Communication & Professional Conduct Competency 1.9

Competency 1.9

The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or who might mislead

This competency examines your capability to deal with patients who may be more difficult or challenging to communicate with.  You need to be able to conduct a thorough eye examination and elicit the relevant information to complete all tests, and then be able to successfully communicate the results or onward management decisions with the patient and carers.

This competency also examines the trainee’s ability to communicate and complete an examination with a patient who may be confused, or malingering or not forthcoming with responses for whatever reason.

Best Form Evidence

In an ideal situation, the Assessor would probably prefer to witness this via Direct Observation but in reality this is unlikely to happen.  The most likely method of sign off are via Role Play / Case Scenarios, examination of Patient Records and Questioning.  You should have at least two patient records ready for the Assessor from the third quarter Patient Episode Request sheet.

This competency also investigates the use of non-verbal communication such as body language.  The Assessor may discuss or look for signs in your body language.  For example, you should consider details such as chair height; it may be better to sit at eye level with the patient rather than look down at them.  Remember eye contact is important and making sure the mouth is visible for those who are lip reading.  Trainees should also remember that a cross-legged or cross-armed pose may be intimidating or even defensive and may make a patient nervous.

As verbal communication is also important, this competency also covers the type of questions that you use (open, closed, funnel etc), together with elements such as tone of voice and clarity of speech.

Example of possible scenarios:

A malingering child:

  • How would you detect that the child is malingering?
  • How would you phrase your questions?
  • What test could you use?  e.g. use of plano lens as a “magic lens”
  • How you would explain to parent that the child is malingering and not suffering from a visual problem?A person with learning difficulties (adult or child)

A person who is hard of hearing:

  • With or without lip reading skills

A person who does not speak English or other language spoken by the trainee

  • With or without an attending interpreter
  • Be sympathetic to uncommonly encountered cultures: for example a hand gesture in one culture may translate differently into another

A shy, nervous or frightened patient
A patient with senile dementia

Unacceptable Evidence

Trainees should ideally have evidence that they have actually examined real patients from these patient groups or the Assessor may fail them merely from lack of experience.

In the role-play/case scenarios ensure that the patient is treated with respect and not ridiculed.

Consider that as non-verbal communication is important, over-emphatic hand gestures may appear aggressive; respect the patient’s body space.

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