Consultation Skills Toolbox

The GPSA consultation toolbox is a repository of useful references and resources for GP supervisors to teach consultation skills.

 

 
The toolbox is divided into three sections:
A. Consultation models
B. Consultation skills
C. Challenging consultations

Consultation Models

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.
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.

icon-stop

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.

Consultation Skills

Consultation skills can be considered as the range of skills that underpin the effective doctor-patient encounter. Like any skill, they need to be taught and learnt, and it should not be assumed that they will develop otherwise. This is an important task for the GP supervisor.

Structuring the consultation
Registrars often struggle to facilitate an effective, organised, and time-efficient consultation with their patients.

Connecting and building the doctor-patient relationship
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.

Communicating effectively
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. In this video, Simon Morgan and Jess Wrigley discuss how to teach consultation skills using the Kalamazoo Consensus Statement
Further reading:

Gathering data
Gathering data comprises the skills of effective history taking and physical examination.

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

Providing patient-centred care
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.

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

Clinical reasoning
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.
Further reading / resources:

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

Providing preventive health care
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.

Motivational interviewing
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. 

Counselling
Counselling is a common element of the general practice consultation.

Rational test ordering
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.

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

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

Follow-up and safety netting
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.
Closing the consultation: Language examples
GPSA teaching plan: Follow Up and Safety Netting
2009 BJGP. Diagnostic safety-netting

Documentation
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.
Closing the consultation: Language examples
GPSA teaching plan: Follow Up and Safety Netting
2009 BJGP. Diagnostic safety-netting

Recognising limitations
Recognising one’s limitations and appropriate help-seeking is a core general practice skill, and a fundamental aspect of safe practice and effective learning.
In this video, Gerard Ingham discusses the call for help list.
Further reading:

Managing time
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.

Challenging Consultations

There are many potentially challenging consultations in general practice that require specific consultation or communication skills. Some consultations may be particularly challenging for IMGs due to cultural and other factors. 

Breaking bad news

Adolescent health

Alcohol and other drugs

Mental health

Sexual health

Saying no

Angry patient

Intimate partner violence

‘Heartsink’ patients

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

General teaching tips and resources

Date reviewed: 13 September 2023

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.

This website uses cookies. Read our privacy policy.

Contact

GPTA Ltd t/as GP Supervision Australia

PO Box 787 Gisborne Vic 3437
Level 40/140 William Street Melbourne Vic 3000

Mail admin@gpsa.org.au
T: 03 9607 8590

Follow us

 
© GPSA 2023. All Rights Reserved.