oa South African Family Practice - Teaching consultation skills using juggling as a metaphor : open forum



The consultation is a complex and important skill in medical practice. This article describes how a metaphor model of the consultation is used to train consultation skills. The metaphor is a juggler using 3 balls representing three continuous processes namely facilitation, clinical reasoning and collaboration in the consultation. Facilitation enables the practitioner to help the patient uncover his or her story. Clinical reasoning is the process of making an assessment through reasoning, history taking and physical examination while collaboration is the process of involving the patient in the understanding of the problem and the solution through a mutual plan. Negotiation is used when there is disagreement between the practitioner and the patient. The successful integration of these processes lead to a functional patient-centred consultation. The training first focuses on the training of the individual processes and then its integration. Training takes place through seminars including role plays and fish bowl sessions.


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