Brazil illustrates the depth of communication required in medical practice between people within health care delivery systems.

1. Communication in the heat of
battle
Victoria Brazil

2. Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a bit

3. Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a bit

4. Communication is our most
important clinical skill
•
•
•
•
•
•
Most frequently performed
Greatest diagnostic utility
Saves lives
Best medicolegal defence
Most frequent problems if poorly
performed
Best skill to keep you happy at the end of
the day

5. Your day…….
36.5 communication events per hour
A third of communication events are interruptions
10% are concurrent conversations
Coiera etc al Med J Aust
2002; 176 (9): 415-418.

7. Your consultation

8. You saving lives
•
Urgently
•
Not so urgently

9. Your patients’ safety..

10. Your best medicolegal defence

11. Your happiness at the end of
the day……..

12. Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a bit…..

13. Teamwork and leadership

14. Crisis resource Management
(CRM)
•
•
•
•
•
•
Know your environment
Call for help early
Take a leadership role
Communicate effectively
Maintain situational awareness
Distribute the workload

15. Crisis resource Management
(CRM)
•
•
•
•
•
•
Know your environment
Call for help early
Take a leadership role
Communicate effectively
Maintain situational awareness
Distribute the workload

16. Training for CRM

17. Handovers

18. Interprofessional communication

19. Tribes are big in healthcare….

20. Cross cultural communication

21. Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a bit

22. Simulation anyone..?

23. Communication skills
for “early learners”

24. “Hello my name is……..”

25. “Training in
communication skills
does not necessarily lead to
skilled communication”
BEME Guide no 2: Teaching and Learning communication
skills in medicine. Medical Teacher 1999

26. Gender matters

27. Getting more from our
SPs…..?
( Vic sees the light after
8 years of mannequin
sim……!)

31. Patient care interaction with
heightened arousal

32. More confederates…

36. SPs and ‘patient voice’
“There have been times if I am playing the
role of a woman from the lower echelons of
society, that I have actually felt the
student’s disdain for me as a person. …
…..Perhaps the student did not realise he
was showing disdain.”

37. “I have played the role of a pregnant mother
who has been told her unborn baby has Down
Syndrome. ..
In this situation I have been met with many
varied responses… From nervous laughter, to
distracted looks, to a complete lack of
empathy……. I really feel the pain of that pregnant
mother. ………I am physically crying and totally
distraught.
……………. And if the responses to this situation
are not right, I will tell the student exactly what is
lacking, which is so often sensibility.”

38. SPs and Cultural issues
‘I just can’t do this [shaking head]’
—female medical student refuses to apply
ECG electrodes to male SP Instructor

39. ‘Crossing Boundaries’
“The Standardized Patient Instructor has an
essential role in preparing and training medical
students to break through that barrier.
………….the SP has a dual role of patient
advocate and student educator, ……..requires
deep sensitivity, psychological awareness,
sociocultural knowledge and a commitment far
beyond passive participation…….
……. Medical students need clinical scenarios
that trigger conflict between the accepted notion
of duty of care and personal socio-cultural
values……….

40. ………..Triggering the conflict opens the
door to learning opportunities and bridge
building;
……that is, the creation of acceptable
compromises that will preserve the integrity
of personal beliefs and values while
upholding foundational bioethical and legal
principles……...”

41. Lets think about some
simulated patient educators
for postgraduate training?

42. Handovers
•
•
SBAR, isoBAR…….
Training needs to be customised, and
recognise context…..hierarchies, tribalism
and more

43. Simulating patient journeys
Med student …..
“When the doctor isn’t there - who looks
after the patients…?”

44. Simulating patient journeys
-communication for advanced
practitioners
“STEMI-sim”
•
Using sim to improve the care of real
patients with STEMI at our institution

46. CL prep

49. Most valuable aspects?
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•
“The debrief as an entire group, was the most
valuable part of this exercise. I felt it gave an
opportunity to identify and discuss the entire
process, (STEMI Patient), with other
personnel that normally we would only
interact with, in passing. “
“Being able to 'stand back' and observe the
process, allowing identification of potential areas
of delay and ideas for improvement ‘

50. Results – STEMI patient data
•
Baseline (july –Dec 2010)
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Post ‘stemi-sim’ ( July – Dec 2011)
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Median ‘Door to lab’ 60 mins (n= 35)
Median ‘Door to lab’ 27 mins (n= 22)
p = 0.003

51. Communication is our most important
clinical skill
There are some specific challenges in
critical care
Training helps……a bit