Note on using this video
Read the background information to understand the scenario context. On watching the video, observe the communication skills used to achieve the intended outcome. While individuals may use different words and phrasing, the videos illustrate important core communication skills. There may be some areas of the conversation where other skills could have been used or the skills could have been used differently.
The communication skills sheet overleaf includes some examples of different wording for particular skills.
As in any acted version of a healthcare conversation, you will notice that the video does not capture the full nuance of real-life communication. Instead, it highlights skills that are known to make healthcare conversations easier and more effective. The intention is not to teach skills ‘by rote’ and to learn wording by heart, but rather to help viewers reflect on core communication skills and how these skills are used with different emphasis in different situations. The video includes multiple phases and skills. If you are using it in a teaching session, it can be useful to think in advance about the particular skills you want learners to observe.
Supporting materials
Visit our webpage for supporting materials on communication skills for Motivating Others.
Click this link to download the Debrief in PDF format
Background
Dr Lisa Moran is an Intern on an Obstetrics and Gynaecology rotation at a level 4 hospital. A week ago she approached Dr Joe Williams (Specialist Registrar) as she was feeling stressed and demotivated. Dr Williams arranged to meet with Lisa in his office to discuss her concerns.
Clips
There are four clips in this scenario.
FIRST CLIP
ENGAGE
00:17 – 01:33
Joe builds rapport with Lisa and create an environment that is comfortable for Lisa to talk about her areas of concern and any changes that she wants to make.
SECOND CLIP
FOCUS
01:34 – 06:08
Joe uses open questions and summaries to understand Lisa's concerns and perspective and to continue to build and strengthen a collaborative relationship with Lisa.
THIRD CLIP
EVOKE
06:09 – 09:54
Joe elicits and reinforces Lisa's motivation to manage her time more effectively and encourages her to become an active participant in the conversation about change.
FOURTH CLIP
EVOKE
09:55 – END
Joe gives Lisa some information about next steps while emphasising her freedom of choice and autonomy. In doing so, Lisa comes to her own conclusions about next steps that she might take.
Communication Skills
FIRST CLIP
ENGAGE
00:17 – 01:33
In this clip, Joe gets the conversation off to a good start.
- Joe starts the conversation with a warm greeting ("Good morning Lisa"), and makes a connection with Lisa by expressing appreciation for her coming to the meeting, ("Thanks for taking the time to meet today").
- He continues the warm greeting with ("How are you doing?"), listens to Lisa's response and follows on with another open question ("How is your week going?"). These questions show interest in Lisa and help to build the relationship.
- Joe continues to build rapport by affirming ("It's important to keep in touch, isn't it?") in response to Lisa saying that she was looking forward to meeting her college friends on Friday.
- Joe uses signposting to explain the nature of the conversation ("So just to set the parameters for today...") and builds affiliation by assuring Lisa that, ("everything we say to each other is in complete confidence"). He signposts the approximate amount of time that he has available ("I have 30 minutes today...").
- Joe demonstrates that he has prepared for this meeting ("From the text you sent, I have an idea that..."), this helps to build rapport and trust with Lisa. Joe then follows with an open question to explore this and anything else that Lisa wants to talk about today ("I'm interested in what else is going on... So tell me what it is that you want to talk about"). This means Joe can find out what Lisa is thinking, and he can listen to the kind of terms and words Lisa uses. This will help Joe to tailor the remainder of the conversation to Lisa's perspective (her ideas, concerns and expectations) and to match his language to the words and language that Lisa uses. Lisa says that she is ("nervous") and Joe follows by identifying ("I can see that you are nervous") and validating the emotion that he sees ("It's completely normal... we've never spoken like this.").
SECOND CLIP
FOCUS
01:34 – 06:08
In this clip, Joe negotiates a shared agenda for the conversation.
- Joe elicits the issues that Lisa wants to talk about ("You wanted to talk about your time management skills"), then again uses an open question to invite Lisa to give further information ("Tell me a bit more about that").
- Joe uses silence and non-verbal encouragers (eye contact, warm expression, nodding, open body posture), giving Lisa further space to tell her story.
- Joe uses a summary to reflect what Lisa has said ("Ok, so you're on your second rotation now..."). Summaries are useful because they show that Joe has heard exactly what Lisa has said. It also gives Lisa the opportunity to correct Joe's interpretation and to add further information if she wishes to do so.
- Joe screens and invites Lisa to say some more ("Is there anything else?") and uses silence and non-verbal encouragers (eye contact, nodding), giving Lisa further space to speak.
- Joe conveys empathy and identifies what he thinks Lisa is feeling ("You don't look very happy when you're saying that..."), this skill enables him to convey that Lisa' concerns are expectable and understandable, this gives Lisa permission to express her worries and concerns. We can see within this clip Joe responding to Lisa's emotions in several ways – noticeably open body posture and positioning, eye contact, nodding and remaining silent while Lisa is speaking and demonstrating empathy through summaries that include the emotional content of the conversation, ("You're getting frazzled and it's affecting your rapport..."). This repetition of what Lisa has said in conjunction with his warm tone expresses his interest and empathy in a sensitive way.
- When Lisa mentions her difficulty in relation to paperwork, Joe encourages her to clarify what she means by this, using repetition and an inquiring tone ("The paperwork?").
- Joe uses another open question to invite Lisa to say some more ("Tell me a bit more") and uses silence and non-verbal encouragers (eye contact, nodding), supporting Lisa to continue talking.
- Joe again summarises key information, ("So you're under a lot of pressure with the paperwork..."), and encourages Lisa to tell him more about this. He conveys empathy ("And then you're feeling exhausted") and this prompts Lisa to give him further information.
- Next Joe summarises and communicates back to Lisa his understanding of what she has said, including an empathic statement signalling his understanding of her concerns ("So you're finding it difficult to get out of bed..."). This shows Lisa that Joe has heard what she has said and further helps to build rapport. He then asks an agenda setting question ("I'm wondering what would be helpful for you to focus on today?") in a way that promotes Lisa's autonomy in deciding how the conversation will go ("What do you want to talk about now?").
- Joe then uses an open question to explore what strategies Lisa has been using so that he can further understand her concerns ("tell me a bit about the time management strategies...?").
- When Lisa mentions one of her strategies (to- do lists), Joe encourages her to clarify what she means by this, using repetition and an inquiring tone ("To-do lists?").
- Joe elicits further information in relation to using the time-management matrix using an open question, ("And what did you find?").
- Joe encourages Lisa to clarify what she means when she talks about her findings in using the time-management matrix, using repetition and an inquiring tone ("Not urgent or important?") and open questions, ("What else have you found?"/” What strategies...have worked for you?").
- Joe supports and encourages Lisa using positive nonverbals (eye contact, leaning, nodding, warm facial expression, affirmations, ("Those are good strategies") and an open question ("What else?"), to support and encourage self-efficacy. Affirmations help Joe to build rapport with Lisa and any reduce feelings of defensiveness that Lisa might have about the conversation.
- Joe summarises and repeats key information, ("So planning, prioritising, scheduling and checking for those time stealers...") and Lisa confirms his understanding is correct.
THIRD CLIP
EVOKE
06:09 – 09:54
In this clip, Joe assesses Lisa's readiness to change and elicits talk about why and how she might change (change talk).
- Joe supports and encourages Lisa using positive nonverbals (eye contact, leaning, nodding, warm facial expression, and affirmations, ("So it sounds like you know what steps to take"), to support and encourage self-efficacy.
- He uses scaling questions (confidence) to assess Lisa's readiness to change ("On a scale from zero to ten"... and "why is it that we're at a four and not at a lower number...?").
- Joe acknowledges what Lisa says about her confidence to change with a reflection ("It sounds like what we really need to focus on..."), and an open question ("what do you think we could do to help you...?").
- Joe again uses open questions to emphasise Lisa's autonomy ("What do you think we could do to help..."). This helps to build collaboration, affiliation and establishes Lisa as a joint problem solver in the conversation.
- Joe asks permission to focus the conversation on previous attempts that Lisa has made to change and the strategies that have worked for her ("So if it's ok, I'm going to put time management to the side for now..."/"What skills did you bring to the table..."). This is an important skill in motivational interviewing as otherwise the conversation may feel like a lecture and Lisa may be less receptive to listening and taking the information on board. Joe uses an open question to invite Lisa to begin talking about her strategies ("What strategies did you use for that?"). His tone of voice implies an interested and non-judgemental approach.
- Joe uses silence, non-verbal encouragers (eye contact, nodding) and open questions ("What else helped?") giving Lisa further encouragement to speak.
- Joe summarises and repeats what Lisa has said, ("So you set your goal and your training programme to help..."). These skills enable him to encourage Lisa to consider strategies that have already worked for her and explore any discrepancy between her beliefs and her current behaviour.
- Joe demonstrates that he believes in Lisa's ability to implement this change with an affirmation, ("That's about it Lisa.."), thus supporting self- efficacy.
- Joe signposts that he would like to share his thinking regarding a strategy that Lisa may find useful ("Something in my own experience I have found important... I wonder do you find yourself... using the communication skills you would have learned in college...") and gives the information in a neutral way.
- Joe gives small chunks of information to Lisa ("The hospital runs communication skills workshops") and emphasises her autonomy in deciding whether or not she would find this strategy useful, ("If you're interested...maybe you could sign up..."). This helps to minimise resistance and allows Lisa to come to her own conclusions about which strategies she might use.
FOURTH CLIP
EVOKE
09:55 – END
In this clip, Joe supports Lisa's motivation to change and continues to build a strong rapport with Lisa, which furthers her sense of self-efficacy.
- Joe supports and encourages Lisa to think about her readiness for change using positive nonverbals (eye contact, leaning, nodding, warm facial expression, and affirmations, ("how ready do you feel to make this change?"). This promotes collaboration with Lisa feeling more ownership for the change and taking more responsibility for next steps. Lisa responds with change talk ("I feel motivated to change").
- Joe uses a focussed question to help Lisa explore any barriers to making this change ("What barriers do you anticipate...?") and assessing support for her ("Anyone you think could help support you on the journey?").
- Joe checks the next steps with Lisa and also uses signposting to indicate that the conversation is coming to an end ("So before we finish our conversation...what are three things...").
- Joe affirms Lisa's ability and motivation to change, ("You're clearly a very resourceful person...you're very motivated to make this change") and outlines what he will do next to support Lisa ("I will send you the email address for that communication skills workshop...").
- Safety netting, a term derived from primary care, is used when a person has been given some information and is then leaving the conversation (going home for example). Safety netting involves telling the person what to do if things unexpectedly get worse/go wrong. Joe puts a safety-net in place ("If there's anything else I can help you with... feel free to reach out any time") acknowledging that Lisa may require further support/information when she has had time to consider the information they have discussed and/or when she is initiating the change.