Calgary-Cambridge Guide Research Articles

Application of the Calgary-Cambridge Guide in the training of nurse-patient relationship for practice nurses

Objective To explore the effects of the Calgary-Cambridge Guide training for practice nurses in promoting the nurse-patient relationship .Methods Totals of 52 practice nurses in our hospital from June 2012 to December 2012 were selected and randomly divided into the experimental group （ 25 cases ） and the control group （27 cases）.Communication skills training based on the Calgary-Cambridge Guide was applied in the experimental group, while the general training materials were distributed in the control group .Nurse-patient relationship was assessed with the trust scale and the Calgary-Cambridge Guide Scale .Results After the training , the scores of respect, consistency, the authority of knowledge and technology , the sense of security and the confidence in the future of the experimental group were （3.65 ±0.45）,（3.68 ±0.58）,（3.62 ±0.51）, （3.81 ±0.45） and （3.67 ±0.64）, which were significantly higher than the scores before the training （t =-2.664,-2.712,-2.435,-3.429,-3.431, respectively;P〈0.05）.The scores of respect, consistency, the sense of security in the experimental group were significantly higher than those of the control group after the training （ t=2.560, 2.513, 2.231, respectively;P 〈0.05 ）.The general score and the scores of eight dimensions of Calgary-Cambridge were significantly higher than those before （P〈0.05）.The general score and the scores of eight dimensions of Calgary-Cambridge of the experimental group were significantly higher than those of the control group （P〈0.05）.Conclusions The nurse-patient communication skills training based on the Calgary-Cambridge Guide can effectively improve the communication skills of practice nurses , and promote the nurse-patient relationship . Key words: Calgary-Cambridge Guide; Practice nurses; Nurse-patient communication; Skill training

Standardised clients as assessors in a veterinary communication OSCE: a reliability and validity study

In human medicine, standardised patients (SP) have been shown to reliably and accurately assess learners’ communication performance in high-stakes certification Objective Structured Clinical Examinations (OSCE), offering a feasible way to...

Resident physicians’ attitudes and confidence in communicating with patients: A pilot study at a Japanese university hospital

ObjectiveThis study aimed to explore the relationships among physicians’ confidence in conducting medical interviews, their attitudes toward the patient–physician relationship, and undergraduate training in communication skills among resident physicians in Japan. MethodsParticipants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary–Cambridge Guide. Additionally, participants’ attitudes toward the patient–physician relationship (Patient–Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. ResultsThe internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. ConclusionThese scales could be useful tools to measure physicians’ confidence and attitudes in communicating with patients and to explore their changes through medical education. Practice implicationsResidency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment.

Mandatory communication training of all employees with patient contact

In 2010 a communication program that included mandatory communication skills training for all employees with patient contact was developed and launched at a large regional hospital in Denmark. ObjectiveWe describe the communication program, the implementation process, and the initial assessment of the process to date. MethodThe cornerstone of the program is a communication course based on the Calgary Cambridge Guide and on the experiences of several efficacy and effectiveness studies conducted at the same hospital. The specific elements of the program are described in steps and a preliminary assessment based on feedback from the departments will be presented. ResultsThe elements of the communication program are as follows: (1) education of trainers; (2) courses for health professionals employed in clinical departments; (3) education of new staff; (4) courses for health professionals in service departments; and (5) maintenance of communication skills.Thus far, 70 of 86 staff have become certified trainers and 17 of 18 departments have been included in the program. Conclusion and practice implicationsEven though the communication program is resource-intensive and competes with several other development projects in the clinical departments, the experiences of the staff and the managers are positive and the program continues as planned.

Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview

ObjectivesTo investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor–patient consultation, based on the Calgary-Cambridge guide to...

A critical approach to the development of blended medical communication training materials

Effective communication between doctors and patients improves patient health outcomes (Hewett et al. 2009; Stewart 1995; Watson et al. 2012), and communication skills courses have become an integrated component of the medical curriculum. However, language-discordant contexts are not fully provided for yet, since “[l]anguage support guides (such as the Calgary-Cambridge guides; Silverman et al. 2005) generally target native speakers rather than language learners, and typically mention the use of a second or foreign language as just one of many issues in cross-cultural communication without providing any solutions or prescriptions to address ensuing communication problems” (Gasiorek and Van de Poel 2012:372). In a South African professional healthcare context, communication challenges are manifold because of the number of languages and cultures involved and because of the diverse views on the nature of a medical encounter. South African public healthcare is further hampered by a lack of doctors (KZN Department of Health 2013). Given the need for tailored communication materials, a new vocational training course in Afrikaans as a second language was introduced for first-year medical students at one South African university applying a blended learning approach (i.e. restricted contact teaching and autonomous online learning). To facilitate the development and implementation process, the European project Medics on the Move (MoM) was adapted and adopted as a communication tool. This paper addresses principles and practices underlying the MoM materials as part of the process of adapting the vocational training concept to the specific South African context, needs and learners. The development process is presented as an integral part of a comprehensive needs analysis (Brown 1995), at the end of which new questions and needs are identified. The results corroborate that MoM-SA is a dynamic and effective teaching/learning tool which functions as a language support system that helps build skills for a multilingual professional environment.

Effect of Shanghai's standardized training of residents on the history taking mode of physicians

Objective To evaluate the needs of performing a standardized communication skill training program for residents according to the differences in history taking mode of residents with different degrees and before and after the standardized training in Shanghai Changhai Hospital in 2010.Methods History taking modes of 81 residents in 2010 before and after the standardized training in Shanghai Changhai hospital were categorized.History taking modes were classified into:no effectiveness mode,traditional mode,disease-sickness mode and Calgary-Cambridge Guide mode.Distribution differences of history taking mode of residents with different medical degrees were analyzed by Fisher exact probability method (α =0.05).Distribution differences of history taking mode of residents before and after standardized training were analyzed by Pearson x2 test (α =0.05).Results 19.8％ residents took no effectiveness mode,53.0％ took traditional mode and 27.2％ used disease-sickness mode.There were significant differences in history taking modes among residents with different medical degrees (P =0.008).After training,history taking modes of residents were significantly changed (P=0.001),only 1.2％ residents used no effectiveness mode,59.3％ used traditional mode and 34.6％ used disease-sickness mode.But residents using the Calgary-Cambridge mode were not increased.Conclusions There are significant differences in history taking modes among residents with different medical degrees.History taking mode of residents changed after standardized training.But some of the residents still use non-optimal history taking modes; therefore a standardized communication skill training program might be needed in the future. Key words: History taking; Standardized training of resident physicians; Communication skills ; Medical education; Evaluation

Nonverbal Communication in a Caribbean Medical School: “Touch Is a Touchy Issue”

Background: The heath communication curriculum at the Trinidad campus of the University of the West Indies was developed out of practices advocated in large Western countries. Many students and tutors observed that the nonverbal skills advocated in these approaches did not fit the complex cultural dynamics of the Caribbean. Purpose: A study was developed to understand the problems Caribbean students faced with these nonverbal communication practices. Methods: Thirty-six students representing different Caribbean territories were randomly selected from the two compulsory communication skills courses: Communication Skills for Health Personnel and Communication Skills for the Health Professions class list. These students participated in 4 focus group discussions (FGD). The FGD questions were formulated on the nonverbal skills advanced in the Calgary–Cambridge Guide to the doctor–patient interview. Results: The findings supported the view that recommended nonverbal skills were in conflict with expected doctor–patient behavior in different Caribbean territories. Students felt that nonverbal communication needed to be treated with greater cultural sensitivity. Conclusions: These findings stimulated changes to the health communication program. This article identifies changes made to the communication skills program in response to cultural difference.

Do communication training programs improve students’ communication skills? - a follow-up study

BackgroundAlthough it is taken for granted that history-taking and communication skills are learnable, this learning process should be confirmed by rigorous studies, such as randomized pre- and post-comparisons. The purpose of this paper is to analyse whether a communication course measurably improves the communicative competence of third-year medical students at a German medical school and whether technical or emotional aspects of communication changed differently.MethodA sample of 32 randomly selected students performed an interview with a simulated patient before the communication course (pre-intervention) and a second interview after the course (post-intervention), using the Calgary-Cambridge Observation Guide (CCOG) to assess history taking ability.ResultsOn average, the students improved in all of the 28 items of the CCOG. The 6 more technically-orientated communication items improved on average from 3.4 for the first interview to 2.6 in the second interview (p < 0.0001), the 6 emotional items from 2.7 to 2.3 (p = 0.023). The overall score for women improved from 3.2 to 2.5 (p = 0.0019); male students improved from 3.0 to 2.7 (n.s.). The mean interview time significantly increased from the first to the second interview, but the increase in the interview duration and the change of the overall score for the students’ communication skills were not correlated (Pearson’s r = 0.03; n.s.).ConclusionsOur communication course measurably improved communication skills, especially for female students. These improvements did not depend predominantly on an extension of the interview time. Obviously, “technical” aspects of communication can be taught better than “emotional” communication skills.

Comparison of Patient-Physician Interaction (PPI) Evaluation between Different Grade Medical Students.

A proper patient-physician interaction (PPI) creates rapport between doctors and patients and improves medical outcomes. The importance of PPI evaluation items was evaluated in each medical student in grades 3 and 4, before and after their clinical clerkship. Six PPI evaluation guidelines (SEGUE, Kalamazoo Consensus, Calgary-Cambridge Guide, Macy guideline, 2 Korean Consortium guidelines) were selected and importance of each guideline was evaluated through the structured questionnaire in 73 pre-clinical clerkship (3rd-grade) and 78 post-clinical clerkship (4th-grade) medical students. The importance of medical communication items among total clinical performance, students-rated PPI portion was 21+/-9.7%. In SEGUE recommendations, 'Elicit information' was evaluated to be most important items before (58.3%) and after (65.8%) clinical clerkship. In Kalamazoo Consensus, 'Gathering information' was evaluated to be most important (49.3%/42.3%), same as in Calgary-Cambridge Guide (52.1%/56.4%) and Daegu Gyeongbuk Consortium (47.9%/43.6%). In the Macy guideline, 'Listening' was evaluated to be most important (28.8%/33.3%). In the Seoul Gyeonggi Consortium, 'Buidling relationships' was evaluated to be most important (23.3%/28.2%). In the 4th-grade post-clerkship medical students after clinical clerkship, importance of 'Gathering information' was evaluated to be less important, however, 'Giving information' and 'Understanding the patient perspective' was evaluated to be more important, compared to pre-clerkship students 3rd-grade students.

A qualitative study of caregivers’ expectations and communication desires during medical consultation for sick children in Uganda

Objective Little data exist on patients’ expectations and communication desires during medical consultation in Non-Western settings. We conducted a qualitative study to compare expectations and communication desires of sick children's caregivers at Mulago Hospital, Uganda, to those of patients in Western countries. Methods Three Focus Group Interviews and three Key Informant Interviews were conducted with 24 caregivers of sick children in Mulago Hospital Kampala, Uganda. An interview guide adapted from the Calgary-Cambridge Guide was used to conduct focus group and Key Informant Interviews. Two investigators worked independently to review transcripts and analyse them for content and emerging themes. Results Caregivers of sick children in Mulago Hospital expect attending doctors to build a relationship with them, by demonstrating the verbal and nonverbal skills outlined in the CCG including maintaining eye contact, using appropriate gestures and voice during communication, and being nonjudgmental. Conclusion The communication needs and expectations of caregivers of sick children in Mulago Hospital are similar to those of patients and caregivers in Western countries. Practice implications The CCG can be used as a training guide to enhance the communication skills of current and future doctors in Mulago Hospital.

La comunicación médico paciente: ¿Cuáles son las habilidades efectivas?

Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician patient communication to a professional level of competence. There are six goals that physicians and patients work to achieve through their communication with each other. These are to construct a relationship, structure an interview, start the interview, gather information, explain, plan and close the interview. The outcomes that can be improved with an effective communication and the "first principles" of communication are described. A brief look at the historical context that has influenced our thinking about communication in health care is carried out. Finally, the Calgary Cambridge Guide, an approach for delineating and organizing the specific skills required of an effective communication with patients is described. It is clear from the literature that better communication skills improve patient satisfaction and clinical outcomes.

Doctor patient communication: which skills are effective?

Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician patient communication to a professional level of competence. There are six goals that physicians and patients work to achieve through their communication with each other. These are to construct a relationship, structure an interview, start the interview, gather information, explain, plan and close the interview. The outcomes that can be improved with an effective communication and the "first principles" of communication are described. A brief look at the historical context that has influenced our thinking about communication in health care is carried out. Finally, the Calgary Cambridge Guide, an approach for delineating and organizing the specific skills required of an effective communication with patients is described. It is clear from the literature that better communication skills improve patient satisfaction and clinical outcomes.

Teaching and assessment of explanation and planning in medical schools in the United Kingdom: Cross sectional questionnaire survey

Background: The second half of the consultation (explanation and planning) has been described as neglected in communication skills teaching in medical schools, with programmes concentrating on information gathering.Aims: To identify the extent and ways in which explanation and planning is taught in medical schools in the United Kingdom.Methods: Questionnaire mailed to consultation teaching leadsResults: Teaching in explanation and planning occurred in 32/32 medical schools. Teaching commenced in years 1 or 2 in 14/32 and year three onwards in 17/32 medical schools. Teaching took place over one year in 12/32, two years in 13/32, three years in 3/32 and 4 years in 2/32 medical schools. Different teaching methods were used, but most use discussion and rehearsal of skills with a simulated patient (21/32). 20/32 medical schools based their teaching on a published consultation model, with 18/20 using the Calgary Cambridge Guide to the Consultation. 31/32 medical schools examined their students in explanation and planning: formative assessment (3/31) or summative (16/31) or both (9/31).Conclusions: There is now universal teaching and almost universal assessment of the second half of the consultation in medical schools in the UK. Timing of teaching, educational methods, consultation models and assessment used varies between schools

EACH (European Association for Communication in Healthcare) International Conference 2008, 2-5 September 2008, Oslo, Norway.

This biannual conference is themed around education, research and policy issues related to healthcare communication. I mainly attend research conferences and by the end my mind is usually overloaded and exhausted with trying to concentrate on the detail of research methodology and findings and trying to consider links and applications to my own teaching and research. The balance of this conference was different in that the programme included a good mix of research presentations, symposia and workshops. The main topics covered were: teaching communication skills, shared decision making, analysing clinical communication behaviour, disclosure of medical errors to patients, emotion and non-verbal communication skills, communication in cancer care, communication in different clinical settings, family issues and communication with children, and cultural perspectives. Regarding research, the best talk I went to was by Tanya Stivers who spoke about her research on communication between doctors, children and parents in a public clinic in the USA. She conducted detailed qualitative analysis of the talk between the participants in a large sample of consultations and combined this with detailed demographic data. Her analysis produced some interesting findings, notably for me, that there were marked inequalities observed in communication styles between different social groups. Although Stivers’ primary interest is in communication rather than health inequalities, she raised the question at the end as to whether patient-centred interviewing with its emphasis on patients being actively engaged in the interview may disadvantage some social groups. As a medical sociologist with teaching and research interests in health inequalities on a macro-level and communication on a micro-level, I was impressed by the thoroughness of this analysis and the important questions it raises that are clearly linked to clinical care. There were many talks, symposia and workshops on teaching communication skills. Jonathan Silverman, co-developer of the ‘Calgary-Cambridge Guide’, gave an excellent plenary talk on communication skills teaching, ending with an update on the ‘UK consensus statement on the content of communication curricula in undergraduate medical education’. On a more hands-on level, I attended a great workshop by two theatre academics from the USA (David Leong and Aaron Anderson) who have developed a communication skills programme with a physician. In their workshop they focused on ‘active listening’. Now this is something I thought I was good at. I was trained in it when I did my ‘experiential’ psychiatric nursing course many years ago. I teach it in my role as a communication skills tutor. I therefore know I am good at active listening. I was somewhat shaken out of my complacency when they demonstrated how in professional situations when listening to people talking about issues they are concerned about how often we jump straight to problem-solving. I had to acknowledge that I'm guilty of this. Maybe I was a great active listener 20 years ago and maybe I am OK at teaching it (I'll need to check) but I clearly have to rethink things. I am left wondering whether my urge to problem solve has been adversely affected by CSI and House on TV in recent years. The workshop made me realise that being reflexive about practice (my own as a teacher and researcher) is an ongoing process and I need to beware of assuming that once you have learnt a skill that it remains in place for ever. Although the conference was aimed at communication issues across healthcare, it primarily focused on doctors and medical education, with GPs being the largest group of clinicians in attendance. The feeling seemed to be that it would be good to attract a wider group of healthcare professionals in the future. The next conference is in 2010 and I would recommend this to clinicians with an interest in communication from a practice, research or teaching perspective. I left the conference feeling surprisingly refreshed. I had received a good update on what is happening in the academic world of healthcare communication (beyond my own teaching), I had been involved in workshops and discussions, and I had listened to some excellent research presentations. As we know communication is about more than words but on how they are used. Hearing people talk about issues and share perspectives is something that you cannot get from merely reading journal papers. In this sense I think that this conference was very good value. Right, I'm off to my GP to see if they've got any ideas about cures for CSI addiction. We'll come to a shared decision of course.

The Calgary-Cambridge guides: the ?teenage years?

The Calgary-Cambridge guides: the ?teenage years?

An early patient contact programme combining simulation and real settings

Context and setting We present the format and the first year's evaluation results of our Early Patient Contact Programme (EPCP) in the Year 2 curriculum. We implemented the EPCP during the 13-week ‘Introduction to Clinical and Pathological Sciences’ block. We used a portfolio-driven, multisetting-based, experiential learning approach to teach patient interviewing skills to students. Why the idea was necessary Although early student−patient contact is generally seen as an educationally sound approach, the hospital setting seems not to be optimal. Previously, there was no structured patient contact programme in our curriculum. Teaching took place on an ad hoc basis during the clinical years and there was neither content nor method consensus among teachers. What was done In the preparation phase, an educational collaboration contract was signed with 20 primary health care centres (PHCCs). A computerised standardised patient laboratory was established. Using guidelines drawn from the Calgary-Cambridge Observation Guide to the Consultation and MAAS-Global (an instrument designed to rate the communication and clinical skills of doctors in consultations), a conceptual framework and a set of patient interview guidelines were developed. A total of 284 Year 2 students were divided into 3 main rotating groups and then into 32 subgroups, each consisting of 3 students. Teaching teams were formed, each composed of 1 clinical teacher and 1 general practitioner (GP) teacher and each in charge of 3–6 subgroups. Nine teacher training and programme development workshops were organised for GPs and faculty members. A student learning and assessment portfolio was developed. In the implementation phase, the programme included 8 hours of preparatory lectures, 3 half-day work sessions at PHCCs and hospital clinics, 9 SP encounters (in 3 doctor and 6 observational roles) and 3 group feedback sessions. In each session, teachers worked with 3–6 students and used the experiential learning cycle. Students were given feedback on the SP contacts by their peers and the SPs following the SP contact and from their GP teachers through the records. Evaluation of results and impact The EPCP was evaluated by: student achievement: assessed with a portfolio (40%) and an SP-based performance examination (60%); a student feedback questionnaire; a student programme evaluation meeting, and teachers' SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Students' mean assessment score was 93.2 ± 5.5 out of a possible total of 100 points. The minimum score was 59.5. A total of 226 (79.6%) students scored > 90 points. The student questionnaire results showed the following student perceptions (% of ratings ≥ 7 on a 10-point scale): I can take an appropriate history (84.4%), and: I can conduct a complete clinical examination (81.0%). The average for the global rating item was 6.8 ± 2.1; that for learning at clinics and PHCCs was 6.5 ± 2.4. The highest rating score was for the SP sessions (7.5 ± 1.8). Similar positive feedback was given at the evaluation meetings. At the SWOT analysis, effective collaboration, bottom-up planning, teacher training programmes, the patient interview guidelines, teacher enthusiasm and student motivation were identified as strengths. The high number of students, time pressure, portfolio compilation procedure, and students' level of prior knowledge were identified as weaknesses. Our results demonstrate that in the early phase of the curriculum, an experiential learning-based, portfolio-driven EPCP using a combination of simulation, primary care and hospital clinics is feasible and is associated with high levels of student satisfaction and achievement.

Building on Existing Models from Human Medical Education to Develop a Communication Curriculum in Veterinary Medicine

Communication is a core clinical skill of veterinary medicine and one that needs to be taught and learned to the same degree as other clinical skills. To provide this education and essential expertise, veterinary schools in many countries, especially including North America, the United Kingdom, and Australia, have begun to develop programs and communication curricula. Human medical education, however, has 30 years' experience in developing communication curricula, and is thus an excellent resource upon which veterinary educators can build and shape their own communication programs. This article describes a skills-based communication course that has been successfully implemented for veterinary medical education at Ontario Veterinary College (OVC) and was based on the University of Calgary Faculty of Medicine's well-established program. The Calgary-Cambridge Guides and supporting textbooks provide the scaffolding for teaching, learning, and evaluation in both programs. Resources such as space and materials to support the OVC program were also patterned after Calgary's program. Communication skills, and the methods for teaching and learning them, are equally applicable for the needs of both human medicine and veterinary medicine. The research evidence from human medicine is also very applicable for veterinary medicine and provides it the leverage it needs to move forward. With this extensive base available, veterinary medicine is in a position to move communication skills training forward rapidly.

Teaching and Learning Communication in Veterinary Medicine

Drawing on extensive evidence and experience in human medicine, this article offers a practical conceptual framework for thinking more precisely about how to teach and learn communication systematically and intentionally in veterinary medicine. The overarching goal is to promote the development of communication programs so as to improve communication in veterinary practice to a professional level of competence. A three-part conceptual framework is presented that first explores the rationale behind teaching and learning communication, including the evidence base regarding the impact of communication on clinician-client interactions and outcomes of care and the research on teaching and learning communication skills in medicine. The second part considers four ways to conceptualize what to teach and learn, as explicated by (a) the domains of communication in veterinary medicine; (b) ''first principles'' of effective communication; (c) evidence-based goals or outcomes for communication programs; and (d) delineation and definition of the specific individual skills that research evidence supports, as presented in the Calgary-Cambridge Guides. The last part of the conceptual framework examines how to teach communication, including the use of models, a primary focus on skill development as the backbone of communication programs, and the value of other methods supported by the evidence, such as simulated patients, videotape, small groups, and feedback and facilitation skills. Communication impacts the clinician- client interaction and outcomes of care in very significant ways. Communication can and should be taught and learned with as much rigor as other aspects of clinical competence. Veterinary programs at all levels should include the teaching of communication.

Communication: An Essential Veterinary Professional Attribute

Communication skills are considered a core clinical skill in human medicine. Recognizing the importance of communication skills and addressing them in veterinary curricula, however, is just beginning. In the fall of 2003, the Atlantic Veterinary College, University of Prince Edward Island, markedly changed the way in which it approaches communication teaching. An intensive one-week elective rotation on client communication was offered in the senior year. This rotation made extensive use of experiential techniques through the use of role plays and videotaped real client interactions. A group of faculty and hospital staff members were trained as coaches to support students as they practiced their communication in various client scenarios. The skills taught were based on the Calgary-Cambridge Observation Guide, which outlines observable behaviors that contribute to effective medical communication. Student response to and feedback on the rotation have been very positive. As a result, the number of rotations given per year has been increased. Long-term plans include expanding communication skills teaching into other years of the DVM program and incorporating simulated clients into the teaching program. Challenges that lie ahead include the development of a fully integrated communication teaching program that spans the whole curriculum, addressing the ongoing need for the professional development of coaches, improving methods of student assessment, and recruiting/training a sufficient number of coaches.