Consultation Skills Toolbox

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.

Introduction

The consultation
At the heart of general practice is the consultation – the vehicle by which GPs ‘ply their trade’ and deliver best practice care. In its simplest form, the consultation can be viewed as ‘the sharing of information between patient and doctor in order to develop both a common understanding and a plan of management’. The consultation provides the core context for general practice education and training.

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 of the GP supervisor. The nature of the general practice consultation has evolved rapidly over recent years. In addition to the traditional content and tasks, the consultation now incorporates challenges such as telehealth, increasing complexity, changing patient expectations, ‘Dr Google’, defensive medicine, and preventive care. This further reinforces the need for supervisors to teach registrars consultation skills.

International Medical Graduates
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 our guide or take a look at our IMG Resource Pack.

Resources
This toolkit is a repository of useful resources for GP supervisors to teach consultation skills. It is not designed to be a platform for self-directed learning, more a catalogue of resources and tools for supervisors to access as needed. The primary source of teaching material, activities and references in this toolkit are the GPSA consultation skills teaching plans. The links contained in these teaching plans are not duplicated here.

One very useful and practical resource that we recommend reading is the 2014 AFP article Consultation skill tips for new GP registrars. This is a great summary of consultation skill tips for new GP registrars. The resources in this toolkit are categorised by the following types for ready use by supervisors:

Teaching Plans  GPSA Teaching Plan      Journal Article           Book           Webinar

 Teaching Tool               Assessment Tool      Podcast

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.

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. 

 

Neighbours Model

Neighbour’s ‘The Inner Consultation’ model

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?

Reference

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
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5060308/
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Calgary cambridge model

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 model

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

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.

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.

Teaching Plans  Info sheet: Communication and building professional relationships

  Kalamazoo consensus statement

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.

Teaching Plans Patient-centred care teaching plan

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.

Teaching Plans  Aboriginal and Torres Strait Islander health teaching plans

 Aboriginal and Torres Strait Islander health guide

 Aboriginal and Torres Strait Islander health web page

 2008 AFP paper ‘Patient-centred care – cultural safety in Indigenous health’

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.

 GPSA Guide Teaching Clinical Reasoning

  Developing thinking skills – using a Socratic questioning approach

  Teaching Clinical reasoning webinar

  Clinical reasoning the game webinar

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.

Teaching Plans Managing uncertainty teaching plan

  GPSA Guide Managing Uncertainty

 Ghosh AK. Dealing with medical uncertainty: a physician’s perspective. Minn Med 2004; 87: 48-51.

  Managing uncertainty webinar

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.

Teaching Plans  GPSA Teaching Plan Professional and Ethical Practice

 Medical Board of Australia. Codes, Guidelines and Policies
 2012 AFP article ‘The informal curriculum – general practitioner perceptions of ethics in clinical practice

 GPSA Guide ‘Teaching Professionalism

  Flash Cards – Shades of Grey – Ethical Dilemmas

  Professionalism webinar

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

  Webinar: A ‘Call For Help’ List To Improve Safety For Supervised General Practitioners

Specific consultation skills

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 first stage of the consultation is to connect and build the doctor-patient relationship. The specific consultation skills within this are:
  • Building rapport (empathy)
 Developing rapport (R2.13)  Computers in the consultation (R2.28)
  • Using effective non-verbal communication

The second stage of the consultation is gathering data. The specific consultation skills within this are:

The third stage of the consultation is reasoning. The specific consultation skills within this are:

  • Integrating and interpreting data
  • Generating a differential diagnosis

 GPSA Guide Teaching Clinical Reasoning

  Developing thinking skills – using a Socratic questioning approach

  Teaching Clinical reasoning webinar

  Clinical reasoning the game webinar

The fourth stage of the consultation is planning management. The specific consultation skills within this are:

 

Challenging consultations

Challenging Consultations

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.

  • Breaking bad news is a very difficult task, even for experienced GPs
  • IMG doctors may feel insecure when delivering bad news if they are uncertain of the cultural rules surrounding the topic
References and resources
  • Engagement of adolescents can be very challenging
  • This may be particularly challenging for IMGs, as adult status and parental consent may be dictated by cultural norms

References and resources

  • Alcohol misuse and abuse is a very common issue in Australia
  • Attitudes and approaches to alcohol consumption vary greatly between cultures

References and resources

  • Mental health problems like depression and anxiety are very commonly managed in Australian general practice
  • Attitudes and approaches to mental health issues are culturally determined

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.