GP Supervision Australia has 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.
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, view our guide or take a look at our Supervising IMGs web page.
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:
GPSA Teaching Plan 
Journal Article 
Book 
Webinar 
Teaching Tool 
Assessment Tool 
Podcast
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.
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/ |
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.
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. Info sheet: Communication and building professional relationships Kalamazoo Essential Elements
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.
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
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.
Managing uncertainty teaching plan
GPSA Guide Managing Uncertainty
Ghosh AK. Dealing with medical uncertainty: a physician’s perspective. Minn Med 2004; 87: 48-51.
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.
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
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
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.
Developing rapport (R2.13)
Computers in the consultation (R2.28)
The second stage of the consultation is gathering data. The specific consultation skills within this are:
Initiating a consultation: Examples (R2.8), Exercises (R.2.9) GPSA teaching plan on history taking
Building a history rather than taking one (R2.5)
Exploring the problem: Examples (2.10)
Using open-ended questions: Information (R2.11) and Worksheet (R2.12)
Communication skills in stages 2 and 3 of the consultation (R2.21)
GPSA teaching plan Physical Examination Skills Identifying the patient agenda using ideas, concerns, and expectations – video Language examples of summarising and signposting (R2.22)The third stage of the consultation is reasoning. The specific consultation skills within this are:
GPSA Guide Teaching Clinical Reasoning
Developing thinking skills – using a Socratic questioning approach
The fourth stage of the consultation is planning management. The specific consultation skills within this are:
GPSA teaching plan: Patient centred care Podcast: Fostering shared decision-making in primary care 2014 MJA article ‘Shared decision making: what do clinicians need to know and why should they bother?’Negotiating treatment options – examples (R2.23)Management role-play exercises (R2.24)
GPSA teaching plan on Rational test orderingGPSA teaching plan on Rational prescribingGPSA teaching plan on Brief Intervention and Motivational InterviewingGPSA teaching plan on Writing Quality ReferralsRACGP resource – Referring to other medical specialists: a guide for ensuring good referral outcomes for your patientsClosing the consultation Language examples (R2.25)GPSA teaching plan on Follow Up and Safety Netting 2009 BJGP article Diagnostic safety-netting GPSA teaching plan on Quality Medical Records 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
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.
Date reviewed: 11 May 2023
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