GP Supervisors Australia have developed this repository of resources to help GP supervisors in various aspects
of their work and training with GP registrars. Note: This page has recently been revised, click here to view the legacy
Communication Skills Toolbox page.
Stay up to date on the release of more resources through GPSA member communications.
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.
Dr Simon Hay gives an overview of some of the key models for the GP Consultation and some practical advice in the video on the right.
Neighbour’s model proposed that the general practice consultation is ‘a journey, not a destination’, and described five ‘checkpoints’ along the way.
|Neighbour R. The Inner Consultation: how to develop an effective|
and intuitive consulting style. 2nd ed.
Oxford: Radcliffe Medical Press; 2004
|Fine M. The Inner Consultation – how to develop an effective and intuitive consulting style (2e). Health Expect. 2005;8(4):362-363. doi:10.1111/j.1369-7625.2005.00349.x|
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.
Ron Roth, a GP supervisor from Victoria, has developed his own model as discussed in this recent journal article.
2022 AJGP A new framework for teaching the art of general practice consultation to registrars and supervised doctors
He presents the model in this GPSA webinar.
Global consultation skills are those broad competencies that are required at all stages of the doctor-patient encounter. Each of these global skills can be broken into a number of more specific skills, which are listed in the next section.
Registrars often struggle to facilitate an effective, organised, and time-efficient consultation with their patients.
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.
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.
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.
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.
Flash Cards – Shades of Grey – Ethical Dilemmas
Recognising one’s limitations and appropriate help-seeking is a core general practice skill, and a fundamental aspect of safe practice and effective learning.
2020 AJGP article A ‘call for help’ list for Australian general practice registrars
Each global consultation skill can be broken into a number of more specific skills. These are more discrete and ‘observable’, and hence more ‘teachable’ than global skills.
The second stage of the consultation is gathering data. The specific consultation skills within this are:
GPSA teaching plan on history taking
Exploring the problem: Examples (2.10)
The third stage of the consultation is reasoning. The specific consultation skills within this are:
The fourth stage of the consultation is planning management. The specific consultation skills within this are:
There are many potentially challenging consultations in general practice that require specific consultation or communication skills. Additionally, some consultations may be particularly challenging for IMGs due to cultural and other factors.
References and resources
Saying no to patients can be a difficult undertaking, but is an important consultation skill for delivery of best practice care and minimising medicolegal risk.
Managing patients who are angry or aggressive is a not uncommon scenario in general practice, and one that requires high level communication skills in order to de-escalate.
A ‘heart-sink’ patient has been defined as ‘when we feel a sense of helplessness in the face of patients when they’re actually looking for psychological, social and spiritual answers to what we might think are not medical problems’.
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.