Does the structure of the medical consultation align with an educational model of clinical communication? A study of physicians’ consultations from a postgraduate examination |
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| Institution: | 1. Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany;2. Institute for Medical Sociology & Rehabilitation Science, Charité – University Hospital Berlin, Berlin, Germany;3. Drug Commission of the German Medical Association, Berlin, Germany;4. Center for Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Germany;1. Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia;2. Pharmacy Department, Perth Children’s Hospital, Perth, Australia;3. Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia;4. Perioperative Medicine, Telethon Kids Institute, Perth Australia;5. Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia;6. Pharmacy Department, Sir Charles Gairdner Hospital, Nedlands, Australia;1. Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA;2. Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA;3. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA;1. Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;2. Faculty of Human Sciences and Faculty of Medicine, Graduate School GROW – Gerontological Research on Well-being, University of Cologne, Cologne, Germany;3. Division of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany;4. Federal Centre of Health Education, Cologne, Germany;5. Department of Pediatrics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany;1. Patient Education and Counseling, Oslo, Norway;2. Department of Communication, Texas A&M University, College Station, TX, United States;1. College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA;2. Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA;3. Department of Sociology and Anthropology, Southern Oregon University, Ashland, OR, USA |
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| Abstract: | ObjectiveThis study examined whether the structure of consultations in which physicians were tasked with sharing information corresponded to the chronological stages proposed by an established educational model of clinical communication.MethodSeventy six simulated consultations from a postgraduate examination for general medical hospital physicians were transcribed verbatim and converted into diagrams showing consultation structure. All doctor-patient/relative talk was allocated into six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing, using the ‘communication process skills’ from the Calgary-Cambridge Guide to the Medical Interview.ResultsThe majority of consultations included four or five of the expected phases, with most talk (41–92%) in Explanation and Planning. There was no discernible consistency of structure across the consultations or in consultations from the same scenario. Consultations varied in the presence, sequential order, size, location and reappearance of phases.ConclusionsThe structure of consultations in this standardised setting bore little resemblance to the chronological order of phases predicted by an educational model.Practice implicationsEducational guidance and interventions to support patients in preparing for consultations need to take account of doctors’ behaviour in practice. Assumptions about the organisation of medical consultations should be queried in the absence of an evidence base. |
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| Keywords: | Consultation structure Calgary-Cambridge Guide Patient-centred communication Patient autonomy Clinical communication Medical education Postgraduate assessment |
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