Communication Models: The Calgary-Cambridge Model

Introduction

Effective communication is vital in medical practice. Over the years, communication has been recognized as a fundamental skill for clinicians. Communication has a significant impact on the interaction with the patient, contribution to the health care team settings, and the overall medical community. A consultation is an intimate and private communication between the patient and the clinician (Denness, 2013). Communication helps in the analysis of health issues in the medical setting. It provides a chance to progress a therapeutic connection with the patient while listening to their stories and unfolding problems, symptoms, and feelings. Patients narrate their stories in diverse ways and using a model enhances stricture and offers a route to consultation.

Deprived of the use of models, the clinicians may omit crucial issues and oversee information that is vital for accurate diagnosis and safe practice. Many communication models can be used by practitioners, including Calgary-Cambridge, Byrne-Long, Pendleton’s, Helmann’s Folk, and Neighbour’s model (Herqutanto, 2017). Consultation models help in the preparation of Clinical Skills Assessment (CSA). The models are used to recognize communication techniques that improve understanding of the patients’ problems and promote a shared strategy for solving the issue. Consultation models are viewed as learning aids that develop practitioners’ communication skills and provides them with an internal guide to apply during a consultation to attain the best outcomes for the patient (Main et al., 2010). Practitioners are required to convey a differential diagnosis during the consultation with the patients and establish an understanding, explore ideas, expectations, concerns, and discuss a management plan keeping in mind that there are limited resources, outcome frameworks, health promotion, and information technology skills. The paper aims to address Calgary-Cambridge as a consultation model in the health care setting.

The Calgary-Cambridge Model

The Calgary-Cambridge model offers guidelines that are extensively applied to consider doctor-patient communiqué. The guide comprises fifty-six points that are divided into six subsections. The aspects describe the consultation process routine. Fifteen optional pints give planning and explanation. Excellent communication between the doctor and the patient offers tangible benefits (Burt et al., 2014). Many studies show that a positive relationship between the communication skills applied by a practitioner and other factors enhance the understanding and memory, adherence and concordance, symptoms relief, improved psychological and health outcomes, doctor and patient satisfaction as well as the patient’s safety. Research shows a correlation between active patient-doctor communication and reduction in patient complaints, treatment costs, and malpractice litigation (Herqutanto, 2017). The interaction between the doctor and patient may be challenging to learn and master entirely since it is a delicate process. Therefore, a systematic and precise assessment and guiding tool are vital for practitioners. The Calgary-Cambridge model was developed by a group from the University of Calgary based in Canada and The University of Cambridge based in England. The model describes an approach that delineates and organizes particular skills that research and support effective communication with patients. The model provides an easy-to-use system for the practitioners that act as complementary to the nursing traditional general valuation approach (Denness, 2013). The guide briefly defines the seventy-one principle communication process skills. However, practitioners find it impractical to follow all the steps, especially in daily consultation practice that has time limitations and patients are in infinite numbers. Over the years, the guide has been modified, and it’s easy for practitioners to use in their daily consultations.

The first section in the Calgary-Cambridge model is the initiation of the process. The initiation of the consultation has separate and unique objectives that should be finalized before shifting to the primary history-taking and gathering information. The step involves the preparation of the encounter, the establishment of a rapport with the client, and the identification of the reason behind consultation (Gold et al., 2017). Practitioners are required to be very attentive during the consultation since lack of attention in this session can have an advanced effect on clinical reasoning, performing effectively, perceptual skills, and impartiality in the discussion. Practitioners are required to review the patient’s notes during the pre-consultation period to create attentiveness to the prior issues or treatment that the patient may be undergoing or the medication that the client may be taking. The patients should be provided with a safe, comfortable, and private environment since the likelihood of the patient being overheard or interrupted may discourage them from telling their story. The physician should handle any negative stress before the patient gets into the room (Herqutanto, 2017). Patients seek consultation for a range of reasons including psychological, physical, and social reasons. Therefore, the practitioner should hang on for some time to deal with emotions and stress that may result from the previous encounter. Distraction during the consultation can lead to clinical error and affect performance. If the practitioner finds them distracted during the discussion, they should try to take a break or speak to a colleague to ensure that they regain focus for the following appointment.

The success of the consultation depends on the level of communication efficiency between the patient and the practitioner. Effective communication is generally required for people to understand each other even in our daily life. Studies connect the clinical outcomes to the quality of communication (Main et al., 2010). Maintaining and developing rapport form a basis for effective consultation and excellent communication. Rapport involves the ability to connect emotionally and mentally with the patient, hence promoting mutual respect and trust. To establish a rapport, clinicians should greet the patient, introduce themselves, and reveal their role at the beginning of the consultation. It is essential to tell and use the patient’s name. The practitioner should also make the patient feel welcome by being attentive to their coziness and using non-verbal signs like smiling, handshake, and eye contact. The Calgary-Cambridge model also provides a guideline on the distance that the clinician should maintain from the patient, which is viewed as an essential aspect of rapport (Gold et al., 2017). The practitioner should give the patient as much time as possible during the early period of consultation without interruption. This gives the patient time to say what is relevant. Interrupting the patient makes it hard for them to disclose the issue.

In the second session, the guide, as described by the model, involves gathering information. Information gathered helps the clinician to integrate clinical findings with a comprehension of how patients deal with symptoms and obligation ideas and distress that they may display about their condition (Burt et al., 2014). Most patients tend to rehearse their narration before seeing the doctor. However, they may still require help to convey themselves and ultimately offer their medical history. Help in the patient’s history helps to gather information, find clues, and stay on track to solve the problem. Accurate history provided by the patient may reveal eighty percent or more information that is required to come up with a diagnosis, therefore taking the patient’s history is vital to the consultation process (Gold et al., 2017).

Active listening is the most central communication skill in obtaining an extensive history. Active listening consists of both non-verbal and verbal behaviors. Using open questions during the consultation, reassure the patient to explain more on their story. For example, when a practitioner tells the patient to explain more about the chest pain, the patient is encouraged to reveal more.

On the other hand, closed questions that encourage yes or no answers may not gather as much information as required. The calgary-Cambridge guide helps the clinician to avoid omitting essential queries when talking with the patient (Main et al., 2010). A good starting point when taking the patient’s history is the presentation of the problem since it is the patient’s primary concern. Exploring the patient’s idea on the problem consists of asking what the patient think might be the issue. Gathering information also involves finding out what aggravates or relieves the symptoms. Other information to gather in this session includes the quality of the symptoms, the region when the symptoms are experienced, relevant family history, psychosocial history, and lastly review the system to double-check that no relevant information has been omitted (Sommer et al., 2016). Chunking and checking is an important communication skill that allows the practitioner to deliver info in small amounts and check whether the patient has understood before continuing. The ability should also be used during consultation. The practitioners also perform a physical examination on the patient, but first, they have to explain the process and ask for permission.

Explaining and planning is another session in the Calgary-Cambridge model. It involves emphasizing a collective tactic to discussing and planning therapeutic options between the consultant and the patient. Additionally, the level addresses how to give different types and the correct amount of information and methods that would aid in understanding and accurate recall (Gold et al., 2017). The partnership ensures that the patient is fully learned about the diagnosis as well as treatment choices. However, some patients find it challenging to participate in decision-making. Providing the precise extent and type of information involves exploring what the client already now, the experience they have, and the amount of information they want to know. The patients should be given the information understandably and clearly to enhance their remembrance. Ways to simplify the info include signposting and categorizing the information into discrete aspects. While explaining, the practitioner should consider chucking and checking for effective communication that aids in recall and understanding. The practitioners should also use terms and phrases that do not disrespect the patient and show care and concern. The practitioner summarises and repeats the information to double-check whether the patient has fully understood (Kaufman, 2008). The patient response can be used as a guide to the next step. While explaining the practitioner can use visual methods, such as diagrams, written instructions, and information as well as models to convey the information. The clinician can also involve the patient in planning by asking suggestions, and encouraging the patient to contribute with their ideas, negotiating a plan that is acceptable to both the patient and the practitioner (Silverman, Kurtz, and Draper, 1998). Also, offering choices and encouraging the patient to make decisions and choices and check with the patient if there are other concerns.

The last step is closing the consultation session and involves activities, such as final checking and safety netting (Sommer et al., 2016). Safety netting ensures emergency plans are made to cover anything that may go wrong. That ensures the patient is empowered, and the practitioner is protected. Safety netting comprises restating to the client what the doctor thinks the problem is and explaining how the patient can recognize unanticipated development through recurrence or persistence of the symptoms as well as the duration and timing (Kaufman, 2008). At this session, the practitioner also gives the patient directions on where to seek further assistance. Safety netting is essential, especially when dealing with an encounter where limited information is provided. Such cases may include situations where consultation is through the phone, and hence the doctor cannot use visual clues. Another case is the out-of-hours consultations where the doctor has no access to the medical history of the patient, or in case the consultant is tired or not in the usual form. Session closing gives the practitioner the last chance to ask if the patient has something else to add to the discussion. It also provides the patient with a final opportunity to state any worries or concerns (Munson and Willcox, 2007). The last session can be both beneficial and problematic. The benefits are seen when the practitioner discovers a significant problem. The practitioner may be excellent in the skills they use during the consultation, but some patients may save a problem until the end of the consultation. On the other hand, it may be problematic since discussion may require the willingness of the clinician to listen and the availability of time if the patient has something else to discuss. The last step in the session is summarising the discussion, further clarifying the care plan, and final check if the patient still agrees with the plan.

The Calgary-Cambridge model focuses more on the clues. Sometimes the practitioners may repeat the evidence back to the patient to show that they have heard and are responding and also give the patients a chance to explain further. Global Consultation Rating Scale (GCRS) mostly applies the Calgary-Cambridge guide in evaluating the communication skills used by the practitioners during medical interviews (Kurtz, Draper, and Silverman, 2017). It also helps in identifying any potential training that may be necessary and establish a strategy to improve the practitioners’ communication skills. The Calgary-Cambridge model was established in 1998 by Draper, Silverman, and Kurtz. As seen through the discussion, the model is patient-centered and helps the physician to form a connection with the patient. This is achieved by the establishment of a rapport using the patient notes in a manner that would not interfere with consultation while demonstrating sensitivity and empathy. The model puts into consideration both the doctor’s and the patient’s views and suggestions (Herqutanto, 2017). The model ensures medical interviews flow well by providing a guiding structure. Both the doctor and the patient have a clear understanding of what will happen during the consultation. For example, the doctor informs the patients that they have to as several questions they examine. The Calgary-Cambridge model tends to be practical and gives clinicians tasks to complete. It also incorporates social, physical, and psychological aspects (Munson and Willcox, 2007). The model can significantly help trainees with valuation since it contains similar features with Consultation Observation Tool (COT). There is a section in the COT that also assesses the ability of medical professionals to communicate.

The model is widely taught and promoted, but it does not suit all consultations. It may be difficult for some trainees, while some patients may dislike it. Most medical training and teaching apply the Calgary-Cambridge approach to teach the communication process (Burt et al., 2014). The key principles behind the Calgary-Cambridge concept are the amalgamation of biomedical standpoint with the patient’s in the setting of background medical, social, and personal history. Core evidence-based abilities are displayed in every consultation facet. Studies have shown that the model enhances patient satisfaction and improves clinical findings. Practitioners should be encouraged to use the guide to ensure relevant information is not emitted and that the patients receive an accurate diagnosis as well as effective treatment and follow-up.

Conclusion

Skills applied in inpatient consultation and taking history are becoming exceedingly important in nursing, and other medical fields as practitioners increase borders of their profession and work more independently. Consultants take accountability for their sovereign decision-making. Therefore, clinicians must develop practical consultation skills to strengthen clinical decision-making and problem-solving. The Calgary-Cambridge consultation guide (CCCG) provides a framework that significantly supports direction and structure and provides the skills necessary for adequate consultation. The guide explains the impacts of developing a rapport and being ready for a consultation. The communication models allow the doctors to process the non-verbal and verbal information displayed to them during the consultation. 

References

1. Burt, J., Abel, G., Elmore, N., Campbell, J., Roland, M., Benson, J., and Silverman, J., 2014. Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview. BMJ Open, 4(3), p.e004339.
2. Denness, C., 2013. What are consultation models for? InnovAit, 6(9), pp.592-599.
3. Gold, J.I., Boulos, R., Shah, P., and Rossi-Foulkes, R., 2017. Transition consultation models in two academic medical centers. Pediatric Annals, 46(6), pp. e235-e241.
4. Herqutanto, H., 2017. Modification of Calgary-Cambridge Observation Guide: a more simplified and practical communication guide for daily consultation practice. Health Science Journal of Indonesia, 8(2), pp.111-117.
5. Kaufman, G., 2008. Patient assessment: effective consultation and history taking. Nursing Standard, 23(4).
6. Kurtz, S., Draper, J. and Silverman, J., 2017. Teaching and learning communication skills in medicine. CRC Press.
7. Main, C.J., Buchbinder, R., Porcheret, M. and Foster, N., 2010. Addressing patient beliefs and expectations in the consultation. Best Practice & Research Clinical Rheumatology, 24(2), pp.219-225.
8. Munson, E. and Willcox, A., 2007. Applying the Calgary-Cambridge model. Practice Nursing, 18(9), pp.464-468.
9. Silverman, J.D., Kurtz, S.M. and Draper, J., 1998. Calgary Cambridge guide to the medical interview–communication process. [Online] Available at http://www. GP-training. net/training/communication_skills/calgary/calgary.pdf [Accessed 24 December 2015].
10. Sommer, J., Lanier, C., Perron, N.J., Nendaz, M., Clavet, D. and Audétat, M.C., 2016. A teaching skills assessment tool inspired by the Calgary–Cambridge model and the patient-centered approach. Patient Education and Counselling, 99(4), pp.600-609.