October 21, 2012

MU0011 [Management and Organizational Development] Set2 Q6

Q6) Write a note on training for consultation skills.

Ans:


1 Defining Consultations
It is a process of regulation by which input from the public on matters affecting them is sought and solved. Its major goals are in improving the transparency, efficiency and public involvement in large-scale projects or laws and policies. It usually involves sending a notification to publicize the matter to be consulted on followed by consultation which is a two-way flow of information and opinion exchange and lastly participation which involves interest groups in the drafting of policy or legislation.

2 Principles for Effective Consulting
An effective consulting has different perspectives. The following guidelines might be useful as you reflect on your own principles for effective consulting.

The answer to complex problems lies between you and your client
The answer emerges during the project as you and your client work collaboratively to clarify current issues and address them, while learning at the same time.

Encouraging and recognizing diverse values and perspectives
An experienced organizational consultant is aware of the different perspectives on an issue in the organization. Those perspectives should be encouraged and explored because they often lead to more successful problem solving.

When working with your client, start from where they are now
Understand your clients perspective on their issues, including what they have tried, what has worked, what has not worked and what they think should be done now. It is better to go slower with your client than faster without them.

No blame is to be put on consulting situations
It is rare that anyone sets out to hurt someone else or an organization. An atmosphere of blame only serves to inhibit people in your clients organization from the trust, collaboration and commitment necessary for successful change.

Come to the project with a basic consultation framework in mind
Early in a project, the major purpose of the framework can be used as a common frame of reference when talking about the project goals, methods, evaluation and learning. Be willing to modify that framework as you and your client work together.

Your value is in the flow of the process, not in the details of the project
If both of you continue to work together in a process that is collaborative, well understood, communicated to all and focused on results, your client will value you.

The road to success is paved from who you are as from your expertise
If you’re perceived authentic, respectful, and consulting with focus on results and learning by the client then it paves the way for success. Similarly, one of the most powerful influences that can have with your clients is to model the behaviors that you want from them.

Do what you say you are going to do
While the client is confused, you can help a great deal by remaining grounded and centered, clear and consistent. Your consistency builds trust and commitment with clients, as well.

Know yourself
You are an instrument of change with your client, so you should be willing to suspend your overall biases, assumptions and beliefs when working with people. Be honest about them when they arise during a project.

Avoid making your clients to do something just because you said so
Always first explain the reasons for your advice and the benefits that might come to your client as a result. Then provide time for your client to respond to your advice. This is usually true even if you are a leader acting as an internal change agent.

It is up to your client to use your advice or not
This is sometimes one of the hardest principles for new consultants to accept. It helps if you remember that people learn only what they are ready to learn.

Do not take it personally
Often your client struggles with an issue, in part, because of their role in the issue. They may not want to change themselves and might resist your attempts to help them. In those instances, remember that those responses are their choices, not yours.

The importance of communication skills teaching in the context of undergraduate medical education has increasingly been recognized over the past decade. Within postgraduate medical education, its role in the curriculum is stressed in the training of general practitioners (GPs). It can also be argued that teaching in this area should continue in the postgraduate setting in secondary care, particularly as the content of many secondary care consultations requires a high level of specialist knowledge. 

Successful consultations are the foundation of good medical practice and demand competent communication skills from all doctors. In a publication entitled ‘Tomorrow's doctors' the General Medical Council has listed, among essential attributes of every independent practitioner regardless of speciality, possession of consultation skills, which include ‘skills in sensitive and effective communication with patients and their families…’  

Patients rightly expect their doctors to be effective communicators, and communication failure has been cited as the commonest cause of complaint by patients . Specific areas of complaint centre on: failure to gather adequate and accurate information; failure to provide sufficient, comprehensible information; failure to listen to patients' concerns; neglect of patients' psychosocial needs; and failure to develop a mutually acceptable relationship with patients. 

There is evidence that patients benefit from consultations with doctors possessing good interpersonal skills, not only in terms of satisfaction but also through improved compliance with treatment and better health outcomes . Even when the physician has no effective therapy to offer, demonstrating understanding and empathy and providing adequate information reduces patient anxiety and distress.

Consultation skills can be taught and assessed , and there is a significant evidence base to inform the context, content and methods of such teaching . Even taking a biomedical view of the consultation, in which eliciting all relevant information and reaching a clear diagnosis is the paramount goal, there is evidence that specific teaching of communication skills improves the performance of medical students and that this improvement is sustained.

Prior to 1991, there seems to have been very little undergraduate teaching of communication skills in UK medical schools , and there is evidence that implementation is still patchy and poorly integrated, with departments of psychiatry and general practice being the prime movers . Therefore, it is to be expected that many UK doctors currently undergoing specialist training will not have experienced any communication skills training and would benefit from this, both for their own clinical practice and as teachers and supervisors of their juniors.

In the UK, the specialist registrar has been established as a higher‐grade training post that leads to accreditation for eligibility to become a consultant . Within the medical specialities, the post is started after completion of the Royal College of Physicians membership examination. Specialist registrars in rheumatology in West Midlands have monthly joint educational workshops, lasting a full day. Until the advent of the workshop reported here, the emphasis had tended to be on specialist skills and knowledge. 

Objectives
As an introductory workshop, we set limited and rather general objectives:
1. to define the purpose of effective communication;
2. to examine the style, content and outcomes of real consultations;
3. to increase the understanding of the consultation process, using different schemes and models; and
4. to use the techniques and material to improve our own consultations.

Structure and process
A key element in planning the workshop was to demonstrate cooperation between a consultant, with subjectspecific knowledge and skills, and a general practitioner educationist, with generic skills in consultation teaching and practice. The latter was responsible for the overall format of the workshop, whilst the former constructed the case scenarios and led discussion on these. 

The workshop took place in a postgraduate medical centre, away from everyone's usual place of work. It was planned as a half day session for 14 registrars. Following a brief introduction, it consisted of the following three main components. 

(i) Small group discussion to address the following questions:
1. Is effective communication with patients important and why?
2. What do I try to achieve in a consultation?
3. What do patients want to get out of it?
4. What went wrong with a recent ‘bad’ consultation? Why did it go wrong and what could have changed it?

(ii) Videotape of consultations. Consultations were selected from videotape recorded by the facilitators and shown to the groups after a short introduction, emphasizing important ‘rules' for handling this material. 
1. Respect for the patient: consent and confidentiality issues.
2. Respect for the doctor: Pendleton's Rules  
3. Clarity about the purpose for looking at the tape: avoiding clinical discussion; discovering what the doctor bringing the video would like to achieve; deciding on any observational tools or framework to use. 

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