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1. Head-to-Toe Assessment: Adult
10. Cardiovascular System
2. Head-to-Toe Assessment: Infant
11. Peripheral Vascular System
3. Head-to-Toe Assessment: Child
12. Breasts and Axillae
4. Head-to-Toe Assessment: Older Adult
5. General Survey and Vital Signs
14. Male Genitalia, Rectum, Anus, and Prostate
15. Female Genitalia, Anus, and Rectum
7. Head, Eyes, and Ears
16. Musculoskeletal System
8. Nose, Mouth, and Neck
17. Nervous System: Cranial Nerves and Motor System
9. Thorax and Lungs
18. Nervous System: Sensory System and Reflexes
Communication and Interpersonal Skills
OSCE Clinical Skills
Communication and Interpersonal Skills
1. Technique: Active or Attentive Listening
The skill of active listening, also known as attentive listening, involves various techniques intended to help facilitate, direct, and structure the clinician’s interaction with the patient.
2. Technique: Guided Questioning
The clinician's use of guided questioning of the patient includes multiple techniques such as moving from open-ended to focused questions; using questioning that elicits a graded response; asking a series of questions, one at a time; offering multiple choices for answers; clarifying what the patient means; encouraging with continuers; and using echoing/repetition.
3. Technique: Empathic Responses
The clinician's use of empathic responses is vital to establishing rapport with the patient and contributes to patient healing.
4. Technique: Summarization
Summarization is one of the most important tools of a skilled interviewer. Accurate summarization communicates that the clinician has been actively listening to the patient and identifies what the clinician knows and doesn't know.
5. Technique: Transitions
The clinician's use of transitioning—orienting the patient with brief transitional phrases—helps to put the patient more at ease during the health care visit by preparing the patient for what comes next.
6. Technique: Empowering the Patient
It is key for the clinician to establish a clinician–patient relationship that promotes partnership and builds trust, empowering the patient.
7. Technique: Reassurance
The clinician's use of effective reassurance involves identifying and acknowledging the patient's feelings, without minimizing those feelings, and communicating that any of the patient's concerns and problems have been fully understood and are being addressed.
8. Use of Understandable Language
The clinician's use of understandable language relates to how information is communicated to the patient—regardless of the patient's level of health literacy—including using clear, recognizable words and short sentences; communicating only essential information; and avoiding the use of medical jargon, abbreviations, or any complex words or phrases that might obstruct the information the clinician is trying to convey.
9. Use of Non-Stigmatizing Language
The clinician's use of non-stigmatizing language reflects the patient's full identity, and acknowledges the patient's capacity to change and grow, by avoiding words or phrases that could be perceived by the patient as dehumanizing, that perpetuate stigma, and that marginalize rather than support.
10. Appropriate Nonverbal Communication
The clinician's nonverbal communication such as posture, gestures, head nodding, and eye contact can all convey to the patient the extent of interest, attention, acceptance, and understanding and can affect the effectiveness of the interview.
11. Use of Preferred Title, Name, and Gender Pronoun
The clinician's inquiry and use of the patient's preferred name, title, and gender pronoun promotes a welcoming environment—especially for a patient whose preferred pronoun or name does not conform to historically conventional societal norms.
12. Interprofessional Communication
Effective interprofessional communication is key to providing efficient, quality care that leads to excellence in patient outcomes. In the clinical environment, the clinician will often need to collaborate with team members from various fields such as medicine, nursing, dentistry, advance practice nursing, dietetics, social work, podiatry, and rehabilitation therapy.
13. Patient-Centeredness in Computerized Clinical Settings
One of the most common changes in general clinical practice is the introduction of the electronic health record. Some feel that the presence of a computer during a clinical interview has created a three-way interaction whereas formerly it was purely a two-person, patient–clinician interaction. The novice clinician may find it particularly challenging to engage the patient during the clinical encounter while also attending to the accuracy of the record and contributing to a culture of information safety.
14. Teach-Back Method
The teach-back method is an effective way for the clinician to know if the patient has understood and retained important information shared by asking the patient to teach the information back to the clinician.
15. Rapport: Newborns and Infants
Communication with patients of all ages is important. Although the clinician will not be able to communicate with a newborn or infant patient as with an older child, the clinician should still work to build rapport with the newborn or infant and the parents and caregivers. Having a baby is a major milestone in many people's lives. Whether the family is elated, anxious, or exhausted during the visit, an empathetic, calm, and helpful clinician can be an invaluable source of comfort and guidance. This approach serves to create trust between the parents and clinician.
16. Rapport: Young Children
Establishing rapport with a toddler or school-age child can be challenging. Young childhood is characterized by rapid development and new experiences. The clinician can learn about the young patient by observing and using those observations in developing rapport and determining when to interact directly with the parents.
17. Rapport: Adolescents
Although adolescents are on their way to becoming adults, in many ways they are still children. The challenge to the clinician is to allow the adolescent to participate in their own care, while at the same time, including the parent or guardian in the process.
18. Rapport: Older Adults
Whether the clinician is interviewing the older adult patient in an office, hospital, or nursing home, adjusting the physical environment and the interviewing approach to put the patient at ease will result in better communication and more effective medical treatment.
19. Rapport: Patients with Physical and Sensory Disabilities
Clinicians should use always use "people-first" language in the patient interview, and this is especially true when speaking with patients with physical and/or sensory disabilities. Establishing rapport with these patients during the interview involves eliciting their preferences for how best to communicate, how they wish to navigate the physical exam room, and whether they require assistance, or some combination of these approaches. Always speak directly to the patient, even when they are accompanied.
20. Rapport: LGBTQ+ Adults
LGBTQIA+ patients who experience high rates of health care disparities and bias are less likely to express their health care concerns. The successful interview starts with asking the patient how they would like to be addressed, including their preferred pronouns. A supportive, nonjudgmental approach allows the clinician to stablish rapport with LGBTQIA+ patients and explore all facets of their health and well-being, including sexual orientation and gender identity (SOGI).
21. Broaching Sensitive Topics
Discussing sensitive topics is a difficult yet integral part of the clinician's role. Several basic principles can guide the approach to these discussions, the most important of which is to be nonjudgmental and practice acceptance. Using these techniques, the clinician will become more comfortable discussing sensitive topics and help patients achieve better health.
22. Obtaining Informed Consent
Obtaining informed consent is a communication process between the clinician and patient. Educating patients about the risks, benefits, and alternatives of a procedure or intervention is not just the clinician's legal and ethical duty, it also ensures that patients are involved in decision making regarding their care.
23. Discussing Advance Directives
Advance directives allow the patient to guide critical care decisions that might need to be made if they become seriously ill. Every patient should have an advance directive, but clinicians should especially encourage their older adult and chronically ill patients to consider these important decisions and make their preferences known.
24. Working with Medical Interpreters
The key to the patient interview is getting as full a story from the patient as possible, even when the patient and clinician speak different languages. When working with a medical interpreter, the clinican should outline their specific goals for the interview. The ideal interpreter is a "cultural navigator" who is neutral but trained in both languages and cultures and can help the clinician obtain relevant patient information that might otherwise be missed.
25. Disclosing Serious News
The clinician's obligation to disclose serious news to the patient not only requires advanced communication skills, but also involves responding to patient's emotional reactions, engaging in shared decision making, and managing the stress of a bleak situation. The SPIKES protocol can guide clinicians through these complex situations.
26. Responding to Emotional Cues
Experiencing illness can cause emotional distress, and clinicians can learn more about a patient's health concern by picking up on and responding to emotional cues the patient might exhibit. Using the techniques summarized in the NURSE mnemonic, clinicians can convey their support for the patient in distress and explore their health problems more fully.
27. Motivational Interviewing
Clinicians often need to discuss behavior change with patients to optimize health or treat illness. Using three key aspects of the motivational interviewing technique--ask, listen, and inform--clinicians help patients discover their own reasons for wanting to make behavior changes and improve their health.