Consultation Skills Toolbox

The GPSA consultation skills toolbox is a repository of useful references and resources for the development of consultation skills.

It has been developed for use by:

 

The toolbox is divided into four sections:

  • The consultation
  • Consultation models
  • Consultation skills
  • Challenging consultations
The primary resources in this toolbox are the GPSA consultation skills teaching plans. 
References and other resources referred to in the teaching plans are not duplicated in the toolbox.
For a broad overview of the teaching consultations skills, have a look at this webinar recording (right).
Another practical resource we recommend is the 2014 AFP article Consultation skill tips for new GP registrars.
It is recognised that International Medical Graduates (IMGs) may have specific learning needs in consultation skill development. For specific consultation skill tools and resources for IMGs, download the IMG guide or view the GPSA online resource ‘Supervising International Medical Graduates (IMGs)’.
At the heart of general practice is the consultation, the means by which GPs deliver best practice care. In its simplest form, the consultation is the sharing of information between patient and doctor, to develop both a common understanding and a plan of management.
Consultation skills encompass communication skills, but also skills such as relationship building, identifying agendas, shared decision-making, time management and follow-up. Development of consultation skills is a fundamental element of Australian general practice training.

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Understanding common pitfalls in the consultation can be very useful to guide teaching and learning.
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In this video, Dr Andy Morgan discusses common pitfalls in consultations.
There have been a number of formal models of the consultation described in the international literature. Consultation models can be used as a framework to teach registrars about the importance of a structured, patient-centred and safe consultation.

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In this video, Dr Simon Hay gives an overview of some of the key models for the GP consultation and some practical advice on assessing the registrar undertaking a consultation.
Further reading:

Neighbours Model
 
 
 
Neighbour’s model proposed that the general practice consultation is ‘a journey, not a destination’, and described five ‘checkpoints’ along the way.
  • Connecting: Have we got rapport?
  • Summarising: Do I know why the patient that has come today?
  • Handing over: – Have we agreed on a management plan?
  • Safety netting: – Have I covered the ‘what ifs’?
  • Housekeeping: – Am I in good shape for the next patient?
  • Neighbour R. The Inner Consultation: how to develop an effective and intuitive consulting style. 2nd ed. Oxford: Radcliffe Medical Press; 2004
The Calgary Cambridge Model incorporates the physical, psychological and social aspects of the consultation. In addition to its five stages, there are two ‘threads’ that run throughout the consultation.

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Ron Roth, a GP supervisor from Victoria, has developed his own model as discussed in this recent journal article published in the AJGP (2022): A new framework for teaching the art of general practice consultation to registrars and supervised doctors.
He presents his model in this GPSA webinar.
Registrars often struggle to facilitate an effective, organised, and time-efficient consultation with their patients.

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A critical first step in the consultation is to connect with the patient and establish a relationship. This includes building rapport and limiting use of the computer.
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Effective communication is an essential skill in general practice consultations. There is strong evidence linking good communication with improved outcomes for both patients and doctors.
The ‘art of communication’ has been described as applying the most appropriate skills to suit each unique patient-doctor interaction.
         


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Further reading:
RACGP gplearning Communication skills module
Gathering data comprises the skills of effective history taking and physical examination.

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Undifferentiated presentations are very common in general practice and establishing a pathological diagnosis is often not a realistic goal. Management of uncertainty of both diagnosis and management is an essential skill for general practitioners.

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In this video, Simon Morgan and Justin Coleman discuss some practical strategies to support registrars to better manage anxiety.

Further reading:

Patient-centred care can be regarded as where ‘the provider tries to enter the patient’s world to see illness through the patient’s eyes’. Common elements of patient-centred care include informing and involving patients; eliciting and respecting patient preferences; engaging patients and sharing decisions in management planning; and continuity of care.

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Cultural competence is defined as ‘the development of awareness and respect for differences in social structure and culture, and acknowledgement of the impacts of these on health and wellness beliefs and ability to engage with health services’. Cultural competence is a core aspect of safe general practice.

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In this video, Karen Nicholls discusses an approach to providing culturally safe care to Aboriginal and Torres Strait Islander patients.

 

Further reading:

Clinical reasoning has been defined as ‘the sum of thinking and decision-making processes associated with practice … it enables practitioners to take … the best judged action in a specific context.’ It is a core element of high-quality general practice. Clinical reasoning encompasses skills in effective data gathering (history, examination and investigation); data synthesis and interpretation; communication; managing uncertainty; patient-centred care, and evidence-based medicine. 
In this video, Simon Morgan explores clinical reasoning in the general practice training setting.
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Further reading:
Risk communication is an essential part of shared decision making and evidence-based patient choice.

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In this brief video, Dr Simon Morgan gives some tips about teaching risk communication.

Medical professionalism is regarded as one of the core factors in providing high-quality patient care. Professionalism is closely associated with improvements in doctor-patient relationships, patient satisfaction, and healthcare outcomes.

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In this video, Justin Coleman and Simon Morgan discuss teaching and learning professional and ethical practice in general practice.
Further reading:

Preventive healthcare is a core aspect of many consultations. It includes the prevention of illness, screening activities for the early detection of specific disease, and the promotion and maintenance of health. Preventive health is particularly important in addressing the health disparities faced by disadvantaged population groups, like Aboriginal and Torres Strait Islander people.

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Effective health education involves the provision of accurate, timely, evidence-based, quality health information to patients, taking into account sociocultural factors and their level of health literacy. Two core skills for effective delivery of health education are brief intervention and motivational interviewing. 

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Counselling is a common element of the general practice consultation.

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Non-rational testing, and/or over-testing, is increasingly recognised as an important issue in health care. Rational use of investigations is one of the core skills of Australian general practice training and previous research has demonstrated that this is a challenging area for GP registrars.

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Rational prescribing is ‘the judicious, appropriate, safe and efficacious use of medicines’, and is known to be a challenging area for GP registrars.

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Management planning is a core aspect of the effective and safe consultation.

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The basis of effective continuity of care in general practice is appropriate patient follow up. Safety netting is a key element of follow-up to ensure patient safety and help manage uncertainty.

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Maintaining good quality medical records is a core aspect of good quality practice.

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Recognising one’s limitations and appropriate help-seeking is a core general practice skill, and a fundamental aspect of safe practice and effective learning.

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In this video, Gerard Ingham discusses the call for help list.
Further reading:

Time management in the general practice environment is particularly challenging, where every clinical assessment is required to be sufficiently comprehensive in scope to manage the presenting issues and exclude potentially serious causes, but also time efficient in order to meet patient demand. Time management is a core consulting skill but one that can take some time to develop.

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Telehealth, using either phone or video technology, has increased significantly over recent years as a result of the COVID-19 pandemic. Telehealth consultations can be particularly challenging for IMG doctors as they require high level oral language skills to compensate for unavailability of non-verbal clues.

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In this video, Simon Morgan discusses how to assess the registrar undertaking a telehealth consultation.

Further reading:


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Date reviewed: 19 April 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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