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BackgroundAimMethodsResultsConclusionRecorded consultations are a useful tool for developing consultation skills for general practice speciality trainees (GPSTs). Historical barriers to utility include a lack of recording equipment and trainee discomfort. Widespread use of online communication platforms during the pandemic led to the introduction of the Recorded Consultation Assessment (RCA), prompting an exploration of its impact on GPSTs’ attitudes and acceptability of using recorded consultations for feedback.This sequential explanatory mixed methods study explored attitudes of military GPSTs towards using recorded consultations for feedback to develop consultation skills, and identify factors influencing GPST attitudes.Participants of this study completed a questionnaire, followed by a representative sample focus group. Descriptive statistics were used to analyse quantitative data, reflexive thematic analysis was employed for qualitative data. Triangulation was conducted using a meta-matrix.Results indicated agreement among respondents on the usefulness of recorded consultations for developing consultation skills, particularly communication skills. Perceived trainer attitudes significantly influence the GPST utility of this tool. The RCA positively impacted attitudes, providing familiarity, free access to easy-to-use online recording platforms, simplified consenting procedures, secure data storage, and improved feedback quality from trainers.Pre-pandemic studies cited equipment access and consent procedures as barriers to utilising recording as a method of feedback. The pandemic and RCA introduced online resources and imperative to utilise this method, resulting in largely positive GPST learning experiences. As we move away from the RCA it is important to retain institutional memory of the benefits gained from feedback using recorded methods. [ABSTRACT FROM AUTHOR]

Advanced clinical practitioners (ACPs) are experienced health professionals educated to master's level. They are accountable for the assessment, diagnosis and treatment of individuals, and are responsible for making complex decisions. The case study presented in this article critically analyses the consultation involving a male patient in his sixties with a 2-day history of abdominal pain, who was referred by his GP to a surgical assessment unit. Analysis was carried out using the Calgary-Cambridge Model. The article discusses history-taking, abdominal examination and differential diagnoses, and presents the process of how the trainee ACP arrived at the diagnosis of appendicitis. [ABSTRACT FROM AUTHOR]

Combining key elements from the learning tools of reflection, feedback and debriefing into a single reflective event is a novel concept. This powerful combination amalgamates into a tool useful in experiential learning. Linking the three concepts in a way that combines self-reflection in a debriefing framework, powered by trusted peer feedback resulted in a new teaching tool. It was piloted within the clinical setting of the primary health care (PHC) clinics in the Saldanha Bay sub-district in South Africa among final (6th) year undergraduate medical students of the University of Cape Town. This sub-district is a peri-urban community and encompasses a district health care system with less resources in both human and infrastructure than in an urban area. Being intentional and analytical as to optimal use of every resource not only impacts the students but also alleviates the pressure on clinician supervisors of activities. Pairing students alleviates the pressure of the insufficient number of consultation rooms for solo consultations and the pressure on the single supervising clinician when the consultations are conducted simultaneously. Using this tool at the end of the session facilitates the reflection and experiential learning of both the students individually. Self-reports indicated this tool kept both students engaged throughout all consultations and facilitated peer learning Alternating between being the doctor and the observer and knowing what roles entailed, the students never felt victimised in the reflection and feedback on their performance. And individually they developed their self-reflection and providing feedback as life skills.

Introduction: Previously, we identified eight effective consultation skills to support decision‐making in the voluntary surrender of older adult drivers' licences in super‐aged Japan. This study aimed to clarify the transferability of these skills. Methods: We collected text data by interviewing 11 safe‐driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi‐structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision‐making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software. Results: As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'. Conclusion: The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow‐up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe‐driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision‐making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age. [ABSTRACT FROM AUTHOR]

Background: Aboriginal culture stands as the oldest continuous culture in the world. It gives paramount importance to a harmonious balance between personal connections to the body, spirit, and mind, as well as collective relationships with family, land, and community, integral to the wellbeing of Aboriginal people. However, obstacles can emerge for patients due to language barriers, cultural differences, or a historical lack of trust in the healthcare system. The establishment of Aboriginal Community Controlled Health Organisations (ACCHOs) has undoubtedly improved the healthcare experience for Aboriginal patients, yet there is limited research on the specific approaches utilised by general practitioners (GPs) working in these clinics. Methods: Twelve semi-structured interviews were conducted with two groups of GPs working in Aboriginal health. Each GP was presented with three scenarios and asked questions related to each scenario. Braun and Clarke's method of thematic analysis was applied to transcribed interviews. Results: Patient-doctor relationship, health literacy, and engagement with the health system emerged as key factors influencing communication with Aboriginal patients. Experienced GPs, despite differing clinical backgrounds, shared concise yet similar ideas to their less experienced counterparts. Notably, experienced GPs prioritised non-medical conversations and mindful body language, emphasising the importance of building strong patient relationships over other consultation aspects. Conclusions: This research provides initial insights for GPs in Aboriginal health, comparing experienced GPs with more than 10 years experience to novices. However, further research involving Aboriginal patients is needed to validate GP strategies and understand their significance from the patients' perspective. Communicating health information can be a challenging skill to clinicians especially when working in Aboriginal health. Despite Aboriginal Health Community Controlled Health Organisations having enriched the experience of Aboriginal patients, there is limited research on the approaches adopted by general practitioners (GPs) working in these clinics. Our research combines thoughts from experienced and novice GPs who worked in Aboriginal Health, and shares some of their experiences related to communicating medical information with Aboriginal patients in this highly complex field. [ABSTRACT FROM AUTHOR]

their life (ICEE), is a widely recommended communication technique. However, it is not known how frequently ICEE components are raised in UK GP consultations. Aim: To assess the frequency of ICEE in routine GP consultations with adult patients and explore variables associated with ICEE. Design & setting: An observational study was undertaken. It involved secondary analysis of a pre-existing archive of video-recorded, face-to-face GP consultations in the UK. Method: Observational coding of 92 consultations took place. Associations were assessed using binomial and ordered logistic regression. Results: Most consultations included at least one ICEE component (90.2%). The most common ICEE component per consultation was patient ideas (79.3%), followed by concerns (55.4%), expectations (51.1%), and then effects on life (42.4%). For all ICEE components patients more commonly initiated the ICEE dialogue, and in only three consultations (3.3%) did GPs directly ask patients about their expectations. Problems that were acute (odds ratio [OR] 2.98, 95% confidence interval [CI] = 1.36 to 6.53, P = 0.007) or assessed by GPs aged ≥50 years (OR 2.10, 95% CI = 1.07 to 4.13, P = 0.030) were associated with more ICEE components. Problems assessed later in the consultation (OR 0.60 per problem order increase, 95% CI = 0.41 to 0.87, P = 0.007) by patients aged ≥75 years (OR 0.40, 95% CI = 0.16 to 0.98, P = 0.046) and from the most deprived cohort (OR 0.39, 95% CI = 0.17 to 0.92, P = 0.032) were associated with fewer ICEE components. Patient ideas were associated with more patients being 'very satisfied' post-consultation (OR 10.74, 95% CI = 1.60 to 72.0, P = 0.014) and the opposite was true of concerns (OR 0.14, 95% CI = 0.02 to 0.86, P = 0.034). Conclusion: ICEE components were associated with patient satisfaction and demographic variables. Further research is required to assess if the way ICEE are communicated affects these associations and other potential confounders. [ABSTRACT FROM AUTHOR]

Background: Eliciting patients’ ideas, concerns, expectations, and whether a problem has an 'effect' on their life (ICEE), is a widely recommended communication technique. However, it is not known how frequently ICEE components are raised in UK GP consultations. Aim: To assess the frequency of ICEE in routine GP consultations with adult patients and explore variables associated with ICEE. Design & setting: An observational study was undertaken. It involved secondary analysis of a pre-existing archive of video-recorded, face-to-face GP consultations in the UK. Method: Observational coding of 92 consultations took place. Associations were assessed using binomial and ordered logistic regression. Results: Most consultations included at least one ICEE component (90.2%). The most common ICEE component per consultation was patient ideas (79.3%), followed by concerns (55.4%), expectations (51.1%), and then effects on life (42.4%). For all ICEE components patients more commonly initiated the ICEE dialogue, and in only three consultations (3.3%) did GPs directly ask patients about their expectations. Problems that were acute (odds ratio [OR] 2.98, 95% confidence interval [CI] = 1.36 to 6.53, P = 0.007) or assessed by GPs aged ≥50 years (OR 2.10, 95% CI = 1.07 to 4.13, P = 0.030) were associated with more ICEE components. Problems assessed later in the consultation (OR 0.60 per problem order increase, 95% CI = 0.41 to 0.87, P = 0.007) by patients aged ≥75 years (OR 0.40, 95% CI = 0.16 to 0.98, P = 0.046) and from the most deprived cohort (OR 0.39, 95% CI = 0.17 to 0.92, P = 0.032) were associated with fewer ICEE components. Patient ideas were associated with more patients being ‘very satisfied’ post-consultation (OR 10.74, 95% CI = 1.60 to 72.0, P = 0.014) and the opposite was true of concerns (OR 0.14, 95% CI = 0.02 to 0.86, P = 0.034). Conclusion: ICEE components were associated with patient satisfaction and demographic variables. Further research is required to assess if the way ICEE are communicated affects these associations and other potential confounders.

Abstract Background Person-centred care is integral to high-quality health service provision, though concepts vary and the literature is complex. Validated instruments that measure person-centred practitioner skills, and behaviours within consultations, are needed for many reasons, including in training programmes. We aimed to provide a high-level synthesis of what was expected to be a large and diverse literature through a systematic review of existing reviews of validation studies a of instruments that measure person-centred practitioner skills and behaviours in consultations. The objectives were to undertake a critical appraisal of these reviews, and to summarise the available validated instruments and the evidence underpinning them. Methods A systematic search of Medline, EMBASE, PsycINFO and CINAHL was conducted in September 2020. Systematic reviews of validation studies of instruments measuring individual practitioner person-centred consultation skills or behaviours which report measurement properties were included. Review quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Details of the reviews, the included validation studies, and the instruments themselves are tabulated, including psychometric data, and a narrative overview of the reviews is provided. Results Four reviews were eligible for inclusion. These used different conceptualisations of person-centredness and targeted distinct, sometimes mutually exclusive, practitioners and settings. The four reviews included 68 unique validation studies examining 42 instruments, but with very few overlaps. The critical appraisal shows there is a need for improvements in the design of reviews in this area. The instruments included within these reviews have not been subject to extensive validation study. Discussion There are many instruments available which measure person-centred skills in healthcare practitioners and this study offers a guide to what is available to researchers and research users. The most relevant and promising instruments that have already been developed, or items within them, should be further studied rigorously. Validation study of existing material is needed, not the development of new measures.

Background: Person-centred care is integral to high-quality health service provision, though concepts vary and the literature is complex. Validated instruments that measure person-centred practitioner skills, and behaviours within consultations, are needed for many reasons, including in training programmes. We aimed to provide a high-level synthesis of what was expected to be a large and diverse literature through a systematic review of existing reviews of validation studies a of instruments that measure person-centred practitioner skills and behaviours in consultations. The objectives were to undertake a critical appraisal of these reviews, and to summarise the available validated instruments and the evidence underpinning them. Methods: A systematic search of Medline, EMBASE, PsycINFO and CINAHL was conducted in September 2020. Systematic reviews of validation studies of instruments measuring individual practitioner person-centred consultation skills or behaviours which report measurement properties were included. Review quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Details of the reviews, the included validation studies, and the instruments themselves are tabulated, including psychometric data, and a narrative overview of the reviews is provided. Results: Four reviews were eligible for inclusion. These used different conceptualisations of person-centredness and targeted distinct, sometimes mutually exclusive, practitioners and settings. The four reviews included 68 unique validation studies examining 42 instruments, but with very few overlaps. The critical appraisal shows there is a need for improvements in the design of reviews in this area. The instruments included within these reviews have not been subject to extensive validation study. Discussion: There are many instruments available which measure person-centred skills in healthcare practitioners and this study offers a guide to what is available to researchers and research users. The most relevant and promising instruments that have already been developed, or items within them, should be further studied rigorously. Validation study of existing material is needed, not the development of new measures. [ABSTRACT FROM AUTHOR]

Background: Demonstrating a person-centred approach in a consultation is a key component of delivering high-quality healthcare. To support development of such an approach requires training underpinned by valid assessment tools. Given the lack of a suitable pharmacy-specific tool, a new global consultation skills assessment tool: the medicines related-consultation assessment tool (MR-CAT) was designed and tested. Aim: This study aimed to test the validity and reliability of the MR-CAT using psychometric methods. Method: Psychometric testing involved analysis of participants' (n = 13) assessment of fifteen pre-recorded simulated consultations using the MR-CAT. Analysis included discriminant validity testing, intrarater and interrater reliability testing for each of the five sections of the MR-CAT and for the overall global assessment of the consultation. Analysis also included internal consistency testing for the whole tool. Results: Internal consistency for the overall global assessment of the consultation was good (Cronbach's alpha = 0.97). The MR-CAT discriminated well for the overall global assessment of the consultation (p < 0.001). Moderate to high intrarater reliability was observed for the overall global assessment of the consultation and for all five sections of the MR-CAT (rho = 0.64–0.84) in the test–retest analysis. Moderate to good interrater reliability (Kendall's W = 0.68–0.90) was observed for the overall global assessment of the consultation and for all five sections of the MR-CAT. Conclusion: The MR-CAT is a valid and reliable tool for assessing person-centred pharmacist's consultations. Moreover, its unique design means that the MR-CAT can be used in both formative and summative assessment. [ABSTRACT FROM AUTHOR]

Background: The UK National Institute for Health and Care (NICE) recommends that GPs inform patients referred onto the Urgent Suspected Cancer (USC) pathway about what to expect from the service. However, there is a lack of evidence on patient experience and information needs at the point of referral. It is a challenge for GPs to communicate the reasons for referral and provide reassurance., Aim: This study aimed to examine how GPs communicate a potential cancer diagnosis and USC referral in practice., Design & Setting: This is a secondary analysis of a dataset of 23 audio-recorded GP-patient consultations, selected from a larger dataset of 200 consultations collected in Surrey and London, UK in 2017-2018. The consultations were selected based on inclusion criteria related to cancer discussions., Method: This is a qualitative analysis of video recordings of face to face patient consultations., Results: We found that most GPs informed patients that they might have cancer and engaged in reassurance using personalised risk statements. Some GPs avoided all mention of cancer, using symptom-led language instead. GPs focused on communicating practical rather than support-based information. While most GPs informed patients that they would be seen by a specialist within two weeks, few discussed patients' support needs during the referral period., Conclusion: Clear communication about cancer in primary care is promoted in UK policy, and has an important role driving patient investigations attendance. The study highlights the need for further research on communication practices around cancer referral to improve patient understanding and experience. Our recommendations for enhanced communication may improve patient outcomes by optimising routes to diagnosis via primary care., (Copyright © 2024, The Authors.)

Weight management is an important aspect of type 2 diabetes management; however, for many people with type 2 diabetes, discussions about weight are unwanted, unhelpful and/or stigmatising, making them counterproductive and potentially leading to disengagement from healthcare. In turn, many healthcare professionals avoid discussing weight owing to feelings of pessimism, hopelessness and frustration. In this commentary, the authors draw upon findings from the Your Story: Type 2 Diabetes and Weight Management study to propose five considerations to guide constructive weight management discussions with adults with type 2 diabetes. [ABSTRACT FROM AUTHOR]

McWhinney's first principle of family medicine states that GPs 'are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique'. While indeed committed to the person, we propose that the 'special technique' of general practice exists in the form of core clinical concepts for managing uncertainty (e.g. time as a tool, therapeutic examination, safety netting and doctor as drug). Managing clinical uncertainty calls for GPs (and trainees) to operate in a 'corridor of uncertainty', a cricketing analogy where the batter is unsure whether to play a defensive or attacking shot. For students to recognise and value these concepts requires longitudinal learning and simulation. Here we describe a GP module at Brighton medical school where core concepts are 'drip fed' through small group sessions across year 4. Formative simulated surgeries constitute a 'corridor of uncertainty' where simulated patients drive students into using concepts in practice (e.g. through shared management plans). Although recognised in postgraduate training, these concepts should be taught formally within the undergraduate curriculum. Doing so helps students distinguish general practice from hospital generalism and prepares them for clinical placements in general practice. These concepts are inherently 'soft' and founded upon the GP paradigm of understanding medicine. In the eyes of the specialist, they risk being unacknowledged, misinterpreted as ignoring guidelines or, worse still, as bad medicine. Soft core concepts constitute the tools to prepare students for managing clinical uncertainty and serve to inscribe the art of medicine within the undergraduate curriculum. [ABSTRACT FROM AUTHOR]

Background: GPs can detect cognitive impairment at a very early stage, allowing early support for people and their caregivers. The early onset of cognitive impairment is between 50 and 60 years. Currently, in France, the Mini Mental State Examination remains the most used screening test, though it has a lower sensitivity and specificity than the Montreal Cognitive Assessment (MoCA) for detecting mild cognitive impairment, taking an average of 15 minutes to complete., Aim: To investigate the feasibility of the MoCA during routine consultations in general practice for the early detection of cognitive impairment and to determine prevalence of cognitive impairment in a primary care setting., Design & Setting: A quantitative, prospective feasibility study was carried out in real-life working condition during routine consultation., Method: GPs performed MoCA on adults aged 50 years and older, without suspected or confirmed cognitive impairment., Results and Conclusion: 61 GPs performed 221 MoCA with a mean duration of 8 minutes and detected mild neurocognitive impairment in 62% of patients. The MoCA is feasible and easy to perform during routine consultations in general practice by trained and experienced physicians., (Copyright © 2024, The Authors.)

Introduction This paper discusses the design and impact of a clinical consultation skills session for undergraduate medical students in context of diverse sexual orientation, gender identity and expression, and sex characteristics. Existing teaching approaches omit opportunities for application and skills practice. This innovation seeks to address this gap. Methods Senior medical undergraduate students participated in actor-facilitated standardized simulated patient role-play. The scenarios utilized a structure akin to the end of year final observed objective structured clinical examination. Plan-do-study-act cycles involving facilitator observation, verbal and written feedback from students and actors, confidential student evaluations, and peer evaluation contributed to session modification and improvement. Findings The teaching session offered students the opportunity to practice exam-style simulated patient consultations, communication and empathy skills. Improvements made following the first iteration were reflected in positive student evaluations in the second iteration. Discussion and Conclusion Simulated consultations using standardised scenarios represent an accepted format for medical education. We demonstrated it is possible to include topics that frequently give rise to discrimination and stigma from medical professionals whilst maintaining expected learning outcomes. Student evaluations identify the acceptability and value of the topics for medical education. We present a viable option for integration into medical education.

This study investigated how peer comments made using a video annotation tool (VAT) through an online learning community improved student-teachers' level of reflective thinking and communication competence throughout the simulated (i.e., role-play) context of consultation practice. Eighty student-teachers from two classes of the course "Comprehensive School Guidance" participated in this study, and all recorded two videos for their tripartite practice on parent consultation for self-evaluation and peer comment. Forty student-teachers were in the comparison class and provided general comments to their peers on the learning platform, while those in the experimental class used the VAT on the learning platform to provide specific comments to their peers. Two post-practice online questionnaires and reflective journal entries, which aimed to measure communication competence and reflective thinking ability, were administered to the student-teachers after the first and second consultation practice. The reflective journal entries were segmented into units of analysis that were scored using a 4-level model of reflective thinking (from 1 to 4), with a higher score indicating demonstration of a higher level of reflective thinking for that particular segment. Both the number of reflective notes made and the average level of reflective thinking in student-teachers' journal entries were indicators of reflective thinking ability. Two mixed ANOVAs were conducted to examine whether student-teachers in the experimental (VAT) class improved their reflective thinking ability and communication competence more significantly than those in the comparison (non-VAT) class. The results showed that student-teachers in both the VAT and non-VAT classes had statistically higher scores for communication competence and reflective thinking in the second role-play practice. Student-teachers with the support of VAT, in comparison to those without, significantly improved their average reflective thinking ability. Focus group interviews were also conducted to investigate how VAT could support student-teachers' learning process and to learn their perceptions of the strengths and limitations of the VAT. The results indicated that the VAT could enhance student-teachers' learning by reducing communication barriers created by the tendency to avoid direct observations of peers' weaknesses, enhancing reflection-in-action during practice, and contextualizing written comments by referring to specific video segments. However, student-teachers felt that the VAT should also allow users to draw on the video screens. [ABSTRACT FROM AUTHOR]

In the second Diabetes MILES -- Australia (MILES-2) study, the authors asked people with diabetes the open-ended question, "What do you wish your healthcare professionals understood about living with diabetes?". The resulting answers provide important insights and form the basis of the ten tips presented in this article. These tips for more effective and satisfying consultations are proven and powerful. Most importantly, they are possible in your clinical practice today. [ABSTRACT FROM AUTHOR]

Introduction: Doctor-patient consultation is an essential element of high quality health care. Education and training of medical students in consultation skills is important. The aim of this study was to investigate the medical students' consultation skills before graduation by assessment of the students' video recordings of consultations with real patients at primary health care centres. Methods: All students had to make a video recording of a meeting with a real patient for formative examination. 26 students participated in the study and delivered a video recording and a self-assessment. Four general practitioners assessed the video recordings by Calgary-Cambridge Global Consultation Rating Scale (CC-GCRS). Statistical testing included comparisons between groups of students and assessors using non-parametric methods. Results: The average CC-GCRS-rating was higher for female students. The students' strengths were related to relation and problem exploration. Their limitations were related to patient's perspective, providing structure and providing information. The students assessed their consultation skills higher than the assessors did, while the relative levels were similar. The distribution of rating scores across the assessors was small. Conclusion: Consultation skills were acceptable for most medical students, although there was room for improvement regarding patient centeredness skills. CC-GCRS was feasible and might be a valuable instrument to assess consultation skills for medical students at the end of their medical education.

The parallel consulting method (PCM) is widely used by general practitioners (GPs) for teaching medical students. Studies have described individual aspects of bedside teaching in community settings, including the logistics of using the PCM, but there has been no evaluation of it as a teaching method. This study aimed to evaluate the PCM and whether it helped students develop consultation, clinical and clinical reasoning skills. The study was based at the Oxford University Primary Care Department. Penultimate clinical year students (n = 63) were recruited to take part in this mixed methods study. Students completed a questionnaire with closed and open-ended questions rating the PCM. A focus group explored questionnaire themes. GP tutors completed a questionnaire about the PCM and the logistics of delivering it. Three tutors took part in semi-structured interviews. The PCM helped develop students' consulting, and clinical reasoning skills. Teaching was improved when tutors were unrushed and had increased time to provide feedback and teaching. Delivery logistics of the PCM impacted on whether tutors were rushed and found it difficult to teach. Most benefit was derived when students were well briefed with sufficient debriefing time following a consultation. The following steps are recommended for effective delivery of the PCM teaching model: ensure tutors are appropriately trained; comprehensively brief the student about how to gain the most out of the learning experience; plan the logistics; ensure appropriate review and debriefing following consultation; review clinical cases after the session teaching on any outstanding aspects. [ABSTRACT FROM AUTHOR]

Robert Hamilton (1749-1830) was born in Coleraine, Ireland, attended medical school in Edinburgh, Scotland, served in the British army and practised in South-East England. In order to differentiate him from his contemporary and namesake, Hamilton is identified by having worked in Ipswich, Suffolk and Colchester, Essex. This submission considers Hamilton's biography, his 1787 book on the British regimental surgeon and his ideas therein about professionalism. Central to his concept of professionalism is 'tenderness', a notion that broadly equates to empathy. He notes that tenderness brings improvement in clinical outcome and he has the foresight to recognise nurses as key to such care. The authors explore the concept of 'consulting in the dark', i.e. without access to clinical investigations. This is exemplified by doctors of the eighteenth century and earlier. Today general practitioners must still be comfortable 'consulting in the dark', e.g. when attending a patient's home. Hamilton's biography offers a further example of 'consulting in the dark': In later life, he lost his vision but continued to practise successfully. Central to his gift of consulting 'in the dark' was likely to be 'tenderness' for his patients, expressed through language and gentle touch. Hamilton's entreaty for 'tenderness' contrasts with modern medical education where reliance upon clinical tests, technology and pharmacology risksblinding young doctors towards patients and their lives., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Collaborative and empowering consultations are key to facilitating people with diabetes to develop skills and knowledge in self-managing their condition, as well as improving healthcare professional and patient relationships. Previous research conducted in Portsmouth Hospitals NHS Trust demonstrated that patients and healthcare professionals often had poor recall and discordant interpretations of the decisions and goals set in their consultations, and so the decision was made to begin occasionally video recording the diabetes team in their consultations and to analyse them in peer review. Though at first daunting, members of the team find this process invaluable. This article describes the process of recording and reflecting on consultations, as well as the impressions of six diabetes team members who have taken part in the process. [ABSTRACT FROM AUTHOR]

The number of physician associates (PAs) training in the United Kingdom is rising dramatically, yet the approaches to teaching this new professional group are yet to be examined. We set out to determine if and how the 'Safe and Effective Clinical Outcomes' (SECO) simulation training could help this new group of students to develop skills around conducting a consultation in primary care. Six clinics were designed and implemented over three academic years (2016–2018) in a clinical skills simulation centre in a university hospital. In total, 71 PA students took part and feedback was collected from students and simulated patients as part of routine evaluation processes. We found that the SECO simulation training offered PA students the opportunity to practise consultation skills and review their scope of practice in a safe environment. It helped students build confidence in their approach and gave them the opportunity to discuss what it means to be a 'safe' practitioner. The simulated patients were positive about the experience but remained unsure of what the PA role was even after the simulation training. Based on our experience, the SECO clinics have value for those training PA students. [ABSTRACT FROM AUTHOR]

We conducted a confirmatory factor analysis (CFA) to obtain validity support for the Consultation Skills Scale (CSS) in a sample of 369 counseling professionals and interns. Upon obtaining a poor model fit from an initial CFA, we utilized modification indices and removed nine items from the CSS. As a result, we achieved a better model fit for the shorter 8-item instrument (CSS-S). To further examine validity of the CSS-S, we also explored the relationships between counselors' consultation skills and two related professional activities, ability to foster supervisory working alliance and ability to engage in interprofessional collaboration. We discuss the results along with the implications for further practice and research as well as limitations to the current study. [ABSTRACT FROM AUTHOR]

Objective: To develop a tool to support medicine-focused person-centred consultations between community pharmacists and stroke survivors.Method: Semi-structured interviews with 15 stroke survivors and 16 community pharmacists were conducted. Thematic analysis of the data was performed and emerging themes examined to determine their relevance to the principles of delivering person-centred care. Findings were used to generate a framework from which a consultation tool was created. Face validity and the feasibility of using the tool in practice were explored with participating pharmacists.Results: Three major themes were identified; personal, process and environmental factors. A tool, in two parts, was developed, A 'Getting to know me' form which would help the pharmacist to appreciate the individual needs of the stroke survivor and a consultation guide to facilitate the consultation process. Pharmacists considered that both were useful and would support a person-centred medicine-focussed consultation.Conclusion: A consultation tool, reflecting the needs of stroke survivors, has been developed and is feasible for use within community pharmacy practice.Practice Implications: Pharmacists must recognise the individual needs of stroke survivors to ensure that they provide consultations which are truly person-centred. The tool developed could support medicine-related consultations with patients with other long term conditions. [ABSTRACT FROM AUTHOR]

Objective: To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.Methods: We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies.Results: Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners' performance.Conclusion: Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners.Practice Implications: Several patient feedback questionnaires are available, showing potential for supporting practitioners' development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations. [ABSTRACT FROM AUTHOR]

Abstract: Healthcare consultations with patients lacking English proficiency are challenging for all parties, even in Australian primary care where the engagement of interpreters is encouraged and fully subsidised. Our objective was to understand these challenges from the perspectives of interpreters, patients and general practitioners in order to improve the effectiveness of interpreted consultations. Our investigator team approached the interpreted consultation as an interprofessional collaboration. A convenience sample of seven general practitioners, eight health interpreters and six representatives from culturally and linguistically diverse communities (representing the patient perspective) participated in three separate focus group discussions, lasting 60–90 min each, exploring participant experiences with healthcare consultations in which interpreters were present. Two semistructured interviews were undertaken subsequently with three additional community representatives purposively recruited to increase participant diversity. Data were collected in 2016 and analysed inductively using a method of constant comparison to identify, and reach consensus on, key emerging themes. All participant groups emphasised the importance of working with trained interpreters, rather than relying on family interpreters or a doctor's own second language skills. Although participants reported experiences of effective interpreted consultations, other reports suggested that some doctors are unaware of, or have difficulty following, accepted guidelines about speech, gaze and turn‐taking. Challenges identified in relation to interpreted consultations fell into the five themes of contextual constraints, consultation complexity, communication difficulties, the interpreter role and collaboration. Some general practitioner participants appeared to be unsure and anxious about the etiquette of interpreted consultations, and there was some confusion between and within participant groups about interpreter roles and professional codes. A briefing session prior to the consultation, clarifying the roles of all parties, including any family or bicultural workers present, may help to establish respectful, flexible and effective interprofessional collaborations and to encourage participants to directly address any problems during the consultation. [ABSTRACT FROM AUTHOR]

Objectives: Community pharmacists’ roles in the UK are evolving; pharmacists currently deliver a wider range of clinical services with more patient-focused care. The objectives of this study were (i) to investigate UK community pharmacists’ views on their current communication skills in pharmacist-patient facing consultations, and (ii) to explore the perceptions of UK community pharmacists towards the application of motivational interviewing (MI) in a pharmacy consultation. In-depth qualitative face-to-face, semi-structured interviews with ten practicing community pharmacists were carried out, ranging from 30−60 min in length. The interviews were audio recorded, transcribed verbatim and thematic analysis was employed. Four themes emerged from the data: (1) the fight for time; (2) wrestling with consultation styles; (3) a personal communication evolution; and (4) unfamiliar but engaging motivational interviewing. These themes demonstrated the juxtaposition between the desire for patient-centred care and the pressures of managing broader dispensing work. Participants were critical of academic and continuous professional learning (CPD) training in communication skills and there was a strong recognition of the potential role of MI in promoting patient autonomy and outcomes. Participants recognized a few elements of MI techniques in their current consultations, but welcomed further training on behavioral change for effective consultations, expressing a desire for practical MI-specific training. Face-to-face CPD of consultation skills is needed to avoid the feeling of isolation among UK practicing pharmacists and rigidity in consultation delivery. Support for community pharmacists from other pharmacy staff could relieve current pressures and allow pharmacists time to develop and acquire effective skills for patient facing roles. Behavioural change consultation skills training for pharmacists could be an effective strategy to address these current challenges.

Background Physicians face the challenge of individualizing aesthetic treatments in order to match the aesthetic needs of patients with their expectations. Objective To review issues underlying patient satisfaction with minimally invasive aesthetic treatment and to present a patient-centric assessment tool (the Global Ranking Scale [ GRS]) designed to set higher standards for patient consultation and treatment experience; ensure a comprehensive patient-centric aesthetic consultation process; and raise patient satisfaction with facial rejuvenation treatment. Methods A review of the design and content of the GRS and its use as part of the wider Galderma Harmony Program. Results of a small survey of clinicians who have switched to the GRS, and case studies of patients who have used the tool, are also presented. Results The GRS is used in ~500 clinics around the world. In a small survey, physicians who have used the GRS report that it has changed the way that patients are assessed and treated. While no patient survey was conducted, anecdotal evidence suggests that patients are satisfied with the GRS procedure and the outcomes of treatment. Conclusions The GRS is a new patient assessment tool that is designed as a guide for clinicians to help ensure consistency in the quality of patient assessment and consultation in their clinics offering minimally invasive facial cosmetic procedures. Qualitative research suggests that it gives patients a better chance to achieve results aligned with their needs resulting in a higher level of satisfaction with aesthetic treatments, but this needs to be confirmed in a formal patient survey. [ABSTRACT FROM AUTHOR]

Dictionary consultation and compilation is a two-way engagement between two par­ties, namely a dictionary user and a lexicographer. How well users cope with looking up words in a Bantu language dictionary and to what extent their expectations are met, depends on their con­sultation skills, their knowledge of the structure of a Bantu language and the dictionary design. There are also demands that the lexicographer places on the user. These demands are of varying degrees, ranging from low-level expectations, where basic look-up skills according to the letters of the alphabet are assumed to have been mastered already (as needed when using a word-based dictionary), to medium-level expectations (such as being able to look up words in a stem-based dictionary), to high-level demands (where intuitive dictionary skills no longer suffice). A fine bal­ance must be struck between the user's guidelines and the presumed dictionary consultation skill of the target user. This article endeavours to look into the matter of various levels of expectation of Bantu language dictionaries, both from the perspective of the user and the compiler.

Objectives: To determine UK pharmacists’ experiences of their current communication skills and undergraduate training and to identify communication skills training and teaching at UK schools of pharmacy. Methods: Two surveys were developed. The first survey was sent to UK practicing pharmacists examining their current communication skills and interest in behavioural counselling techniques such as Motivational Interviewing (MI). A second survey was sent to all UK Schools of Pharmacy investigating communication skills training and teaching. Results: In the first survey pharmacists reported low satisfaction with their undergraduate communication skills training. A convenience sample of 109 UK pharmacists responded to the first survey. Forty-four per cent (n = 48) of the respondents stated that they continued their professional development in communication skills after an undergraduate degree. Seventy (65.4%) were not familiar with behavioural counselling techniques such as MI. The most common patient consultation delivered by pharmacists was around adherence to medicine 22.4% (n = 50). Pharmacists expressed a need for further training in clinical areas such as mental health 25.7% (n = 80). Results from the second survey to pharmacy schools showed that Schools of Pharmacy response rate was 60% (18/30). All 18 schools stated that they teach health behaviour change consultation skills and this is mostly delivered by a clinical pharmacist. Teaching communication skills was mostly delivered as role play with peers (n = 17). Conclusion: This first national survey of communication skills training in Schools of Pharmacy shows that newer graduates have received more communication training compared to older graduates, however pharmacists’ respondents still felt that they were under prepared for behaviour change patient consultations. MI training would be welcomed by those. Practice Implications: Structured courses in communication skills, including behavioural change techniques, are needed for practicing UK pharmacists.

Background: Sharing the electronic health ‐ care record (EHR) during consultations has the potential to facilitate patient involvement in their health care, but research about this practice is limited. Methods: We used multichannel video recordings to identify examples and examine the practice of screen ‐ sharing within 114 primary care consultations. A subset of 16 consultations was viewed by the general practitioner and/or patient in 26 reflexive interviews. Screen ‐ sharing emerged as a significant theme and was explored further in seven additional patient interviews. Final analysis involved refining themes from interviews and observation of videos to understand how screen ‐ sharing occurred, and its significance to patients and professionals. Results: Eighteen (16%) of 114 videoed consultations involved instances of screen ‐ sharing. Screen ‐ sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: ‘convincing’ the patient of a diagnosis or treatment; ‘translating’ between medical and lay understandings of disease/medication; and by patients ‘verifying’ the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient. Conclusions: Screen ‐ sharing can facilitate patient involvement in the consultation, depending on the way in which sharing comes about, but the perception that the record belongs to the doctor is a barrier. To exploit the potential of sharing the screen to promote patient involvement, there is a need to reconceptualise and redesign the EHR. [ABSTRACT FROM AUTHOR]

Background Pharmacy professionals are playing an increasing role in caring for patients, yet evidence has shown their consultation skills are lacking. Objective This article aims to discuss the need to enhance pharmacy professionals’ (pharmacists and pharmacy technicians) consultation skills in England and describe the development of a national consultation skills training program to meet these needs. Methods The Centre for Pharmacy Postgraduate Education led on a project to create a consultation skills training program for all pharmacy professionals across England. The program embedded a set of consultation skills practice standards developed by a large task and finish group consisting of pharmacy professionals of varying roles from the National Health Service, private pharmacy organizations and academia. Key findings A Consultation Skills for Pharmacy Practice (CSfPP) training program, consisting of a distance learning workbook and website, was produced and disseminated to all registered pharmacy professionals in England, in March 2014. Conclusions The first consultation skills training program of its kind was created that aimed to address the growing need to improve the consultations skills of pharmacy professionals in England. Future work will examine the reception of the CSfPP among pharmacy professionals and the impact it has on their practice. [ABSTRACT FROM AUTHOR]

Parkinson's is a complex neurological disorder characterised by a large number of motor and non-motor features. As a consequence of these wide-ranging symptoms, quality of life (QoL) in patients with Parkinson's can be affected by many factors that can also vary depending on social support, activity, and environment. The large number of issues that could be raised in a single visit means it can be challenging to probe for additional disease- related problems that a patient or caregiver does not spontaneously report, although these may be the most important to the patient's QoL. To help address a patient's most important issues and QoL concerns, a group of experts set out to design a simple consultation aid to help facilitate a patient's preparation for, and participation in routine visits. The 'Parkinson's QoL Consultation Aid' is available for use and includes 17 prompts relating to Parkinson's and its potential impact on QoL. [ABSTRACT FROM AUTHOR]

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of written feedback. To systematically develop, validate and maximise the utility of a comprehensive list of strategies for improvement of consultation skills through a process involving both medical students and their clinical primary and secondary care tutors. Modified Delphi study with tutors, modified nominal group study with students with moderation of outputs by consensus round table discussion by the authors. 35 hospital and 21 GP tutors participated in the Delphi study and contributed 153 new or modified strategies. After review of these and the 205 original strategies, 265 strategies entered the nominal group study to which 46 year four and five students contributed, resulting in the final list of 249 validated strategies. We have developed a valid and comprehensive set of strategies which are considered useful by medical students. This list can be immediately applied by any school which uses the Calgary Cambridge Framework to inform the content of formative feedback on consultation skills. We consider that the list could also be mapped to alternative skills frameworks and so be utilised by schools which do not use the Calgary Cambridge Framework. [ABSTRACT FROM AUTHOR]

Summary: Medical consultations are complex and multi-faceted, requiring that nurses develop a sound knowledge and skill base in a wide variety of different areas, from communication skills to clinical reasoning and from physical assessment skills to prescription writing. Clinical assessment is an integral part of the medical consultation process, although it is often taught as a stand-alone module in nurse education programmes, such that nurses at different levels in their training will learn these skills. This article describes how patient safety skills and practices can be incorporated into clinical assessment teaching for nurses at all levels of training but especially within training programmes for Emergency Nurse Practitioners, Nurse Practitioners and for nurses involved in the assessment and management of patients with minor illnesses. [Copyright &y& Elsevier]

Purpose The purpose of this paper is to describe the results of an evaluation of teaching health coaching to GP trainees for use in consultations with patients. Design Fourteen GP trainees were invited to attend a coaching skills training course. Each trainee was asked to apply coaching skills to up to four patients with long-term conditions. The evaluation used observation, surveys, review of trainee portfolios, and interviews with GP trainees, patients, and other stakeholders. Findings This evaluation found that it is feasible and useful to train GPs in health coaching. It had positive benefits for GP trainees, their patients, and the wider system. Lessons were also learned about the timing of the training, the style and content, the challenges of practising coaching skills within clinical practice, and selecting the most appropriate patients for coaching. Limitations This is a small pilot with a keen group of GP trainees. Further research is needed to determine if such an approach provides meaningful changes to patient outcomes and whether such approaches are costeffective. [ABSTRACT FROM AUTHOR]

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The article discusses practice-based small group learning (PBSGL). It is a popular and acceptable form of learning that supports an increasing proportion of general practitioners(GP)s' continuing professional development (CPD) in Scotland. It states that it involves small groups of GPs who work through clinical modules. It mentions that PBSGL could help for future care planning, and also to find alternatives to trainees' current approaches and this provides a psychological safety to them.

This article will introduce the perceptions and practicalities framework as a way to understand medication non-adherence in the cardiac patient. Practical recommendations on how to identify non-adherence are presented; interventions to improve non-adherence are drawn from the literature of pharmacy practice and health psychology. Interventions need to be matched according to whether the patient is intentionally or unintentionally not taking his/her medicines as prescribed. Patient-centred approaches, such as motivational interviewing, are encouraged as a way to communicate effectively with patients. Distinctions between methods used in research studies and those available in clinical practice are highlighted where appropriate. [ABSTRACT FROM AUTHOR]

Objectives: To develop and test a framework for evaluating the consultation skills of practitioners undertaking medication-related consultations. Methods: Key components of medication-related consultations were identified through a literature review and compiled to form an initial consultation skills framework. This was iteratively refined through consultation with experts (n =21) to form the Medication-Related Consultation Framework (MRCF). Psychometric testing was undertaken by analyzing pharmacists’ (n =10) assessment of fifteen pre-recorded simulated consultations. Results: The MRCF consisted of 46 consultation behaviors, grouped into five sections. Performance was rated at individual behavior, framework section and global consultation levels. The MRCF discriminated between good, satisfactory and poor consultations at the global rating level (p <0.01) with good test–retest reliability (rho=0.59–0.95) and moderate inter-assessor reliability (Kendall's W =0.67). There was also good internal consistency for the five sections (Cronbach's alphas=0.58–0.97). Conclusions: The MRCF demonstrated good psychometric properties at the global and section rating levels. Some inconsistencies in assessors’ ratings of individual consultation behaviors were indentified, which may represent a future training need. Practice implications: The MRCF provides healthcare professionals with a patient-centered consultation structure, serving to identify medication-related needs and potentially support adherence. It also allows the quality of a practitioner's consultation to be evaluated. [Copyright &y& Elsevier]

The article focuses on the residency training programme in family medicine conducted at Ramathibodi Hospital in Thailand that laid emphasis on major points concerning doctor-patient communication. In the programme the academic staff prepared a lesson and a scenario and were made to act as patient in each scenario and summarize tips for dealing with difficult patients. As stated, all the 14 trainee who attended this programme reported a greater understanding of dealing with difficult patients.

The article discusses whether charm is a communication skill among primary care physicians. Topics covered include the view that charm is necessary for successful conversation, negotiation and persuasion, the use of television dramas in medical education, and the gender differences between male and female trainees in terms of charm and negotiation skills. Also mentioned is the role of general practice in doctor-patient relationship, and the development of trust.

There is increasing emphasis on the need for nurses to develop history-taking and consultation skills for prescribing and advanced clinical practice roles. This article discusses both theoretical and practical aspects that could facilitate the development of these skills using safe and structured approaches. It explores some of the origins of consultation theory, and the challenge that nurses face in integrating new consultation skills with existing nursing assessment practice. This article outlines practical generic approaches to history taking in the clinical consultation and considers the main areas that need to be covered to support safe prescribing decisions. [ABSTRACT FROM AUTHOR]