(PDF) Essential Elements of Communication in Medi
(PDF) Essential Elements of Communication in Medi
Essential Elements of
Communication in Medical
Encounters: The Kalamazoo
Consensus Statement
April 2001 · Academic Medicine 76(4):390-393
DOI:10.1097/00001888-200104000-00021
Authors:
Gregory Makoul
UConn Health Center
Patrick H. Brunett
Thomas L. Campbell
Kathleen Cole-Kelly
Case Western Reserve University School of …
Abstract
Public Full-text 1
ES S A Y
ABSTRACT
In May 1999, 21 leaders and representatives from major participated in discussion of the models and common el-
medical education and professional organizations at- ements. Written proceedings generated during the con-
tended an invitational conference jointly sponsored by ference were posted on an electronic listserv for review
the Bayer Institute for Health Care Communication and comment by the entire group. A three-person writing
and the Fetzer Institute. The participants focused on committee synthesized suggestions, resolved questions,
delineating a coherent set of essential elements in and posted a succession of drafts on a listserv. The current
physician –patient communication to: (1) facilitate the document was circulated to the entire group for final ap-
development, implementation, and evaluation of com- proval before it was submitted for publication. The group
munication-oriented curricula in medical education and identified seven essential sets of communication tasks: (1)
(2) inform the development of specific standards in this build the doctor –patient relationship; (2) open the dis-
domain. Since the group included architects and repre- cussion; (3) gather information; (4) understand the pa-
sentatives of five currently used models of doctor– patient tient’s perspective; (5) share information; (6) reach agree-
communication, participants agreed that the goals might ment on problems and plans; and (7) provide closure.
best be achieved through review and synthesis of the These broadly supported elements provide a useful frame-
models. Presentations about the five models encompassed work for communication-oriented curricula and stan-
their research base, overarching views of the medical dards.
encounter, and current applications. All attendees Acad. Med. 2001;76:390 –393.
A growing emphasis on physician –pa- days in Kalamazoo, Michigan, for the 2. Providing tangible examples of
tient communication in medicine and Bayer –Fetzer Conference on Physi- skill competencies that would be useful
medical education is reflected in inter- cian –Patient Communication in Med- for licensing bodies, organizations that
national consensus statements,1,2 guide- ical Education. The aim of this invita- accredit medical schools and residency
lines for medical schools,3–6 and stan- tional conference was to identify and programs, and directors of medical ed-
dards for professional practice and specifically articulate ways to facilitate ucation programs at all levels.
education.7–12 In May 1999, with work communication teaching, assessment, 3. Ensuring that the product gener-
in these areas and related research13–17 and evaluation. ated by the group would be evidence
as a backdrop, 21 people from medical The group used an open-ended, iter- based and appropriate for teaching, as-
schools, residency programs, continuing ative process to identify and prioritize sessment, and evaluation.
medical education providers, and prom- topics for discussion. A major topic of
inent medical educational organizations interest to the entire group was deline- Since the group included architects
in North America convened for three ating a set of essential elements in phy- and representatives of five currently
sician –patient communication. Partici- used models of doctor –patient com-
pants expressed three goals for the munication, participants agreed that
The conference participants are listed in a box at the discussion: the goals might best be achieved
end of the text.
1. Reaching consensus on a ‘‘short through review and synthesis of the
Correspondence and requests for reprints should be models’ essential elements. Toward that
addressed to the Bayer Institute for Health Care
list’’ of elements that would characterize
Communication, 400 Morgan Lane, West Haven, effective communication in several end, brief presentations were delivered
CT 06516; e-mail: 具[email protected]典. clinical contexts. about each of the five models:
䡲 Bayer Institute for Health Care Com- lines, and standards. While the list is by Understand the Patient’s Perspective
munication E4 Model 18 no means exhaustive, the intent was to
䡲 Three Function Model/Brown Inter- make it easier for people working in this 䡲 Explore contextual factors (e.g., fam-
view Checklist19 area to identify not only the key tasks, ily, culture, gender, age, socioeco-
䡲 The Calgary – Cambridge Observation but the relevant knowledge, skills, and nomic status, spirituality)
Guide20 attitudes as well. References for the sup- 䡲 Explore beliefs, concerns, and expec-
䡲 Patient-centered clinical method21 porting research are listed and discussed tations about health and illness
䡲 SEGUE Framework for teaching and in a number of texts.20,21,23– 28 䡲 Acknowledge and respond to the pa-
assessing communication skills22 tient’s ideas, feelings, and values
Build a Relationship: The
Each presentation included an ex- Fundamental Communication Task Share Information
plicit description of the model, encom-
passing its research base, overarching A strong, therapeutic, and effective re- 䡲 Use language the patient can under-
views of the medical encounter, and lationship is the sine qua non of phy- stand
current applications. After discussion of sician –patient communication.29,30 The 䡲 Check for understanding
the models, attendees from the Accred- group endorses a patient-centered, or 䡲 Encourage questions
itation Council for Graduate Medical relationship-centered, approach to care,
Education (ACGME), the CanMEDS which emphasizes both the patient’s dis- Reach Agreement on Problems
2000 Project, the Educational Commis- ease and his or her illness experi- and Plans
sion for Foreign Medical Graduates ence.31,32 This requires eliciting the pa-
(ECFMG), and the Macy Health Com- tient’s story of illness while guiding the 䡲 Encourage the patient to participate
munication Initiative provided infor- interview through a process of diagnos- in decisions to the extent he or she
mation about their efforts to develop tic reasoning. It also requires an aware- desires
criteria for teaching and evaluating ness that the ideas, feelings, and values 䡲 Check the patient’s willingness and
physician –patient communication. The of both the patient and the physician ability to follow the plan
group then began looking for common- influence the relationship.2,15,33 Further, 䡲 Identify and enlist resources and sup-
alities among the models as well as this approach regards the physician – pa- ports
points of departure. This process was tient relationship as a partnership, and
enriched by the number and diversity of respects patients’ active participation in Provide Closure
organizations represented by conference decision making.34–36 The task of build-
participants. ing a relationship is also relevant for 䡲 Ask whether the patient has other is-
work with patients’ families and support sues or concerns
THE ESSENTIAL ELEMENTS networks. In essence, building a rela- 䡲 Summarize and affirm agreement with
tionship is an ongoing task within and the plan of action
Consensus on the essential elements of across encounters: it undergirds the 䡲 Discuss follow-up (e.g., next visit,
physician –patient communication was more sequentially ordered sets of tasks plan for unexpected outcomes)
reached by using the three goals out- identified below.
lined above to guide and ground dis- CONCLUSION
cussion. The group’s perspective on es- Open the Discussion
sential elements is consistent with the This outline of essential elements in ef-
task approach, a concept that has been 䡲 Allow the patient to complete his or fective physician – patient communica-
well supported in communication skills her opening statement tion provides a coherent framework for
teaching since the early 1980s. 3,18– 25 As 䡲 Elicit the patient’s full set of concerns teaching and assessing communication
noted by Makoul and Schofield,2 ‘‘fo- 䡲 Establish/maintain a personal connec- skills, determining relevant knowledge
cusing on tasks provides a sense of pur- tion and attitudes, and evaluating educa-
pose for learning communication skills. tional programs. In addition, the out-
The task approach also preserves the in- Gather Information line can inform the development of spe-
dividuality of [learners] by encouraging cific standards in this domain. Most of
them to develop a repertoire of strate- 䡲 Use open-ended and closed-ended the elements included in this document
gies and skills, and respond to patients questions appropriately are present in each of the five models
in a flexible way.’’ 䡲 Structure, clarify, and summarize in- examined during the process of consen-
By identifying specific communica- formation sus building. A major strength of the
tion tasks, the group worked to high- 䡲 Actively listen using nonverbal (e.g., outline is that it represents the collab-
light behaviors that are embedded in eye contact) and verbal (e.g., words oration and consensus of individuals
existing consensus statements, guide- of encouragement) techniques with a variety of backgrounds and in-
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