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OSCE Communication Skills

Louise Murray

Aims & Objectives

What the core curriculum says about communication skills

Communication skills for all OSCE stations Last years OSCE station

Common topics: complaints, counselling, breaking bad news

Summary & questions

What the core curriculum says..

In your dealings with patients, their relatives, and other health care workers, you should:

Understand the psychological and personal impact of illness, disability or sudden death and be able to communicate sensitively with patients and relatives

Understand the principles of handling aggression and act appropriately

Take a supportive role with senior staff in breaking bad news Understand the principles of bereavement counselling Explain basic procedures to patients simply and comprehensively, checking that the patient has understood and allowing the patient to ask questions

General communication skills for all OSCE stations

Youve all done OSCEs before

Introduction, smile, be confident Set the scene

Ideas, concerns, expectations

Summarise, check understanding Thank the patient Offer follow up if appropriate

Last years OSCE station

You are a FY1 on a Care of the Elderly ward. One of your patients, Stanley Smith, was declared nil by mouth due to dysphagia, pending a SALT assessment. Unfortunately there was a miscommunication and Stanley was allowed to eat a sandwich. He aspirated and developed a pneumonia. Stanleys niece, Anita, would like to speak to you about this. Firstly she is very upset that he was deprived of food and drink. She overheard one of the nurses telling a colleague about the mistake and is quite angry that this has happened and nobody has told her about it.

Complaints

E.g drug error, delay in procedure

Establish who you are talking to and how you can help Allow them to talk and vent their anger. Acknowledge this Encourage them to speak, ask open questions, empathise Apologise for the mistake Explain what will happen next i.e to resolve the situation If the patient/relative remains unhappy with your apology and explanation, explain that they can talk to a more senior doctor/nurse or PALS if they wish

Avoid: raising voice, blaming others, making unrealistic promises

Counselling

E.g explaining a procedure such as OGD/colonoscopy, AAA counselling, blood transfusion, C Diff/MRSA, AF + warfarin
Find out what the patient already knows, and what they want to

know Offer information in manageable chunks, avoid jargon Check understanding as you go You could use diagrams Offer written information

AF + warfarin counselling

Check knowledge of AF, explain what it is Explain need for anticoagulant (i.e stroke risk in certain individuals) Check knowledge of warfarin Explain bleeding risk and need to monitor INR Importance of compliance Avoid certain drugs, always check with Dr/pharmacist Alcohol, contact sports Yellow book: record of appointments Summarise, check understanding, written info, follow up

Breaking bad news

E.g poor prognosis, DNACPR

Preparation: Know the facts, ensure privacy and quiet place to talk Find out what the patient/relatives already know Do they want more information? Give a warning shot: Im afraid things look more serious than we first thought. Allow a pause, then break the news. Avoid jargon. Allow denial Explain, listen to concerns Encourage ventilation of feelings: I can tell that was quite a shock for you Summarise Explain what will happen next Offer support/further information/meeting with family

Summary

Practice, practice, practice Importance of a good introduction Always explore the patients ICE Space for questions and future plans

+ Any questions?