Guide

Describe the key components of a patient-centred approach to medical care

Outline the evidence that effective physician–patient communication enhances patient and physician outcomes

Communicate using a patient-centred approach that facilitates patient trust and autonomy and is characterized by empathy, respect, and compassion

Teach and assess the patient-centred approach to communication

Describe elements of the physical environment that affect patient comfort, dignity, privacy, engagement, and safety

Mitigate physical barriers to communication to optimize patient comfort, dignity, privacy, engagement, and safety

Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety

Participate in institutional/system initiatives to improve the physical environment for patients

Describe how patient and physician values, biases, and perspectives can affect clinical encounters

Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly

Teach learners to recognize situations in which patient and physician values, biases, or preferences may threaten the quality of care, and how to modify the approach to patient care

Identify non-verbal communication from a patient and family and its impact on physician–patient communication

Describe how to utilize non-verbal communication to build rapport

Identify, verify, and validate non-verbal cues on the part of patients and their families

Use appropriate non-verbal communication to demonstrate attentiveness, interest, and responsiveness to the patient and family

Respond to patients’ non-verbal communication and use appropriate non-verbal behaviours to enhance communication with patients

Demonstrate advanced non-verbal communication skills in difficult situations

Describe physician, patient, and contextual factors that lead to strong emotions

Describe how strong emotions may affect the patient–physician interaction

Critically reflect upon emotional encounters and identify how different approaches may have affected the interaction

Recognize when personal feelings in an encounter are valuable clues to the patient’s emotional state

Recognize when strong emotions (such as, anger, fear, anxiety, or sadness) are affecting an interaction and respond appropriately

Establish boundaries as needed in emotional situations

Manage disagreements and emotionally charged conversations

Teach others to anticipate, recognize, and manage emotions in routine clinical encounters

Describe models of decision-making along the spectrum from “paternalistic” to “shared” to “autonomous”

Describe the importance of capacity assessment

Assess and appropriately address the patient’s preferred involvement in decisions about care

Assess a patient’s decision-making capacity

Tailor approaches to decision-making to patient capacity, values, and preferences

Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances

Teach others to tailor approaches to decision-making to patient capacity, values, and preferences

Describe the basic elements of the patient-centred interview

Conduct a patient-centred interview under supervision, gathering relevant biomedical and psychosocial information in the context of an uncomplicated presentation of a common medical problem

Conduct a patient-centred interview, gathering all relevant biomedical and psychosocial information for any clinical presentation

Integrate and synthesize information about the patient’s beliefs, values, preferences, context and expectations with biomedical and psychosocial information

Actively listen and respond to patient cues

Integrate, summarize, and present the biopsychosocial information obtained from a patient-centred interview

Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information

Intervene when, during the patient interview, a learner or health care professional ignores the patient’s beliefs, values, preferences, context, or expectations

Conduct a patient encounter using an organizing framework

Conduct a focused and efficient patient interview, managing the flow of the encounter while being attentive to the patient’s cues and responses

Manage the flow of challenging patient encounters, including those with angry, distressed, or excessively talkative individuals

Provide a clear structure for and manage the flow of an entire patient encounter

Describe potential sources of information that may assist in a given patient’s care

Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent

Describe the ethical principles of truth-telling in the physician–patient relationship

Communicate the diagnosis, prognosis and plan of care in a clear, compassionate, respectful, and accurate manner to the patient and family

Recognize when to seek help in providing clear explanations to the patient and family

Use strategies to verify and validate the understanding of the patient and family with regard to the diagnosis, prognosis, and management plan

Provide information on diagnosis and prognosis in a clear, compassionate, respectful, and objective manner

Convey information related to the patient’s health status, care, and needs in a timely, honest, and transparent manner

Communicate clearly with patients and others in the setting of ethical dilemmas

Describe the ethical, professional, and legal obligations, and policies for, disclosure and reporting of patient safety incidents

Describe the steps in providing disclosure after a patient safety incident

Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents

Apologize appropriately for a harmful patient safety incident

Disclose patient safety incidents to the patient and family accurately and appropriately

Plan and document follow-up to harmful patient safety incident

Lead disclosure teams

Conduct peer review and practice assessments related to unexpected clinical outcomes and patient safety incidents

Contribute to the improvement of the system of disclosure for patient safety incidents

Describe the principles of cross-cultural interviewing

Demonstrate interviewing techniques for encouraging discussion, questions, and interaction

Conduct culturally safe interviews with close supervision

Describe steps for conducting an interview with a translator

Conduct an interview, demonstrating cultural awareness

Explore the perspectives of the patient and others when developing care plans

Communicate with cultural awareness and sensitivity

Facilitate discussions with the patient and family in a way that is respectful, non-judgmental, and culturally safe

Teach others and assess their ability to engage patients in a way that is respectful and non-judgmental and that provides cultural safety

Describe the various technologies and information sources available to enhance patients’ understanding and management of their health care

Assist the patient and family to identify, access, and make use of information and communication technologies to support care and manage health

Contribute to the development of communication resources and technologies to enhance patient care and medical knowledge

Describe elements of informed consent

Demonstrate steps to obtaining informed consent

Answer questions from the patient and family about next steps

Use communication skills and strategies that help the patient and family make informed decisions regarding their health

Describe the functions and principal components of a medical record

Describe the regulatory and legal requirements, including privacy legislation, for record keeping

Identify potential difficulties and errors in medical record keeping that have a negative impact on patient care or patient safety

Document the essential elements of a clinical encounter using a structured approach

Include as appropriate in the medical record the patient’s narrative* of the illness experience

Organize information in appropriate sections within an electronic or written medical record

Maintain accurate and up-to-date problem lists and medication lists

Document information about patients and their medical conditions in a manner that enhances intra-and interprofessinal care

Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

Adapt record keeping to the specific guidelines of their discipline and the clinical context

Identify and correct vague or ambiguous documentation

Document clinical encounters in an accurate, complete, timely and accessible manner, and in compliance with legal and privacy requirements

Teach or conduct peer review and practice assessment regarding record keeping practices

Use medical record review to assess trainee clinical reasoning and their understanding of their patients as persons

Demonstrate reflective listening, open-ended inquiry, empathy, and effective eye contact while using a written or electronic medical record

Adapt use of the health record to the patient’s health literacy and the clinical context

Communicate effectively using a written health record, electronic medical record, or other digital technology

Teach others how to effectively communicate with patients while using a medical record

Build reminders and clinical practice guidelines into the health record to enhance care

Describe the principles and legal requirements for privacy and confidentiality of written and electronic communication

Describe the different levels of written and electronic health literacy of patients and their implications for patient care

Describe the advantages, limitations and risks of using electronic communication directly with patients (including telehealth) and strategies to reduce these risks

Assess patients’ needs and preferences with respect to methods of information sharing

Adapt written and electronic communication to the specificity of the discipline and to the expectations of patients

Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding

Teach others, including patients, how to use electronic communication effectively and safely to protect confidentiality