Calgary-Cambridge consultation model

Enhanced Calgary-Cambridge Consultation Model
Kurtz S1, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad Med. 2003 Aug;78(8):802-9.

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Initiating the session

Establishing initial rapport
Identifying the reason(s) for the consultation

Gathering data

Encourages patient to discuss the problem in their own words
Use open and closed questioning techniques
Actively listening
Facilitates patient’s responses (encouragement, silence, repetition, paraphrasing)
Picks up verbal and non–verbal cues
Clarifies patient’s statements that are unclear or need amplification (e.g. “Could you explain what you mean by light headed")
Periodically summarises to verify own understanding of what the patient has said; invites patient to correct interpretation or provide further information.
Understanding the patient’s perspective: explores patient’s ideas (cause?), concerns and expectations (goals from consultation or treatment)

Providing structure

Making organisation overt
Summarises at the end of a specific line of inquiry to confirm understanding before moving on to the next section
Progresses from one section to another using signposting, transitional statements; includes rationale for next section

Attending to flow
Structures interview in logical sequence
Attends to timing and keeping interview on task

Building the relationship

Using appropriate non-verbal behaviour
If reads, writes notes or uses computer, does in a manner that does not interfere with dialogue or rapport
Developing rapport
Accepts legitimacy of patient’s views and feelings; is not judgmental
Uses empathy to communicate understanding and appreciation of the patient’s feelings or predicament; overtly acknowledges patient's views and feelings
Provides support: expresses concern, understanding, willingness to help; acknowledges coping efforts and appropriate self care; offers partnership

Shares thinking with patient to encourage patient’s involvement (e.g. “What I’m thinking now is....”)

Explains rationale for questions or parts of physical examination that could appear to be non-sequiturs
During physical examination, explains process, asks permission

Giving information: explanation and planning

Providing the correct amount and type of information
Assesses patient’s starting point/ prior knowledge
Asks patients what other information would be helpful e.g. aetiology, prognosis
Gives explanation at appropriate times: avoids giving advice, information or reassurance prematurely
Assimilable chunks and checks for understanding

Aiding accurate recall and understanding
Logical sequence
Uses explicit signposting (e.g. ‘There are three important things that I would like to discuss…)
Uses repetition and summarising to reinforce information
Avoids jargon
Uses visual methods of conveying information e.g. diagrams

Checks patient’s understanding of information given (or plans made)

Relates explanations to patient’s illness framework: to previously elicited ideas, concerns and expectations
Provides opportunities for patient to ask questions and/or seek clarification

Planning: shared decision making
Shares own thinking as appropriate: ideas, thought processes, dilemmas
Encourages patient to contribute their thoughts: ideas, suggestions and preferences
Negotiates a mutually acceptable plan
Offers choices
Checks with patient: if plans accepted; if concerns have been addressed

Closing the session

Forward planning
Contracts with patient re next steps for patient and physician such as follow up or investigations
Safety netting: explaining possible unexpected outcomes, what to do if plan is not working, when and how to seek help

Ensuring appropriate point of closure
Summarises briefly and clarifies plan of care
Final check that patient agrees and is comfortable with plan and asks if any corrections, questions or other items to discuss

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