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)’.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Difficult doctor-patient relationships – describes methods for managing difficult relationships that involves acknowledging the problem, setting boundaries, using additional communication skills, and bringing in extra resources
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