Calgary-Cambridge Guide

I lay awake here because the fire alarms have gone off twice tonight and the whole house smells like burnt popcorn. SO mad at my house mate... He is very inconsiderate and very fat and obnoxious.

Now that that is off my chest, I can use this awake time to bring you the AVM stuff I promised. The following is the Calgary-Cambridge Guide to becoming a better communicator in veterinary medicine. Some of it feels silly, but it is actually much harder to incorporate these when faced with the situation head on. We have had a chance now to try this in class with fake clients.

Our simulated client interviews are taped so we get the "pleasure" of having to critic them. In first year we get easy ish ones, just trying to give empathy and praise to the client and try to get a bit of a rapport going. We also have a student coach and a proffessional coach with us to help us through the interview. The nice thing is that we can pause resume and rewind if we are unsure. I feel that I prepared just enough, any more and I would not have been able to handle the "curve balls" they throw at you half way through. I think I did well, but I guess we'll see when I get my tape back.

My first scenario was what we refer to as "The Crazy Rabbit Lady". She was so angry and unmoving. She shook her leg, and crossed her arms and only looked at me when she vented about her ex-husband. It was terrifying. However, I learned a lot. She was upset that she had to care for a smelly rabbit that her two young daughters loved and that her ex-husband gave them for Easter. I had to give her lots of sympathy and ask about her daughters, then let her shred her ex-husband apart verbally before I got anywhere near to asking questions about the rabbit. So crazy...

My second was total opposite. This was a woman who was super chatty and wanted to ask some questions about declawing. For her I had to let her ramble for a couple minutes then change the subject to her cat gently and fluently as not to offend her and ruin the relationship we were building. She wanted to talk about her daughter too and she clearly missed her as she was at university. It made her feel bonded to talk casually. Then I had to let her know that she has some surgical and non-surgical options to deal with her husband's wish to declaw the cat (which she was opposed to). She liked knowing that she was not the only one who felt this way and I praised her for coming in to talk about it so she got all the information to make a proper decision. I actually felt nervous when she wasn't yelling! hahaha

Clearly these were made up and performed by trained actors. The characters were well planned out and actually felt like real people. My class mates expressed some upset that we have to do this exercise but I think it's good that we got the practise. More clients are "difficult" then are easy. It normally is a struggle to get info out of them and build a good relationship with them. There is ALWAYS outside, personal issues that will be affecting them and their pets so as clinicians we will see lots of "crazy ladies" during our careers. I am glad that we get to do this again next year, i just don't want to have to write up a silly report based on my recording....

Before I leave, I would like to say that if anyone out there is reading this and is prepping their vet school applications, please contact me with any questions kmarinac!uoguelph.ca

So here it is, the Calgary-Cambridge Guide:

Step I: Start the clinical interview

Skill 1 – Establish rapport with the client

• Warmth in tone of voice and a smile à connect with client
• Greet client(s) before patient(s), but always both
• Shake hands (if possible)
• Introduce yourself by name and role
• Generally formal mode of address (Mr., Mrs., Ms., etc.) until invited to do otherwise by client
• Find something in common to start off interview (e.g. weather)
• Squarely face the person (whether you are sitting or standing)
• Open your posture and lean towards the person
• Eye contact as appropriate

Skill 2 - Identify reason for the consultation

·         Ask appropriate opening question

·         Listen to client’s opening statement

·         Open ears; close mouth

·         Resist the urge to interrupt the client to clarify a point à make a  mental note to come back to it

·         Don’t just focus on the first issue the client brings up - they may have a ‘list’

·         Establish an agenda to confirm you understand client’s needs and expectations

Skill 3 – You use appropriate non-verbal behaviors

• Provide appropriate eye contact, facial expressions, posture, vocal cues (‘minimal encouragers’)
• Use notes, records, computer appropriately

Skill 4 – You reinforce rapport

• Acknowledge client’s views and feelings

·         Empathize with the client 

Skill 5 – You involve the client

• Explain what you are doing            
• Share your thoughts about what you are finding

Skill 6 – Explore the problem

·         Use open or closed ended questions when appropriate

·         Clarify/paraphrase

·         Summarize interview up until now

Skill 7 – Work to understand the client’s perspective

• Determine client’s ideas and expectations
• Assess effect of problem on client and patient

Skill 8 – You provide timely & appropriate information

·         Ask what client already knows & what other information they want to know (“start where the client is at”)

·         Explain at appropriate times

·         Give information in manageable chunks and check in with client

• When will results of the diagnostic tests be available?
• What are the risks of the disease and the treatment?
• What are the options for treatment?
• What are the costs?
• What is your recommendation?

Skill 9 – You share decision-making with client

·         Share your thinking

·         Negotiate a plan

·         Check for acceptance and concerns

·         Client is educated

·         Client feels that he or she is heard and understood

·         Joint decision making emerges from the conversation

Skill 10 – You summarize and check in

·         Recap interview briefly and clarify plan

·         Do a final check to see if client willingly agrees to plan