Health Care Communication (formerly DocCom) was developed by Drexel University College of Medicine and is used by SGUSOM as its web-based communication skills curriculum. The modules listed in this appendix are organized within the SGUSOM curriculum as Communication Skills Parts A and B. Part A consists of the Basic Modules and Essential Elements and is completed before clinical placement. Part B consists of the remaining modules and is completed during the clinical years through clerkship-assigned modules and modules that must be completed before graduation.
| Chapters | Learning Objectives |
| Basic Modules | |
| Overview | Describe the importance of self-awareness in effective communication |
| Describe seven essential elements of clinical communication | |
| Describe eight evidence-based outcomes linked to clinician communication | |
| Describe four common deficiencies in clinicians’ communication skills | |
| Describe four features that underlie effective communication skills teaching | |
| Mindfulness and Reflection in Clinical Training and Practice | Describe how self-awareness and mindfulness limit mistakes and improve clinical practice |
| Describe why experience seldom builds competence | |
| Describe fundamental qualities of mindful practitioners | |
| Cite 4 “reflective questions” that lead to mindfulness | |
| Describe why mindfulness and self-awareness are essential to improving professionalism | |
| Discuss with a colleague how you might practice becoming more mindful and self-aware, and consider the pros and cons of starting such a practice | |
| Therapeutic Aspects of Medical Encounters | Describe core concepts underlying the therapeutic efficacy of the clinician patient relationship |
| List the therapeutic goals of medical encounters | |
| Describe strategies that advance the therapeutic aims of your medical encounters | |
| Balance and Self Care | Describe common physician personality characteristics that may contribute to unhealthy personal beliefs, behaviors and habits |
| Describe common causes and manifestations of professional burnout | |
| Describe healthy cognitive, emotional and behavioral practices that promote your well-being and sustain you throughout a career in medicine | |
| Describe three changes in attitude, behavior or practice you could commit to undertaking that would improve or sustain your well-being | |
| Disclose these changes and discuss their importance and potential barriers to implementation with two important people in your life | |
| Discuss why clinician well-being results in improved relationships and healthcare outcomes | |
| Essential Elements | |
| Integrating Patient-centered and Clinician-centered Interviewing | Describe the content, and process of a “complete” medical history |
| Describe the difference between the tasks or functions of an interview and its structure, | |
| Describe patient-centered and doctor-centered interview goals and skills,\ | |
| Describe the different contributions of patient-centered and doctor-centered skills to understanding the patient's full (biopsychosocial) history | |
| Describe the content and structure the written medical history. | |
| Build a Relationship | State at least five reasons why relationship building is key to medical care |
| State three key principles of relationship building | |
| Demonstrate five basic relationship building skills | |
| Open the Discussion | Discuss the importance and rationale for eliciting all patient concerns to establish, through negotiation when necessary, the visit agenda |
| Discuss and implement communication strategies at the beginning of each medical encounter to elicit a comprehensive list of patients' concerns | |
| Discuss and implement communication strategies to prioritize and reach agreement on the agenda | |
| Identify personal barriers to the elicitation of concerns, and the risks of failure to do so | |
| Gather Information | Describe the primary goals of relationship-centered information gathering |
| Describe and demonstrate relationship-centered strategies for gathering information | |
| Describe and demonstrate strategies for encouraging patient participation in gathering information | |
| Use your knowledge and skills to gather information effectively from a patient | |
| Understand the Patient's Perspective | Endeavor to more consistently appreciate your patients’ perspectives and to “see the world through their eyes” |
| Understand how patients’ social contexts affect their health and illness behaviors. | |
| Describe and demonstrate skills to elicit patients’ social context, explanatory models, concerns and expectations. | |
| Explore personal assumptions and potential barriers to understanding patients’ contexts and perspectives. | |
| Share Information | Understand the challenges that you will face when sharing information with patients |
| Describe and demonstrate a systematic, relationship-centered approach to sharing information | |
| What skills do you need to practice to improve your relationship-centered sharing of information, and when will you do this? | |
| Reaching Agreement | Describe conceptual models of decision making and reaching agreement. |
| Describe evidence regarding patient participation in their decisions and care. | |
| Describe their own attitudes, preferences and approaches to partnering with patients in decision making. | |
| Describe and demonstrate skills for reaching agreement about decisions and plans | |
| Provide Closure | Describe clinician behaviors that facilitate effective visit closure. |
| Describe clinician and patient behaviors that interrupt or prolong closure. | |
| Describe your approach to saying goodbye to patients in various clinical settings. | |
| Describe and demonstrate specific communication skills for providing closure. | |
| Advanced Elements | |
| Responding to Strong Emotions: Sadness, Anger, Fear | Demonstrate the ability to respond to patients’ emotions with empathic statements. Name, Understand, Respect and Support (NURS) are reminders of some effective examples. |
| Describe the effects (on patients and on clinicians) of clinicians' empathic responses to emotions, as well as the effects of ignoring emotions. | |
| List typical origins of strong emotions. | |
| Describe how maintaining clear personal boundaries promotes clinical effectiveness and professional growth. | |
| Describe situations that may require referral or medication as adjunctive responses to strong emotions. | |
| Nonverbal Communication: It Goes Without Saying. Computers & EHRs | Describe four categories of nonverbal communication |
| Describe four patterns of nonverbal behavior seen in medical settings | |
| Describe four types of proxemics (shaping space) that foster rapport | |
| Discern and name nonverbal behaviors in video clips in this module | |
| Demonstrate ability to match and lead during conversation | |
| Employ computers and EHRs as allies in improving patient interactions | |
| Understanding Difference and Diversity in the Medical Encounter: Communication across Cultures | Describe how cultural differences affect patient-clinician relationships. |
| Demonstrate skills of curiosity, empathy, and respect in cross-cultural encounters. | |
| Demonstrate skills of “empathic, curious confrontation” and “respectful explanation” in management of uncomfortable cross-cultural encounters. | |
| Reflect on your own cultural influences and explore how they affect medical interviewing | |
| Promoting Adherence and Health Behavior Change | Describe the “5 A’s” model for helping patients change a behavior. |
| Assess patients' "stage" of change, and their conviction and confidence about changing. | |
| Explore and appreciate patients' attitudes, values, and feelings about behaviors and changes in behaviors. | |
| Respond empathically and collaboratively when patients voice ambivalence or reluctance about changing behavior, including risky behaviors. | |
| According to patients' readiness, collaborate and negotiate your recommendations and advice about adherence and other behavior changes. | |
| Shared Decision Making | List and describe the key elements of shared decision making |
| Describe the ethical rationale for shared decision making | |
| Involve your patients in clinical decision making | |
| Explore your patients' desire for a role in decision making | |
| Incorporate patient decision aids into shared decision making | |
| Asking about Sexuality | Describe the rationale for routinely asking sexual history questions in medical interviews |
| Demonstrate the skills of engaging patients in conversations about their sexual relationships and concerns | |
| Describe the continuum of sexual boundary issues in patient care and demonstrate skills in responding effectively to patients who cross boundaries. | |
| Exploring Spirituality and Religious Beliefs | Describe the rationale for exploring and supporting the role of religion and spirituality in patients' lives. |
| Ask patients about the importance of religion and spirituality in their lives as part of taking a history. | |
| Explore whether patients' religious beliefs give meaning and support to them in their experience of serious illness, suffering and death. | |
| Offer patients religious and spiritual supports such as referrals to clergy. | |
| Describe possible professional boundary violations with respect to religious and spiritual matters. | |
| Communicating in Specific Situations | |
| The Family Interview | Demonstrate how to join with both patient and family, |
| Demonstrate setting the agenda with the patient and family in the room, | |
| Demonstrate the most effective method of gathering information and managing a medical family interview, | |
| Identify methods of responding to family members' emotions, | |
| Describe an effective method for establishing a plan with a family during a medical family interview. | |
| Communication in the Pediatric Encounter: Attending to Relationships and Values | Describe the rationale for including children in the interview and demonstrate skills for engaging children and their parents /caregivers. |
| Describe the typical illness concepts of preschool children and school-age children. | |
| Describe techniques for communicating with children of varying ages including the use of play and rapport-building strategies. | |
| Elicit the child’s and parents’ perspectives on the illness/problems as well as their understanding of treatment plans. | |
| Invite and elicit feelings of parents and children; acknowledge and accept those emotions. those emotions. | |
| Describe ways to show empathy in the pediatric interview | |
| Share diagnostic and treatment information gently with kindness, respect and compassion; avoid jargon. | |
| Identify core values for each healthcare interaction and consider ways you might demonstrate values. | |
| Communicating with Adolescents | Describe the health impact of exploring the psychosocial and environmental context of adolescent behaviors. |
| Utilize trust-building communication strategies to promote open, honest and mutually respectful collaborative communication with adolescent patients. | |
| Establish an active, collaborative dialog about health promotion (do not simply "tell" or "lecture"). | |
| Help teens recognize their strengths, and encourage change in risk-behaviors by building on strengths. | |
| Compassionately explore how stress drives risk-behaviors. | |
| Compassionately explore how the mind-body connection generates somatic symptoms | |
| Communicating with Geriatric Patients | Describe typical physical and sensory problems that impair communication with elderly patients. |
| Assure older patients’ comfort and make modifications that will enable effective communication. | |
| Describe five clues to cognitive impairment that may be apparent in patients who are well-dressed, socially appropriate and not obviously demented. | |
| When patients describe symptoms in terms that seem vague or downplayed, ask for more detail and consult any caregivers or family members who are present. | |
| Ask patients’ preferences about decision-making, even if they are cognitively impaired or debilitated; address caregivers later. | |
| Initiate conversation about end-of-life values, driving impairment, suicidality, abuse and neglect, and other sensitive topics; utilize open-ended questions and statements of empathy to build relationship and trust. | |
| Even with cognitively impaired patients, encourage a culture of open decision-making; involve caregivers as needed. | |
| Assess stress levels in caregivers and help them reduce caregiver burden. | |
| Value collaboration and teamwork with other health professionals and help manage and resolve team conflict. | |
| Tobacco Intervention | Describe why tobacco dependence is a chronic and relapsing disorder. |
| Use the importance and confidence scales to assess patient readiness to quit smoking. | |
| Describe, employ and adjust counseling skills that help patients who are uncertain about quitting, ready to quit, not ready to try or relapsed. | |
| Increase the likelihood of treatment success by tailoring dialogue and treatment planning to patient beliefs, prior attempts and current readiness. | |
| Motivating Healthy Diet and Physical Activity | Demonstrate ability to properly Assess diet and activity – for lean or overweight patients. |
| Elicit (Assess) patients’ perspectives about diet and activity, respond with empathy and support patients’ autonomy. | |
| Assess patients’ interest in changing diet and activity, Advise them about healthy goals and negotiate Agreement on specific goals. | |
| Assist patients in achieving their change goals, and respond positively to lack of success. | |
| Anxiety and Panic Disorders | Describe the key features of anxiety and common anxiety disorders. |
| List common somatic symptoms that lead anxious patients to seek treatment in office settings. | |
| List medical conditions that can masquerade as an anxiety disorder. | |
| Elicit anxious patients’ symptoms and perspectives. | |
| Assess patients for behavioral and somatic comorbid conditions. | |
| Inform patients how mind-body interactions produce somatic symptoms-using the “ask-tell-ask” format (see Essential Elements modules Integrated Patient-centered and Clinician-centered Interviewing and Share Information). | |
| Inform patients about treatment options and explore their interest in treatment, using the “ask-tell-ask” format. | |
| Communicating with Depressed Patients | Help patients and families distinguish the illness of depression from grief and depressed affect. |
| Name the two cardinal features of depression and list the nine key symptoms of depression. | |
| Use the PHQ9 to screen for depression, to establish a diagnosis and to guide management. | |
| Assess suicidal risk using the P4 screener. | |
| Guide and assist patients in accepting a diagnosis of depression, exploring treatment options and establishing treatment plans. | |
| Use Brief Action Planning (BAP) to support self-management. | |
| Intimate Partner Violence | State the prevalence of intimate partner violence in clinical practice. |
| Describe the severe detrimental impact of violence not only on the victim but also on the family unit. | |
| List the multiple ways intimate partner violence affects how patients present to their practitioners. | |
| List the principles of helping patients move from victim to survivor of abuse. | |
| Use appropriate communication behaviors to respond to patients when you discover domestic violence. | |
| List interventions that may make the situation worse and help patients avoid them. | |
| Name community resources and describe how to utilize them on behalf of patients who are victims of domestic abuse. | |
| Alcohol: Interviewing and Advising | Describe healthy (moderate) drinking, At risk drinking and Alcohol Use Disorder. |
| Describe 2 effective screening strategies for alcohol problems. | |
| Describe the additional information obtained by employing the full 10- question AUDIT. | |
| List 2 physiologic features and 2 psychological features of Alcohol Use Disorder. | |
| Conduct a brief intervention. | |
| List 4 medications that are approved and effective for AUD treatment. | |
| Demonstrate communication skills that minimize patient defensiveness when asking alcohol use questions, making recommendations and adjusting goals. | |
| The Clinical Assessment of Substance Use Disorders | Describe the essential components of the medical model of substance use disorders. |
| Delineate the interviewing skills necessary to screen effectively for substance use and abuse. | |
| Recognize the high rate of psychiatric and medical co-morbidities and effectively screen patients for these disorders. | |
| Demonstrate skills for evaluating patients’ stage of change, including their readiness to accept the diagnosis, motivation to make change, and sense of self-efficacy. | |
| 5. Demonstrate relationship-centered skills to clearly recommend treatment to patients with substance use disorders. | |
| Describe the skills required for addiction prevention counseling. | |
| Define the skills that help set respectful limits on patient requests for prescription medication. | |
| Demonstrate awareness of how clinician/clinician attitudes toward patients with substance use disorders impact recognition, diagnosis, and treatment of patients. | |
| Demonstrate knowledge of substance use disorder treatment standards and the ability to recommend appropriate referrals. | |
| Initiating Medication-Assisted Treatment (MAT) for Opioid Use Disorder (OUD) | Describe the severity and consequences of Substance Use Disorder (SUD) and Opioid Use Disorder (OUD). |
| Explain the pathophysiology of OUD. | |
| List the criteria for diagnosis of OUD. | |
| List and describe the options for treatment of OUD. | |
| Describe the elements of Motivational Interviewing (MI). | |
| Demonstrate how to use MI to develop a treatment plan with your patient. | |
| Discuss how you will practice Trauma-Informed Care. | |
| Managing Chronic Pain: Non-Pharmacological Approaches | Distinguish the many factors that contribute to the experiences of acute and chronic pain. |
| Describe non-pharmacological approaches to chronic pain. | |
| Demonstrate using Motivational Interviewing to develop an action plan including opiate titration. | |
| Explain the use of pain contracts in managing chronic pain. | |
| Describe the use of Acceptance Commitment Therapy (ACT) in the management of chronic pain. | |
| Medically Unexplained Symptoms MUS | Describe steps required to establish a diagnosis of “Medically Unexplained Symptoms” (MUS). |
| Establish and maintain effective relationships with patients with MUS. | |
| Assist patients with MUS in understanding their illness. | |
| Negotiate and agree on specific treatment plans with patients with MUS. | |
| Assist patients with MUS in making a commitment to actively participate in their care. | |
| Advance Care Planning | Describe nine ways that ACP benefits patients, families and healthcare providers. |
| Demonstrate a seven-step approach to ACP. | |
| Focus on patients’ values and goals, rather than treatment options for ACP. | |
| Describe differences between Advance Care Planning and Advance Directives. | |
| Sharing Serious News | Describe a six-step protocol for sharing serious news. |
| ` | Demonstrate four skillful responses to the expressed feelings of patients receiving serious news. |
| Name four common barriers or pitfalls in sharing serious news. | |
| Demonstrate an understanding of the six steps and the ability to use them in a serious news delivery situation. | |
| Communication Near the End of Life | Communicate effectively and compassionately with patients, who are near the end of life. |
| Communicate news of a serious illness or progression towards death in a more sensitive manner. | |
| Discuss prognosis openly, accurately and with empathy. | |
| Elicit your patients' goals of care, and update goals regularly. | |
| Suggest interventions and limits that are consistent with each patient's goals in light of knowledge of their clinical situation. | |
| Describe palliative care and hospice services to patients and families, and assist them in deciding whether or not to accept referrals. | |
| Dialog about Unwanted and Tragic Outcomes | List reasons why an informed consent dialogue helps to prevent undesired outcomes. |
| Describe ethical and professional principles that support honest disclosure of unwanted outcomes and errors. | |
| Describe seven key aspects of a disclosure discussion: setting the stage, reviewing background facts, responding to feelings, including everyone, avoiding hedging and conjecture, apologizing and arranging follow up. | |
| Verbalize respectful responses to the feelings of patients, families and clinicians when communicating about medical error. | |
| Describe principles for managing common error situations involving other clinicians. | |
| Ending Clinician-Patient Relationships | Describe typical psychological and behavioral impacts of clinician-patient separations, for both clinician and patient. |
| List three patient characteristics that increase vulnerability to transfer of care. | |
| List three topics that should be covered in discussions of transfer of care. | |
| List three reasons why patients request transfer of care. | |
| Review with a patient the steps and procedures for the transfer of care to a new clinician. | |
| Elicit patient perspectives and feelings about transfer, and respond with empathy to typical "negative" reactions such as sadness, anxiety and anger. | |
| Communicating with Colleagues | |
| Oral Presentation | Use the STAGE framework to organize and deliver effective oral presentations. |
| List key principles of effective case presentations, and list common problems that diminish effectiveness. | |
| Adjust presentation timing and content to meet relevant clinical and educational goals. | |
| Request, receive and give feedback about oral presentations. | |
| Use the ICE StAR format to create plans that incorporate patients’ perspectives. | |
| Use the SBAR and IPASS formats to efficiently and accurately transmit information among team members. | |
| HIGH PERFORMANCE TEAMS: Diversity and RESPECT | List five stages of team development. |
| List the skills of the RESPECT mnemonic. | |
| Elicit perspectives across all levels of hierarchy, professional roles and diversity of background. | |
| Respond with empathy when team members express feelings and concerns. | |
| Affirm the value of difference and diversity to team effectiveness. | |
| Identify skills that help teams collaborate when challenged by change or conflict and when debriefing adverse events. | |
| Communicating with Impaired Clinicians | Describe diverse ways in which a high level of professional performance can be impaired. |
| Remember a time when you had difficulty performing well as a clinician or student, and describe the contributing factors, how your work was affected, and how colleagues communicated with you. | |
| List reasons for taking action about impaired colleagues, rather than remaining silent. | |
| Describe and demonstrate skills for effective communication with colleagues who are distressed or impaired in some way. | |
| Giving Effective Feedback: Enhancing the Ratio of Signal to Noise | Describe characteristics of a learning environment that facilitates and encourages feedback. |
| Describe general feedback principles. | |
| Describe the problems associated with giving effective feedback and how to overcome them. | |
| Boundary Issues | Describe 'boundary-challenging' situations that clinicians commonly encounter. |
| Reflect on appropriate boundary limits for clinicians in general and yourself personally. | |
| Describe strategies for deciding how to respond to commonly encountered boundary-challenging situations. | |
| Demonstrate the ability to compassionately appeal to professional standards when encountering a boundary-challenging situation by stating a general principle to which you adhere, clarify the nature of the relationship, or postpone a decision. | |
| Effective Clinical Teaching | Describe elements of an effective teaching session. |
| List your own strengths and weaknesses as a teacher. | |
| Lead small groups of learners more effectively. | |
| Enhance your effectiveness as a clinic preceptor. | |
| Improve your mentoring of junior colleagues. |