students to help them enhance their consulting skills, particularly during the stage of 'Gathering Information'. Perhaps start by identifying which skills the learner already uses, then discuss which one ze would like to learn. It is useful to practise the skill during a tutorial, with the Educator being the 'patient' and enabling the Registrar or student to do a 'mini-skills practice' using the chosen Micro-skill. Such 'mini-practice' may last only 10 seconds, and enables the student to feel confident about using the new technique during a real consultation.

This presentation shows each part of the Consultation Navigation Tool, and then describes several Micro-skills:

Consulting Remotely: some ideas Here are some ideas about consulting skills that are particularly relevant when we are consulting remotely, either by telephone or video. Included are some ideas about the non-verbal aspects of voice, using verbal 'receipts' and summaries, and managing silences. There are also some suggestions for ways of practising to enhance skills of showing empathy using words and tone of voice.

Consultation Reflections Form We can use this form to focus our self-observations and reflections immediately after consulting. If we decide to learn a ‘skill of the day’, we can focus on this single consulting skill, practise between patients, and with patients, and become fluent. We can then choose a different consulting skill to focus on.

List of Phrases when Consulting If the learner has difficulty with a particular part of the consultation, ze may wish to consider using one of these phrases. Each person can find a phrase that ze feels comfortable using, perhaps by trying out a few of the phrases on the list with zir Educational Supervisor or clinical teacher, then with patients.

Some Ideas about Active Listening Here are some ideas which enhance active listening while consulting. There is also a list of some common reasons which reduce active listening. GP Educators may wish to discuss these with Registrars and students, perhaps trying some of the ideas during a tutorial, then with patients.

Consulting Behaviours and Personality Types This handout adds some ideas about consulting when the patient and doctor have differing personalities. There are some suggestions about aspects of language and word order, including some ideas about preventing and managing potential conflict during the consultation.

Some Ideas about using pronouns when Consulting This collates some ideas about how pronouns affect aspects of consulting (and other types of communication). There are ideas about using "you" to keep focused on the patient, rather than a third party, and some notes about gender pronouns.

Some Ideas about Teaching Consulting Skills This collates some ideas about teaching consulting skills. It includes ideas about language, and some ideas for Educators who are helping colleagues develop their consulting skills.

The Consulting Cycle is a graphical representation of the cyclical nature of consulting, showing how the patient processes what occurred during the consultation, decides what to do in zir own context, and starts from a different viewpoint during the next consultation. The doctor, too, has learned something about the patient, about zirself and about consulting, and so has the opportunity to consult differently next time.

Consulting Cycle Graphic
Consulting Cycle Graphic

The table mirrors the graphical representation, and has more details, whilst the diagram more clearly shows the cyclical process.

Prezi presentation of The Consulting Cycle demonstrating the Consulting Cycle step by step:

Here is a Prezi presentation which maps various Consultation Models onto a grid which describes each model according to its degree of doctor/patient-centeredness, and according to whether it describes mainly tasks or behaviours. An example model from each quadrant is described in more detail. (Based on an original idea on the website of The Essential Handbook for GP Training and Education).