Consultation and Communication Skills
What this domain tests
How you structure a consultation, elicit the patient's real agenda, and communicate risk so that decisions are shared and documented. The CKT favours questions on frameworks and on the wording that changes outcomes.
Core rules
- Calgary–Cambridge structure. Initiate the session (agenda setting), gather information (biopsychosocial), build rapport, explain and plan, close the session. Skilled consulters signpost transitions: "I'd like to ask about your breathing, then examine you."
- ICE first. Ideas, Concerns and Expectations predict concordance and complaints better than the clinical content. Ask "What were you hoping we'd do today?" before negotiating.
- Elicit–provide–elicit. Draw out the patient's existing understanding, give a short chunk of information, check reception. This is the core of motivational interviewing (OARS: open questions, affirmations, reflections, summaries).
- Safety netting is part of the plan, not an aside. Specify what should happen, how quickly, and by what route: "If the breathlessness worsens over the weekend, ring the out-of-hours service rather than wait for Monday."
- Breaking bad news (SPIKES). Setting, Perception, Invitation, Knowledge, Emotions, Strategy and summary - invite first, warn before the headline, then stop talking.
- Teach-back beats "Do you understand?" for confirming inhaler or insulin technique.
Worked example
A 52-year-old with 10 years of intermittent low back pain asks for an MRI "like my friend had". You elicit the concern (fear of cancer because a colleague was diagnosed), explain that in the absence of red flags imaging rarely changes management and often finds harmless disc bulges, agree a physiotherapy referral plus a review date, and safety-net the specific red flags. The documented plan includes the concern, not just the prescription.
Traps
- Reassuring without safety netting - a common source of delayed diagnosis complaints.
- Jargon and percentage-only risk framing; use natural frequencies ("3 in 100").
- Overlooking the third person in the room or the patient's literacy and language needs.
- Closing the consultation before the hidden agenda surfaces.