Clinical Competency Rubric 2022

1. Communication and consultation skills

This competency focuses on communication with patients, and the use of appropriate general practice consultation techniques. Communication skills enable the consultation to proceed, and the demonstration of specific communication skills, especially in difficult consultations, is a requirement. Communication and the consultation should be patient-centred. The development of respectful therapeutic relationships involves empathy and sensitivity, with the doctor trying to see things from the perspective of the patient.

Required knowledge

  • Holistic approaches and perspectives

Required attitudes

  • Empathy
  • Self-awareness
  • Curiosity
  • Professionalism
  • Respect for patient autonomy

Required skills

  • Cultural safety
  • High-level communication skills (verbal and non-verbal including de-escalation skills)
  • Negotiation

Skills focus: Verbal and written communication skills; Patient-centred communication and consultation; Consultation skills.

Criteria

Communication skills

  1. Communication is appropriate to the person and the sociocultural context
  2. Engages the patient to gather information about their symptoms, ideas, concerns, expectations of health care and the full impact of their illness experience on their lives
  3. Matches modality of communication to patient needs, health literacy and context
  4. Communicates effectively in routine and difficult situations
  5. Demonstrates active listening skills
  6. Uses a variety of communication techniques and materials (e.g. written or electronic) to adapt explanations to the needs of the patient
  7. Uses appropriate strategies to motivate and assist patients in maintaining health behaviours (See 5.7)

Consultation skills

  1. Adapts the consultation to facilitate optimal patient care
  2. Consults effectively in a focused manner within the time-frame of a normal consultation
  3. Prioritises problems, attending to both the patient’s and the doctor’s agenda
  4. Safety netting and specific follow up arrangements are made


Performance lists

Criteria (competent at level of Fellowship) Performs consistently at the standard expected
  1. Communication is appropriate to the person and the sociocultural context
  • Considers and discusses the patient’s socio-cultural context as part of the consultation
  • Considers the occupational aspects of the problem
  • Adapts communication style as appropriate for the patient
  1. Engages the patient to gather information about their symptoms, ideas, concerns, expectations of health care and the full impact of their illness experience on their lives
  • Considers and discusses the impact of the presentation on the patient’s function
  • Shows empathy and respect throughout
  • Responds to verbal cues from the patient or their family
  • Responds to non-verbal cues – this can be verbal (commenting that a patient may seem upset), or active (a change in posture, offering the patient a tissue)
  • Explores presenting problem from the patient’s perspective
  • Shows a genuine curiosity to find out what the patient really thinks
  1. Matches modality of communication to patient needs, health literacy and context
  • Adapts language to match the patient’s level of understanding.
  • Uses concise, easily understood language, avoids or explains jargon
  1. Communicates effectively in routine and difficult situations
  • Uses silence effectively
  • Appropriate balance of closed and open questions
  • Breaks bad news sensitively
  • Has a framework for delivering bad news, such as the SPIKES model
  • Deescalates the situation when a patient is angry or agitated
  • Sensitively discusses prognosis and end-of-life decisions
  • Sensitively manages patients experiencing current or consequences of trauma
  1. Demonstrates active listening skills.
  • Listens attentively to the patient’s opening statement, without interrupting or directing patient’s response
  • Listens attentively, allowing patient to complete statements without interruption and leaving space for patient to think before answering or go on after pausing
  • Confirms list and screens for further problems (eg “so that’s headaches and tiredness; anything else……?”)
  • Uses open and closed questioning technique, appropriately moving from open to closed
  • Clarifies patient’s statements that are unclear or need amplification (eg “Could you explain what you mean by light headed")
  • Periodically summarises to verify own understanding of what the patient
  1. Uses a variety of communication techniques and materials (e.g. written or electronic) to adapt explanations to the needs of the patient
  • The patient’s problem is explained in such a way that they can easily understand
  • The explanation is relevant, understandable and appropriate
  • Checks patient’s understanding of information given, or plans made
  • Uses a variety of explanation techniques including images and patient handouts
  • The patient’s health beliefs are taken into consideration or referenced during the explanation of the problem
  • Gives explanation at appropriate times: avoids giving advice, information or reassurance prematurely 
  • Chunks and checks: gives information in manageable chunks, checks for understanding
  • Uses patient’s response as a guide to how to proceed
  1. Uses appropriate strategies to motivate and assist patients in maintaining health behaviours
  • See 5.7
  1. Adapts the consultation to facilitate optimal patient care
  • Flexible in approach both with regards to what is covered in the consultation and with timing
  • Accommodates the patient’s needs, including having family or other support in the consultation
  • Takes the time to let the patient tell their story
  1. Consults effectively in a focussed manner within the time- frame of a normal consultation
  • Keeps the consultation focused with a clear structure
  • Prioritises when the patient presents with multiple issues
  1. Prioritises problems, attending to both the patient’s and the doctor’s agenda
  • Negotiates the agenda for the consultation with the patient
  • Takes account of the patient’s expectations
  • Takes account of the patient’s medical needs
  1. Safety netting and specific follow up arrangements are made
  • Clear follow up guidance is given to patients routinely
  • Education is provided to patients on when to seek guidance for symptom deterioration
  • Clear guidance is given to patients on how to access appropriate medical care
  • Barriers to addressing care are addressed

Aboriginal and Torres Strait Islander health context

  1. Use a range of methods to facilitate culturally safe communication with Aboriginal and Torres Strait Islander peoples
  2. Integrate cultural perspectives and beliefs on health and wellbeing of Aboriginal and Torres Strait Islander peoples into holistic clinical practice
  3. Appraise and address barriers to development of effective therapeutic relationships with Aboriginal and Torres Strait Islander peoples
 
Rural health context
  1. Develop maintain and review effective communication strategies for communicating with patients and other health professionals who are located remotely
  2. Adapt communication to accommodate situations common in rural and remote areas and maintain effective communication infrastructure relevant to the practice setting
  3. Identify appropriate modes of communication in the practice and the community
 
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Related documents

  Clinical-Competency-Rubric (PDF 0.39 MB)

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