Attitude Ethics and
Communication -AETCOM
Graduate Medical Regulations
“Indian Medical Graduate” (IMG)
possessing requisite knowledge, skills, attitudes, values
and responsiveness, so that he or she may function
appropriately and effectively as a physician of first
contact of the community while being globally
relevant
Revised Regulations on Graduate Medical
Education
“Indian Medical Graduate” ROLES
Clinician - preventive, promotive, curative, palliative and
holistic care with compassion
Leader and member of the health care team - collect
analyze, synthesize and communicate health data
Communicator - patients, families, colleagues and
community
Lifelong learner - continuous improvement
Professional - ethical, responsive and accountable
The hidden curriculum
The hidden curriculum consists of those things the
students learn through the experience of attending
college rather than the stated educational objectives of
such institutions.
Attitude- Teaching?
Modules
Role play
Feed Back
Project work
Fieldtrips
Medical camps
Voluntary services NCC NSS
Attitude and Communication (AT-COM)
Module
Section I: Extract of goals, roles and universal
competencies as envisaged by IMG document.
Section II: Suggested teaching modules for each
professional year, resources cases and method to teach
Section III: List of additional non-core competencies
that form a desirable set of learning
Section IV: Competency log - in a simulated setting. -
progressing in complexity over time.
Attitude and Communication (AT-COM)
Module
Section V: Formative elements that are observable by
guide and marked over time.
Appendix 1: Set of competencies as approved by the
Academic Committee of Medical Council of India
Appendix 2: Modified communication skill rating
tool adapted from the Kalamazoo consensus
COMMUNICATION
Exchange of thoughts or information
to convey different messages by using
verbal, written or non verbal medium.
PRINCIPLES OF COMMUNICATION
Conciseness
Clarity
Correctness
Coherence
Courteousness
Completeness
concreteness
10
Effective communication
T - think
I - introduce
M - manage
E - establish plan
R - revisit and feedback
11
Two way process
GIVE AND RECEIVE
ELEMENTS OF COMMUNICATION
Message
Sender
Medium
Receiver
12
KALAMAZOO STATEMENT
Doctor – Patient encounter
1. Building the doctor patient relationship
2. Opening the discussion
3. Gathering information
4. Understanding the patient’s perspective
5. Sharing information
6. Reaching agreement on problems and plans
Build a Relationship: The Fundamental
Communication Task
Patient-centered or relationship-centered
eliciting the patient’s story of illness while guiding the
interview through a process of diagnostic reasoning.
Building relationship with the patient’s support
networks (family members)
17
Build a Relationship: The Fundamental
Communication Task
Greet - identify - privacy - introduce
ideas, feelings, and values of both the patient and the
physician influence the relationship
this approach regards the physician–patient
relationship as a partnership, and respects patients’
active participation in decision making.
18
Opening the discussion
Allow the patient to complete his or her opening
statement
Elicit the patient’s full set of concerns
Establish/maintain a personal connection
Gathering information
Use open-ended and closed-ended questions
appropriately
Structure, clarify, and summarize information
Actively listen using nonverbal and verbal techniques
Understand the Patient’s Perspective
Explore contextual factors
Explore beliefs, concerns, and expectations about
health and illness
Acknowledge and respond to the patient’s ideas,
feelings, and values
Share Information
Use language the patient can understand
Check for understanding
Encourage questions
Summarise and give opportunity for patient to add.
Reach Agreement on Problems and Plans
Encourage the patient to participate in decisions to
the extent he or she desires
Check the patient’s willingness and ability to follow
the plan
Identify and enlist resources and supports
Provide Closure
Mutual understanding
Ask whether the patient has other issues or concerns
Summarize and affirm agreement with the plan of
action
Discuss follow-up
Breaking a bad news
Goals of the Bad News Interview
To provide intelligible information and educate the
patient / attendants regarding the disease process
To support the patient by employing skills to reduce
the emotional impact
Breaking a bad news
Goals of the Bad News Interview
To develop a strategy in the form of a treatment plan
with the input and cooperation of the patient
To support the relatives/ attendants in accepting the
event
SPIKES- Six- Step Protocol for Delivering
Bad News
S - setting up the interview
P - assessing the patient’s perspective
I - obtaining the patient’s invitation
K - giving knowledge and information to the patient
E - addressing the patient’s emotions with empathic
responses
S - strategy and summary
Thank you