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2018

EFFECTIVE
COMMUNICATION
SKILLS FOR PATIEN

ROSOMED

Russian experience

simulation training

in Clinical Communication Skills

01.04.2018
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The material was prepared with the participation of:

Bottaev N.A., Gorina K.A., Gribkov D.M., Davydova N.S., Dyachenko E.V., Kovtun O.P.,
Makarochkin A.G., Mukhametova E.M., Popov A .A., Samoilenko N.V., Serkina A.V., Sizova
Zh.M., Sonkina A.A., Teplyakova O.V., Chemekov V.P., Chernyadiev S.A., Shubina L.B. ., Erdes
S.I.

annotation

The publication describes the problem of transition to a patient-oriented model of

communication in domestic clinical practice and the Russian experience of using international
recommendations in this area. Some research results are presented on which the evidence
base for effective communication in clinical practice is built. A list of skills is published that
provides a patient-centered model of counseling, known in the world as the Calgary-Cambridge
model of medical consultation. The material was compiled based on the results of a course held
on March 12-14, 2018 for teachers and heads of departments of medical universities in Russia,
conducted by representatives of the International Association for Communicationin Healthcare
in Moscow at the Methodological Center for Accreditation of Sechenov University. The name of
the course is "Evaluation of communication skills during the procedure of an objective structured
clinical examination (OSKE)" The purpose of the publication is to invite domestic specialists to
further study this area.

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Table of contents

Introduction to the problem............................................................... ................................................. .......................................4

Situation today ............................................................... ................................................. .........................................6

Findings from Some Research in Clinical Communication Skills ..........................................................7

Calgary-Cambridge Guide to Medical Communication.................................................................. .........10

Example of a checklist for assessing communication skills demonstrated at exam stations..15

Algorithm of work with the control system of the simulation center "Argus": .............................................. ..17

Description of the buttons of the direct checklist .............................................. ..............................................nineteen

Sources of information................................................ ................................................. ................................twenty

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Introduction to the problem

In the passport of the healthcare "Security
priority project by qualified specialists” (“New personnel of modern healthcare”), one of
the key tasks is to provide quality medical care. A valid indicator of the quality of care is the number of patient complaints
about the medical services provided. An analysis of the structure of complaints explicates the following: “90% of conflicts
arise due to the inability or unwillingness of the doctor to explain information about the state of health to the patient or his
relatives”1 .

In the international citation databases Scopus, WoS, the peak of publication activity on the problem of patient-
oriented communication falls on the 70-80s. Empirical evidence has provided a scientifically sound basis for highlighting
effective communication skills with patients. The criteria for the effectiveness of medical counseling are satisfaction of patients
and doctors with the process and results of medical care, increased compliance and improved clinically significant outcomes.
The publications provide convincing evidence that the use of patient-centered communication skills by medical professionals
correlates with the effectiveness of their professional activities, psycho-emotional well-being and job satisfaction, and also
affects the well-being and health of the patient.

A large-scale reform of the personnel training system for the domestic healthcare system, the need for which has
long matured and is recognized by all participants in this process, is sweeping across Russia. One of the tasks of modern
reforms in the health care system is to replace the paternalistic model of interaction between medical personnel and the
patient with a partner one. There are different ways to implement this transition, and, unfortunately, at the moment not a
single domestic team has proposed a single balanced and specific program in this direction. The Center for Continuing
Professional Education, which is a structural subdivision of the Methodological Center for Accreditation of Sechenov
University, was concerned about the search for specialists in the field of professional training in communication skills. It was
possible to make significant progress in this matter thanks to cooperation with A.A. Sonkina, founder of the School
of Professional Medical Communication Skills "Message" and a member of the authoritative European (since 2017 -
International) Association for Communication in Medicine (International Association for Communication in Healthcare)

2
. The fruits of this collaboration, which has been ongoing since 2014,
steel:

1) Numerous events for practitioners and students, developed on the basis of a proven effective methodology
promoted by the International Association for Communication in Medicine, which showed the applicability, persuasiveness
and relevance of such a scientifically based and structured communication model as the Calgary-Cambridge model of
medical consultation for domestic medical specialists and their patients and its possibilities for solving many urgent problems
of today's clinical practice in Russia. At present

1
Website of the League of Patient Defenders [Link]

[Link]

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The Center hosts programs such as:

- commercial course for practitioners;

- preparation of trainers and simulated patients for training and for examinations;

- providing controlled self-training of students through the tutor movement;

- a cross-cutting program on communication skills for students of the Faculty of Pediatrics at the
Department of Propaedeutics of Children's Diseases (Head of the Department Professor Erdes S.I.), also
domestic research on the problems of transition to a patient-oriented model of interaction has been launched at
this department;

- a master class for those who want to try their hand at status tests
"Moscow doctor";

- development, testing and holding of various examination

activities, including on a commercial basis, upon request
from responsible employers.

2) Implementation of interaction with the Ural State

Medical University, Yekaterinburg, represented by the head
of the Department of Psychology and Pedagogy, Ph.D.,
associate professor, head of the working group for the
development and implementation of the communication project in medicine Elena Dyachenko. The working group
of the university, the ideological inspirer and scientific leader of which was the Vice-Rector for Academic Affairs
(from 2005 to 2017), Doctor of Medical Sciences, Professor Nadezhda Davydova, created a project of a cross-
cutting educational interdisciplinary module on communication skills based on the same Calgary -Cambridge

models.

3) The result of the cooperation of specialists from the two medical universities was, among other things,
the conduct, with the support of the public organization ROSOMED, of a pilot study of a jointly developed
examination station on communication skills during the primary accreditation of graduates studying in the specialty
"Medicine" in 2017. The results of the pilot were submitted as a report to the Ministry of Health of the Russian
Federation.

4) Growing awareness among professionals and officials of the medical education system of the need to
introduce effective communication skills into the practice and training of medical specialists in Russia and, at the
same time, the high complexity and resource intensity of such training.

Studies show that the effective development of communication skills is most appropriate in the format of
practical training, which implies the possibility of training with the participation of simulated patients - specially
trained assistants who perform a number of important tasks, such as role-playing, feedback and support of the
trainer (facilitator) in creating a safe learning atmosphere. . Effective work of a trainer implies perfect mastery not
only of theoretical material (knowledge of the skills and evidence that supports them), but also of a complex
teaching methodology, including orientation on the participant's request, role-play moderation and

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effective feedback based on the results the participant wants to achieve. Training effective trainers
and simulated patients in this way is time consuming and expensive.

Situation today
At the moment, the Department of Education and Personnel Policy in Healthcare of the
Ministry of Health of Russia has entrusted the Methodological Center for Accreditation of
Specialists with the development of methodological support for a station for assessing
communication skills with the prospect of its introduction into the procedure for primary
accreditation of medical specialists in all universities of the country in the coming years.
To help in this difficult task, at the request of A. Sonkina, the International Association for
Communication in Medicine allocated a grant for the representatives of the association to conduct
an intensive course "Assessment of communication skills during the procedure of an objective
structured clinical examination (OSCE)". The course participants were the organizers of simulation
training and teachers of medical universities in Moscow, St. Petersburg, Yekaterinburg, Kazan,
Voronezh, Krasnoyarsk, Perm, Makhachkala, Tver, Novosibirsk, Nizhny Novgorod, Kursk, Ufa,
Tomsk, Arkhangelsk, Vladivostok. Moderators were Professor Mark Van Nuland (MD, Academic
Center for Primary Health Care, Leuven, Belgium), Sandra Winterbourne (Head of Consulting Skills,
Norwich Medical School, University of East Anglia, Norwich, Norfolk) and Kim Taylor ( simulated
patient). The course took place on March 12-14, 2-18 at the Methodological Center for Accreditation
of Specialists (Center for Continuing Professional Education).

The structure of the course included a lot of interactive and group exercises, allowing not
only the presentation of new information by the facilitators, but also the exchange of experience and
thoughts between the participants. The first day of the course was devoted to introducing both the
model and specific counselingskillsand practicing skill discovery by observing videotaped or simulated

counseling segments. The second day covered the principles of assessing communication skills
and included an exercise in simulating four different examination stations, giving participants the
opportunity to experience this type of examination for themselves, acting as either an examiner or
an examinee. The topics of the stations included questioning the patient, giving difficult information,
and explaining.

Both presenters and participants highly appreciated the course, despite the difficulties in
organization, the need for translation and the abundance of contradictions and disputes that arose
in the course of work. The high interest and involvement of the participants, on the one hand, and
the great professionalism and experience of the facilitators, on the other hand, led to the fact that
the course was rated as a success by all. As a result of the event, a working group on methodological
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accompanying the organization of the OSKE Pilot Station for assessing communication skills
during the initial accreditation of specialists in 2018 in the specialty "Medicine".

Results of some studies in the field of clinical

communication skills3
Scores for the course of doctor-patient communication received at the Canadian state
qualification examinations are significantly correlated with the number of complaints to medical
regulatory bodies - a linear relationship was found over 12 years of observation (Tamblynetal.
2007).
Research on patient satisfaction, compliance, recall, and physiological outcomes supports
the need for a broader view of history taking that includes the patient's life world and not just the
biological—and more limited—doctor's approach (Stewartetal. 1995).

Patients' ideas, anxieties and hopes are not part of the traditional medical history and
this too often results in their absence from daily clinical practice (Tuckettetal. 1985)

Stewartetal. (1979) showed that in primary care in Canada, 54% of complaints

patients and 45% of their concerns were not identified.

3Silverman , J. , Kurtz , S. , & Draper , J. (2004). Skills for communicating with patients. 2nd Edition.
Oxford: Radcliffe Medical Press. ÿÿÿÿÿÿÿÿ.ÿ. ÿÿÿÿÿÿÿÿ

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starfieldetal. (1981) recorded that in 50% of appointments in general practice, the patient
and the doctor did not agree on the nature of the main problem presented.

Beckman and Frankel (1984) showed that primary care physicians in the United States
often interrupted patients so soon after the start of their introductions—18 seconds on average—
that other equally important complaints were not detected.
ByrneandLong (1976) found that general practice consultations in the UK were most likely
to become dysfunctional if there were deficiencies in the "clarifying the reason for the patient's
visit" part of the consultation.
A study in the US ER (Rhodesetal. 2004) showed that residents only introduced
themselves to patients two out of three times and only rarely disclosed their trainee status (8%).
Despite the fact that clinicians tend to start with open-ended questions (63%), only 20% of
patients spoke about their complaints without being interrupted, and after an average of 12
seconds.
Lowetal. (2011) showed a significant number of unspoken by patients
needs and concerns in the context of primary care in Malaysia.
The classic study by Byrne and Long's (1976) of 2,000 consultations in British primary
care found that physicians exhibited a remarkably consistent style despite differences in the
problems presented to them and in patient behaviour. They often took a closed "physician-
centered" approach to information gathering that prevented patients from explaining their history
and voicing complaints.
Platt and McMath (1979) observed 300 situations in the context of inpatient care in the
USA. They found that both a "strong management style" and a premature focus on medical
issues led to an overly narrow approach to hypothesizing and reduced patients' ability to
communicate their concerns. All this resulted in inaccurate consultations.

Poole and Sanson-Fisher (1979) showed that there are large gaps in medical education
in the acquisition of relationship building skills. They showed how it is impossible to assume that
doctors already have the ability to communicate empathically with patients or that they will
acquire it in the course of their studies. Both freshman and graduate students showed weak
empathy skills.
Morseetal. (2008) showed that in oncology doctors in 90% of cases did not use
opportunity to express empathy.

Harriganetal. (1985) demonstrated that clinicians who face the patient, make eye contact,
and maintain open postures are perceived as more empathic, interested, and warm.

Swaydenetal. (2012) showed that even something as simple as sitting instead of standing
has a positive impact. In a prospective randomized control study of inpatients hospitalized for
spinal surgery, the authors found that during brief consultations after surgery, if the doctor sat
down, the patient felt that he spent more time at his bed than when he stood. And this was
observed even when in fact the difference in time was negligible.

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Patients at whose bedside the doctor was sitting were more positive about the visit and about
understanding your condition.

Koch-Weseretal. (2009), using the example of rheumatologists in the USA, showed that doctors
did not explain or used in their explanations 79% of the medical terms they introduced, and patients
rarely reacted in such a way that it was clear whether they were using these terms correctly.
interpret.

Bagley et al. (2011) studied patients' understanding of orthopedic terms in the UK and found a
low level of understanding of even the most common words in orthopedic clinics.

Murphyetal. (2004) showed that 30% of patients undergoing laparoscopy in Ireland for acute
abdominal pain either did not receive or could not clearly recall basic information about the procedure.

In a study of audio recordings of consultations with primary care physicians in the United States
(Braddocket al. 1997), it was found that only 2% of patients' understanding of what was discussed was
assessed.

Degneretal. (1997) studied oncology clinic patients with a confirmed diagnosis of breast cancer
and found that 22% of them wanted to choose the method of treatment themselves, 44% preferred to
do it together with doctors, and 34% were willing to delegate it to their doctors. Only 42% of women
believed that the degree of their participation in decision-making corresponded to their preferences.

A meta-analysis of published studies (Zolniereketal. 2009) showed that communication in

healthcare delivery is highly correlated with patient discipline, which increases when doctors are taught
communication skills.

Bensingetal. (2006) compared the characteristics of communication between general

practitioners and patients in 1986 and 2002. Contrary to expectations, in 2002 patients were less
active, spoke less, asked fewer questions, expressed fewer fears and worries. Physicians provided
more medical information, but were less likely to express concern about the condition of their patients.
In addition, they were less involved in process-oriented activities and partnership building.

Hayetal. (2008) showed that 87.5% of patients coming to their first outpatient rheumatological
appointment looked up information about their symptoms or suspected diagnoses in advance, with
62.5% of them on the Internet. During the consultation itself, only 20% of those who searched for
information online discussed it with the doctor.

Bowesetal. (2012) showed that patients used the Internet to be more aware of their health, to
make the best use of their limited consultation time, and to get them to take their problem more
seriously. Patients expected doctors to accept this information, discuss it, explain it, place it in the
proper context, and express their professional opinion. Patients tended to prioritize physician opinion
over Internet information. However, if the doctor appeared uninterested, dismissive, or arrogant,
patients reported to the researchers about the damage done to the doctor-patient relationship,
sometimes to the point of seeking another opinion or changing doctors.

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In our opinion, the above examples testify to universal problems in the field of clinical
communication, which do not depend on any features of the mentality and economic structure of
society.

Calgary-Cambridge Guide to Medical Communication4

This guide was developed by the University of Cambridge School of Medicine and the
University of Calgary, Canada. First published in 1996 by Jonathan Silverman, Suzanne Kurtz.

At the moment, A.A. Sonkina is preparing the original and complete translation
publications in Russian with all the rights of the owners of this material.
In this consultation model, five successive stages are distinguished. At each stage there
are tasks that need to be solved using certain skills. There are also two continuous processes
that go from the beginning to the end of the consultation.

Calgary-Cambridge model of
medical consultation

Start of consultation

Collection of information
Relationship
Structuring Building
Inspection

clarification
and planning

Completion

4Silverman , J. , Kurtz , S. , & Draper , J. (2004). Skills for communicating with patients. 2nd Edition.
Oxford: RadcliffeMedicalPress. ÿÿÿÿÿÿ ÿ.ÿ. ÿÿÿÿÿÿÿ

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The following is a list of the skills included in the proposed model, which can be found in more
detail on the website of the International Association for Communication in Healthcare.

START RECEPTION

Establishing initial contact

1. Greeting the patient and getting to know him.

2. Introduce yourself, explain your role and the purpose of the interview, obtain consent,
if nessesary.

3. Demonstrate respect and interest, create physical comfort for the patient.

Determining the reason for consultation

4. Clarify the patient's concerns and needs with open-ended questions ("What problems got you
going?" or "What would you like to discuss today?" or "What questions would you like answered today?").

5. Listen carefully without interrupting or controlling the patient's answers.

6. Maintain a list of problems and find out more detailed information (for example,
“means headache and fatigue, what else?”).

7. Agree on employment (schedules), taking into account the needs of the patient and
doctor's circumstances.

COLLECTION OF INFORMATION

Investigation of the patient's problems

8. Encourage the patient to tell the whole story of their problems from the very beginning to
present moment in your own words (determining the reason for this visit).

9. Use the techniques of open and closed questions, moving from open to
closed.

10. Listen carefully, allow the patient to speak to the end without interrupting and give the patient
time to gather his thoughts before answering a question or continuing after a pause.

11. Encourage the patient to speak

with verbal and non-verbal cues, using
encouragement, silence, paraphrasing,
repetition, clarification.

12. Notice verbal and non-verbal

signals (body language, manner of speaking,
facial expressions, mood), determining their
meaning.

13. Clarify statements that are unclear

or require explanation
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patient (“Could you clarify what you mean by dizziness?”).

14. Periodically summarize what was heard in order to find out how correctly the doctor understood
the words of the patient, offer the patient to correct the misinterpreted or continue the story further.

15. Use short, clear questions and comments, avoid jargon and inadequate explanation of terms.

16. Set dates and sequence of events.

Additional Skills for Understanding the Patient's Position

17. Actively identify and investigate:

the patient's ideas and beliefs;

anxiety (fears) of the patient regarding each problem;

patient expectations (goals, what kind of help the patient expected to solve each individual problem);

impact: how each problem affects the patient's life

18. Encourage the patient to express emotions.

STRUCTURING CONSULTATION

Making the dialogue open

19. At the end of a special series of questions, summarize to make sure

correct understanding before moving on.

20. Move from one block of questions to another, signaling or informing about such a transition and
justifying it.

following logic

21. Build a conversation in a logical sequence.

22. Control time and stick to a given topic.

BUILDING RELATIONSHIPS

Appropriate nonverbal behavior

23. Demonstrate the correct non-verbal signs:

eye contact, facial expression;

posture, position and body movements;

speech (pitch, volume, intonation).

24. Read, make entries in history or a computer in such a way that it does not
hindered dialogue or understanding.

25. Demonstrate due confidence.

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Building trust

26. Accept without judgment the patient's right to his feelings and views.

27. Use empathy to show the patient understanding of their problems and concerns, openly acknowledge
the views and feelings of the patient.

28. Provide support: express care, understanding, desire to help; recognize the patient's attempts to cope
with the problem and take care of himself; offer partnerships.

29. Be tactful about sensitive topics and sensitive to patient concerns

physical pain, including that associated with a physical examination.

Patient Involvement

30. Share your conclusions with the patient to engage him in a dialogue (for example, “It seems to me now ...”)

31. Explain the need for possible questions or some form of survey in order to avoid misinterpretation.

32. During the examination, ask permission and explain the process.

EXPLANATION AND PLANNING

Providing information in the right amount and in the correct form

33. Crushing information and checking understanding: give information in "pieces" suitable for assimilation;
constantly check for correctness of understanding, using the patient's response as a key to further progress.

34. Assess the patient's background knowledge: ask about the information already available,
to find out the degree of interest of the patient in obtaining information.

35. Ask the patient what other information would be useful: for example, etiology,
forecast.
36. Provide explanations at the right time, avoiding tentative conclusions and premature advice.

Help in accurate assimilation and understanding

37. Structure the explanation: divide information into separate parts,

arranged in a logical chain.

38. Use information separators or control words (for example, “I would like to discuss three important issues”,
“Firstly ...”, “Now we should move on to discussing ...”)

39. Use repetition and summation to confirm information.

40. Be concise, use simple and clear language, avoid jargon

or explain them.

41. Use graphic methods of information transfer: diagrams, models,

written data and instructions.
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42. Check the understanding of the information received by the patient (or planned): for
example, ask the patient to retell what he heard in his own words, if necessary, make clarifications.

Achieving a Shared Understanding: Patient Inclusion

43. Provide explanations about the patient's picture of the disease in
connections with clarified ideas, anxieties and expectations.

44. Encourage the patient to cooperate and provide opportunities for this: ask questions,
request explanations or express doubts, provide appropriate answers.

45. Perceive verbal and non-verbal signals, respond to them, for example: the patient's
desire to receive information or ask a question, information overload, fatigue.

46. Find out the attitude, reactions and feelings of the patient about the received
information and terms used; be accepted and taken into account, if necessary.
Planning: making a joint decision
47. When necessary, share your thoughts: ideas, thoughts, dilemmas.
48. Involve the patient by making suggestions rather than giving instructions.

49. Encourage the patient to express his thoughts: ideas, suggestions and preferences.
50. Agree on a mutually acceptable plan.
51. Offer Choices: Encourage the patient to make choices and make decisions based on
the level at which he is ready to do it.

52. Check with the patient whether he agrees with the plan, whether all problems have been taken into account.

END OF RECEPTION

Planning
53. Agree with the patient on the next joint steps.
54. Safety measures: explain possible unexpected results, what to do if the plan does not
work, when and how to seek help.
Finally accepts
55. Briefly sum up the results of the meeting and clarify the treatment plan.

56. Find out for the last time whether the patient agrees with the plan, whether it suits him,
ask about possible changes, questions that have arisen, etc.

TERMS OF EXPLANATION AND PLANNING

Discussion of examinations and procedures

57. Provide accurate information about procedures: what the patient may experience and
how he will be informed about the results.

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58. Report the purpose of the procedures, their significance for treatment.

59. Encourage questions and discussion of potential concerns or negative

results.

Discussion of the conclusion and significance of the problem

60. Express an opinion on the process, if possible.

61. Express the rationale for your conclusion.

62. Explain causes, severity, expected outcome, short and long term consequences.

63. Find out the opinions, reactions and attitudes of the patient about this conclusion.

When drawing up a joint action plan

64. Discuss options, eg, take no action, investigate, treat medically, surgically or non-pharmacologically
(physiotherapy, solutions, consultations), preventive measures.

65. Provide information about proposed actions or treatments:

names of steps, how they work, benefits, possible side effects.

66. Find out the patient's opinion about the desire to act, perceived benefits, barriers, motivation.

67. Accept the views of the patient, defend an alternative point of view as necessary.

68. Identify patient reactions, tolerance and concerns about plans and
treatment methods.

69. Take into account the patient's lifestyle, beliefs, cultural background and abilities.

70. Encourage the patient to participate in the implementation of plans, take on

responsibility and be independent.

71. Discuss patient support systems, discuss other available measures

support.

An example of a checklist for assessing communication skills,

demonstrated at examination stations
Exam task: You are an outpatient doctor. In the office, a patient is waiting for you, who has applied in a planned
manner for an initial appointment. It is only necessary to conduct a patient interview, which must be completed at the
moment when you are ready to proceed to the examination, informing the patient about this. The results of the survey
must be formalized in writing in the form proposed on the PC. After the invitation to enter, act completely on your own,
as you would in real life.

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Action Evaluation criterion Icon buttons A2

Establish contact: 1.
Greeting the doctor greets the patient tells
where to sit, where to put things
2. Concern for patient comfort A3, A4
introduces himself by name B2
3. Self-presentation
calls his role B3
indicates the nature of the consultation (the
purpose of the meeting). asks if the patient B4
has any objections to the survey ASKING FOR THE
4. Consent to questioning
PATIENT'S NAME, YEAR OF BIRTH (age) "What B5
5. Personal identification brought you?" or “What would you like to discuss
the patient today?” or “What did you come with?” Using the B2, B3, B4, !ÿ6 G2
Questioning : open-ended question "What are you complaining
6. Open question (beginning) 7. Starting about?" or "What's bothering you?"
the questioning with the phrase “What are you
complaining about?” D2
8. Listening Without interruption D3
Repeats what the patient has said to
confirm the correctness of his
9. Summary
understanding of what the patient is saying; G4
inviting the patient to correct or add Attempts to
identify other (minor, latent) problems through the
question "What else is bothering you?" "Is that all
you're worried about?"
D5

10. Screening
at the same time, he uses “address by name (first
name, patronymic), is something else bothering you?”
G7
and screens before revealing details Asks what
the patient attributes their condition to without
G6
suggesting answers when gathering information
11. Taking into account the opinion of the patient
about something specific, e.g. “Tell me more D1
about this”, “What can you say about this problem”
12. Using open-ended questions
D3
13. Offering your own answers to the asking a question, offering options for
questions asked choice of answer D4
14. A series of asks several questions in a row
D6
questions Building relationships in the
at least half the time during the entire interview
process of communication: 15. Eye J7
contact
untimely statements (remarks), as well as phrases
that cannot be regarded as clarifying questions or
16. Interruption
facilitation of the patient's story Calling by name B7
(first name patronymic) expresses regret about the
17. Appeals to the patient late treatment, gives recommendations for calming G7
down, draws attention to the undesirability of such a
18. Comment and rate reaction, etc. . when the patient is silent for a while, it
patient behavior gives the opportunity to continue Listens to the patient E7
without looking up from the notes, standing, etc.
Demonstration of understanding of feelings, fears,
19. Pausing D7
problems, etc. helps the patient with encouragement,
20. Pose repetition, paraphrasing, but without
A6, B6, V6 I7
21. Empathy

22. Facilitation of the patient's response B7

clarifying questions
reveals an exhaustive list of the patient's
problems, allowing to formulate the correct I2, (I1, 2, 3) J2,
diagnostic hypothesis and ensuring patient
23. Outcome of communication 3, 4 E2, 3, 4,
satisfaction with the conversation. Questions for
the doctor ...
5, 6 D5
24. Clarifying questions

Full name of the expert signature Mark of entry into the database (full name)

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Algorithm of work with the control system of the simulation

center "Argus":
1. Announce the date of the pilot by sending it to fantomkurs@[Link] next
information:

• Lists of all accredited persons of that day (full name, e-mail address)

• List of examiners (name, e-mail address) and responsible person

2. Carry out port forwarding5 to provide an annotation of the video stream with checklist items with an icon (see
Figure 1)

3. Ensure the operability of the station

• At the station (inside) there must be a computer with the Internet and a program for
remote access (filling out the patient card)

• And also a table, three chairs

• Examiners have a computer with internet for checklist (+video control)

• Before the station, the task from the passport of the station (briefing)

4. Get confirmation of the technical feasibility of working in the system, as well as a file for
launching a checklist

On the day of the exam

5. Form a queue of examinees at the station (by full name) - timely transmission of information to examiners

6. In the checklist launcher, enter the login and password of the declared examiner

7. Select the desired application, if there are several

8. Choose the right room if there are several

9. Select the desired surname (know in advance the queue for your station)

10. Select the desired checklist if there are several

11. Check the data and run the program

12. When the examinee enters, press the "Start" button and ! "Beginning" (A1 drawing)

13. Next, mark the demonstrated actions (description of the buttons below)

14. Press the button B1 "Ready for examination" at the moment when the examinee said that he was ready to
examine the patient. If this does not happen, press this button after the task time has elapsed. Button B1 is tied
to the time ...

5For example, per camera (ports 554 and 80). The 80th port is needed to access the camera settings, and the 554th
port is for accessing the video stream in the rtp/rtsp format. Accordingly, if there are more than one cameras, it is
better to set up forwarding as follows: Camera 1: 8081 -> 80 IP1, 555 - > 554 IP1 Camera 2: 8082 -> 80 IP2, 556 ->
554 IP2 Camera 3: 8083 -> 80 IP3, 557 -> 554 IP3 and so on...

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15. At the moment when the examinee fills out a written opinion, the SP enters his part in the checklist -
buttons E, Zh, I, having the opportunity to observe what the examinee fills in the "patient card"

*
Many buttons can be pressed several times, as soon as this is exhausted, the button disappears

Buttons V1, G1, E1, Zh1, I1, A5, A7 - do not have a rating - they are just rubricators (do not press them)

Buttons A1 and B1 - must always be pressed, the remaining buttons, depending on the actions
examiner

Buttons Zh1, Zh2 and Zh3 are interchangeable (either, or, or, or nothing at all)

The same I3, I4, I5 (depending on how many hypotheses with justification the doctor suggested).

The G2 and D2 buttons are also interchangeable (either, or)

A6, B6, B6 - also either, or, or

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Description of the buttons of the direct checklist

1 2 3 4 5 6 7

AT

Well

Figure 1. Checklist design with pictograms

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Sources of information
1. Davydova N.S. Chernyadiev S.A. Makarochkin A.G. Dyachenko E.V. Communication skills of
a doctor as an interdisciplinary cross-cutting educational module // Medical education-2015:
materials of the VI All-Russian conference with international participation, April 2-4, 2015
Moscow.

2. Davydova N.S., Makarochkin A.G., Dyachenko E.V., Chernikov I.G., Novikova O.V. The first
experience of carrying out certification according to the method of "standardized patient" //
IV Congress of ROSOMED-2015. M., 30.09-02.10.2015 [Electr. resource].

3. Davydova N.S., Dyachenko E.V., Popov A.A., Makarochkin A.G., Samoilenko N.V., Novikova
O.V. "Standardized patient" as a simulation technology for training and evaluating the
effective communication of future doctors. Medical education and professional education.
2016. No. 3. [Electr. resource].

4. N. S. Davydova, S. A. Chernyad’ev, A. G. Makarochkin, O. V. Teplyakova, A. A. Popov, E. V.

D’yachenko, N. V. Samoilenko, and A. A. Son’kina, Serkina A.V., Bottaev N.A., Shubina L.B.,
Gribkov D.M. Pilot on the assessment of medical workers in the possession of communication
skills with patients // Proceedings of the VIII International Conference “Rosmedob-2017.
Innovative educational technologies in medicine”. October 4-6, 2017 [Electr. resource]

5. Dyachenko E.V. Communicative competencies of a doctor: relevance of the problem,

principles of formation in a medical university, assessment methodology // Modern trends in
the development of pedagogical technologies in medical education: Materials of the All-
Russian. scientific-ped. conf. with international participation (series "University Pedagogy").
Krasnoyarsk, Kras. state honey. un-t im. prof. V.F. Voyno-Yasenetsky, February 4-5, 2014
[Electr. resource]

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working with patients. // Proceedings of the VIII International Conference "Rosmedob-2017.
Innovative educational technologies in medicine”. October 4-6, 2017 [Electr. resource]

7. Sonkina A.A. Professional communication skills in the work of a doctor // ORGZDRAV:

news, opinions, training. 2015. No. 1. P. 101-107.

8. Teplyakova O.V., Sarapulova A.V. Communication skills of students of a medical university:

experience of observation at the department of polyclinic therapy // Medical education and
professional development. 2016, No. 1.

9. Aper L., Veldhuijzen W., Dornan T., van de Ridder M., Koole S., Derese A., Reniers J.,
''Should I prioritize medical problem solving or attentive listening?'': The dilemmas and

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challenges that medical students experience when learning to conduct consultations // Patient
Education and Counseling 98 (2015)77–84.

10. Bombeke K., van Roosbroeck S., de Winter B., Debaene L., Schol S., van Hal G., van Royen
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an observational study comparing two cohorts during clinical clerkships // Patient education &
counseling, 2011, v.84, ÿ3, p.p. 310-318.

11. Cushing A.M. Learning patient-centred communication: The journey and the territory //
Patient education & counseling, 2015, v.98, ÿ 10, p.p. 1236-1242.

12. Hafferty F., Franks R. The hidden curriculum, ethics teaching, and the structure of medical
education // Acad. Med. 1994;69:861–71.

13. Kurtz S., Silverman J., Draper J. Teaching and learning communication skills in medicine,
CRC press, NY, 2013, p.369

14. Rosenbaum M.E., Axelson R. Curricular disconnects in learning communication skills: what
and how students learn about communication during clinical clerkships // Patient education &
counseling, 2013, v.91, ÿ1, p.p. 85-90.

15. Silverman J. Teaching clinical communication: a mainstream activity or just a minority sport? //
Patient Education and Counseling, 2009, volume 76, issue 3, p. 361-367.

16. Skills for Communicating with patients, J.

Silverman, J. Draper & S. Kurz, Oxford University Press, 3 ed. – 2013.

17. Smith S., Hanson J.L., Tewksbury L.R., Christy C., Talib N.J., Harris M.A., Beck G.L., Wolf
F.M. Teaching patient communication skills to medical students: a review of randomized
controlled trials // Eval. Health Prof. 2007 Mar; 30(1):3-21.

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Information about authors

Bottaev Nazir Asretovich - Candidate of Medical Sciences, Trainer of Communication Skills
FGAEI HE "First Moscow State Medical University. THEM. Sechenov" of the Ministry of Health of Russia.

Gorina K.A. - Postgraduate student of the Department of Obstetrics and Gynecology, trainer of
communication skills of the Center for Continuing Professional Education, FGAEI HE "First Moscow
State Medical University. THEM. Sechenov" of the Ministry of Health of Russia
Gribkov Denis Mikhailovich - Deputy Head of the Center for Continuing Professional Education
FSAEI HE "First Moscow State Medical University. THEM. Sechenov" of the Ministry of Health of Russia.

Davydova Nadezhda Stepanovna - Doctor of Medical Sciences, Professor, Head. Department

of Anesthesiology, Resuscitation and Transfusiology FPC and PP FSBEI HE "Ural State Medical
University" of the Ministry of Health of Russia, Vice-Rector for Academic Affairs in the period from 2005
to 2017.

Dyachenko Elena Vasilievna – Ph.D., Associate Professor, Head. Department of Pedagogy

and Psychology, FSBEI HE "Ural State Medical University" of the Ministry of Health of Russia.

Kovtun Olga Petrovna - Doctor of Medical Sciences, Professor, Corresponding Member. RAS, Rector of the Federal State Budgetary Educational Institution of Higher Education

"Ural State Medical University" of the Ministry of Health of Russia.

Makarochkin Andrey Gennadievich - Candidate of Medical Sciences, Associate Professor,
Deputy chief physician for the medical part of the MBU "Central City Clinical Hospital No. 1 of the
Oktyabrsky District".
Mukhametova E.M. – Pediatric Gastroenterologist, Associate Professor of the Department of
Propaedeutics of Children's Diseases, FGAEI HE “First Moscow State Medical University named after
I.I. THEM. Sechenov" of the Ministry of Health of Russia
Popov Artem Anatolyevich – Doctor of Medical Sciences, Associate Professor, place of work,
Professor of the Department of Hospital Therapy, Ural State Medical University, Ministry of Health of
Russia.
Samoylenko Nadezhda Viktorovna – Assistant of the Department of Psychology and
Pedagogy, Ural State Medical University of the Ministry of Health of Russia, simulated patient.

Serkina Anna Vladimirovna – Communication Skills Trainer of the Center for Continuing
Professional Education FGAOU HE “First Moscow State Medical University named after I.I. THEM.
Sechenov" of the Ministry of Health of Russia.
Sizova Zhanna Mikhailovna – Doctor of Medical Sciences, Professor, Head of the Department
of Medical and Social Expertise, Emergency and Polyclinic Therapy, Director of the Methodological
Center for Accreditation of Specialists of the First Moscow State Medical University. THEM. Sechenov"
of the Ministry of Health of Russia.
Sonkina Anna Aleksandrovna – Communication Skills Trainer, Center for Continuing
Professional Education Mentor Medicus, First Moscow State Medical University. THEM. Sechenov" of
the Ministry of Health of Russia.
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Teplyakova Olga Vyacheslavovna – Doctor of Medical Sciences, Associate Professor, Professor

of the Department of Polyclinic Therapy, Ultrasound and Functional Diagnostics, FGBOU HE “Ural State
Medical University” of the Ministry of Health of Russia, Chairman of the Cycle Methodological Commission
on Therapy of USMU.

Chemekov V.P. - Ph.D. Lecturer, Department of Propaedeutics of Children's Diseases, FGAEI HE

"First Moscow State Medical University named after I.I. THEM. Sechenov" of the Ministry of Health of Russia

Chernyadyev Sergey Aleksandrovich – Doctor of Medical Sciences, Professor, Dean of the

Faculty of Preventive Medicine, FSBEI HE “Ural State Medical University” of the Ministry of Health of Russia,
Head. Department of Surgical Diseases.

Shubina Lyubov Borisovna – Candidate of Medical Sciences, Head of the Center for Continuing
Professional Education Mentor Medicus, First Moscow State Medical University. THEM. Sechenov" of the
Ministry of Health of Russia.

Erdes S.I. - Doctor of Medical Sciences, Professor, Head. Department of Propaedeutics of Children's
Diseases, FGAEI HE "First Moscow State Medical University named after I.I. THEM. Sechenov" of the
Ministry of Health of Russia.

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