Microskills

LI: Describe and list the types of microskills, and why we should use them

Microskills are small consultation skills that allow the process to be more effective and efficient. There is a large list that can be employed during a consultation

​So, what is a microskill?

Multiple Select

Which of these are microskills?

• Active Listening

• Judging the Pt

• Empathy and Compassion

• Signposting

• Interrupting the Pt

Involves giving the Pt free and unidivided attention, listening with interest and not interrupting.

Benefits:
- Validates the Pt's thought process
- Non-verbal messages override verbal cues

Active Listening

The direct identification with, understanding of, and resonance with the experience of the Pt.

Benefits:
- More trust developed with the Pt
- Associative thinking by the Dr
- Pts feel validated and heard, and enhances quality of caregiving

Empathy

Similar to empathy but linked to an understanding of the person and action towards reducing their suffering.

Empathetic and compassionate statements that link the ‘I’ of the Dr to the ‘you’ of the Pt.

Example phrases:

-              “I can appreciate how difficult it is for you to talk about this…”

-              “I can sense how angry you have been feeling about your illness…”

Compassion

Acts as a transitional statement that allows the Dr to signal a change in direction of the conversation, and move from one section of the consultation to another. It can be used at the beginning of the consult through to the end. Brings structure to the consult.

 

Benefits:

-              The Pt knows where the Dr is going and why

-              Reduces uncertainty on both sides and promotes collaboration

Signposting

Multiple Select

And again...

• Agenda Setting

• Not sharing thinking

• Ignoring Pt cues

• Screening

• Summarising

Summarises how the time will be structured and leads to a mutually understood common ground. Similar to signposting, but more at the initial stages of consultation. Listen to Pts first problem and allow the story to develop.

 

Benefits:

-              Allows for more efficient use of time

-              Gives a chance for the Pt to raise other concerns and identify the most important one

Examples of phrases:

-              What’s the first thing you’d like to discuss?

-              Which problem is most troubling you?

Agenda Setting

Ensuring that no other symptoms/issues have been missed. The order of presentation is sometimes not related to the medical importance or Pt importance. Vital for Dr to screen effectively to ensure other problems aren’t missed.

 

Example phrases:

-              “apart from this small pimple, I’ve been getting pains in my chest all week”

Screening

Cues in body language, speech, and facial expression are highly significant. It is important to observe these carefully and then sensitively verify your perceptions with the Pt.

 

Benefits:

-              Act as a shortcut to important areas that require attention

-              Builds trust between Pt and Dr, Pt concerns feel validated

Example statements:

-              “I can sense you are very tense, would it help to talk about it?”

-              You sound sad when you talk about John…”

-              Ask “what concerns you?” instead of “what worries you?”

Responding to Pt Cues

-              Explanations: If a Pt understands why they are undertaking a treatment and how it benefits them, they will be more compliant with the treatment plan.

-              Praise

-              Normalising for population: Makes Pt feel more comfortable with sharing sensitive and private information. Example statements: “this is more common for younger women…” “that’s the age people start…”

-              Non-judgemental: Being judgemental is a major barrier to allowing successful interpersonal communication. Want to make sure Pt doesn’t feel belittled or patronised, and stays engaged in the discussion.

-              Clarifying: Checking to make sure the information you have heard from the Pt is accurate and understood by the Dr. Ask open-ended questions, as opposed to yes/no questions to elicit further information.

​

A more extensive list

Most of the microskills flow into one another throughout the course of the consultation. Try to think of them as an interlinking web rather than isolated techniques to employ.

​

References:

https://www.bradfordvts.co.uk/communication-skills/teach-communication-skills/consultation-microskills-tasksheets/

-              Has a trove of information and details about each of the microskills