Enhancing Clinical Communication: A Practical Application of

the Calgary-Cambridge Guidelines

Executive Summary

The Calgary-Cambridge Model stands as a pivotal, evidence-based framework for

structuring medical interviews, widely recognized as a "gold standard" in clinical
communication education globally.1 This comprehensive guide emphasizes a
patient-centered approach to healthcare interactions, moving beyond mere
information exchange to foster genuine therapeutic relationships. Its significance lies
in its capacity to enhance communication effectiveness, improve patient outcomes,
cultivate trust, and facilitate shared decision-making in clinical settings.1 This report
will delve into the model's core principles, provide a detailed clinical example
demonstrating its practical application, and discuss best practices for its
implementation to optimize patient-clinician interactions.

Introduction: The Imperative of Effective Clinical Communication

Effective communication forms the bedrock of quality healthcare, profoundly

influencing patient safety, adherence to treatment regimens, overall satisfaction, and
ultimately, health outcomes. Conversely, deficiencies in communication can lead to
misdiagnosis, patient dissatisfaction, and adverse events, underscoring the critical
need for structured and empathetic interactions. The Calgary-Cambridge Model
emerges as a systematic and structured approach specifically designed to optimize
patient-clinician encounters. It provides a clear roadmap for conducting
consultations, ensuring that both the biomedical and psychosocial dimensions of a
patient's health are thoroughly addressed.1

This model transcends the notion of a mere procedural checklist; it embodies a

fundamental philosophy of patient-centered care. The consistent references to the
Calgary-Cambridge Model as a "gold standard" 2 and "comprehensive" 1, developed
from "evidence from interviews of patients, and what made them successful" 1,
highlight its robust foundation. Its unwavering focus on the patient and their
experience 1, coupled with continuous elements like "Building the Relationship" and
"Providing Structure" 2 throughout the consultation, underscore its pervasive
influence. This suggests that truly successful implementation requires more than rote
memorization of skills; it demands an internalization of this patient-centric ethos. The
emphasis shifts from simply "what to do" during an encounter to a deeper
understanding of "how to be" in a clinical setting, ensuring the patient's perspective,
comfort, and active involvement are paramount from the very beginning to the end of
the interaction.

Understanding the Calgary-Cambridge Guidelines: A

Foundational Framework

The Calgary-Cambridge Model provides a detailed exposition of the structure,

phases, and continuous elements essential for effective clinical communication.

Core Structure and Phases

The model outlines a sequential five-step process for a healthcare conversation:

initiating the session, gathering information, physical examination, explaining results
and planning, and closing the session.1 Integral to this structure are two additional,
continuous elements: "Providing Structure to the Consultation" and "Building the
Relationship".2 These are not discrete steps but rather ongoing processes that
underpin and enhance the entire interaction.

The model explicitly highlights that the manner in which information is gathered and
delivered—the process skills such as providing structure and building rapport—is as
crucial as the content of the diagnosis and treatment itself. The consistent emphasis
on "giving a clear structure" and helping "to build the relationship" 1, alongside the
continuous nature of "Providing Structure" and "Building the Relationship" 2,
demonstrates this interdependence. This means that even a clinician possessing
excellent medical knowledge may conduct an inefficient, less patient-satisfying
consultation, potentially leading to poorer outcomes, if adept process skills are
lacking. The model thus champions a holistic view of communication, where the 'how'
of the interaction effectively facilitates the 'what'.

Detailed Exposition of Each Phase

1. Initiating the Session

The primary purpose of this phase is to establish initial rapport, identify the reason(s)
for the consultation, and prepare the patient for the interaction.1 Key skills involve
clinician preparation, which includes preparing the environment, relevant information,
and checking equipment for video consultations.7 A warm greeting, obtaining the
patient's preferred name, introducing oneself, one's role, and the nature of the
interview are crucial.4 Establishing rapport involves demonstrating respect and
interest, and attending to the patient's physical comfort.4 For video consultations,
ensuring privacy, good lighting, and clear audio are also vital.7 Identifying the
reason(s) for the consultation involves using appropriate opening questions, such as
"What problems brought you today?" or "What would you like to discuss?".4 Attentive
listening to the opening statement without interruption, confirming the list of
problems, screening for further issues, and negotiating an agenda are also part of this
phase.4 Finally, obtaining verbal consent, particularly for video consultations, is a
necessary step.6

This initiation phase serves as a psychological gateway to effective care. Its strong
focus on establishing comfort, trust, and rapport 2 extends beyond mere logistical
steps like introductions and consent to encompass psychological elements such as
attending to comfort, demonstrating respect, and active listening from the very
outset. The initial comfort created is described as "essential for building trust, which is
the cornerstone of any therapeutic relationship".2 If trust is not established early,
subsequent information gathering or shared decision-making becomes significantly
more challenging. A well-executed initiation can proactively reduce patient anxiety,
increase openness, and lay a robust foundation for the entire consultation, potentially
improving diagnostic accuracy and adherence to treatment. Conversely, a rushed or
impersonal initiation can erect barriers that prove difficult to dismantle later in the
interaction. A seemingly minor detail, such as checking how a patient prefers to be
addressed 7, immediately signals respect and a patient-centered approach. This small
act of courtesy at the outset can significantly contribute to building rapport and trust,
making the patient feel seen and valued as an individual rather than just a medical
case, thereby setting a collaborative and respectful tone for the entire consultation.

2. Gathering Information

The objective of this phase is to comprehensively explore the patient's problems from
both a biomedical and the patient's perspective, while also gathering relevant
contextual information.1 This holistic view is vital for formulating an effective care
plan.2 Key skills include the exploration of the biomedical perspective, encouraging
the patient to narrate their story from its onset, and employing a "cone technique" by
moving from open-ended questions to more closed ones.4 Active listening, allowing
the patient to complete statements without interruption, and providing space for
thought are paramount.6 Clarifying statements, periodically summarizing, and using
concise, easily understood language are also essential.4

Crucially, this phase involves the exploration of the patient's perspective, often
referred to as ICE (Ideas, Concerns, Expectations). This entails actively determining
and exploring the patient's ideas (their beliefs regarding the cause), concerns (their
worries), and expectations (their goals and what help they anticipated) regarding
each problem.4 It also involves exploring the effects of the problem on their daily life 4
and encouraging the expression of feelings.4 Contextual information, such as
personal, social, and other medical history, drug and allergy history, and systems
review, is also gathered.1 Throughout this process, picking up on both verbal and
non-verbal cues is vital.4

This comprehensive approach to information gathering unlocks the diagnostic power

of the patient's narrative. By explicitly splitting information gathering into "biomedical
perspective" and "patient's experience" 1 and emphasizing the exploration of "ideas,
concerns, expectations, and effects" 4, the model goes beyond mere symptom
collection. The focus on open-ended questions and active listening 4 allows the
patient to convey their "full story".2 This comprehensive approach recognizes that a
patient's "illness"—their subjective experience—is distinct from their "disease"—the
biomedical pathology. By deeply understanding the patient's narrative, including their
beliefs and emotional responses, clinicians can not only arrive at a more accurate
diagnosis (as patient cues can reveal critical information) but also tailor management
plans that are more acceptable and effective for the individual, thereby enhancing
adherence and overall outcomes. This shifts the diagnostic lens from purely objective
data to a blend of objective and subjective realities.

3. Physical Examination

While inherently a clinical act, the Calgary-Cambridge Model integrates the physical
examination sensitively within the communication framework.1 Its purpose is to
conduct a physical assessment relevant to the patient's presenting complaint. Key
skills include explaining the process of the examination and asking for permission
before proceeding.4 Clinicians should also share their thinking and rationale for parts
of the examination that might appear unusual or uncomfortable.4 Throughout the
examination, maintaining appropriate non-verbal behavior and providing support are
crucial to sustaining rapport.4

The model frames the physical examination as a communication opportunity. The

emphasis on "explaining process, asking permission" 4 and "sharing thinking" 6 during
the examination suggests it is not a pause in communication but an extension of it.
This indicates that the physical examination is an opportunity to reinforce trust and
patient involvement, rather than a purely technical procedure. By communicating
effectively during this phase, clinicians can alleviate patient anxiety, maintain dignity,
and even gather further verbal or non-verbal cues that might inform the diagnosis or
management. It transforms a potentially intimidating experience into a collaborative
one.

4. Explanation and Planning

This phase aims to ensure a shared understanding of the diagnosis, prognosis, and
management options, ultimately leading to shared decision-making.1 Key skills involve
providing the correct amount and type of information by giving it in assimilable
"chunks" and frequently checking understanding (known as chunking and checking).6
Clinicians should assess the patient's starting point by asking about their prior
knowledge 6 and inquire what other information would be helpful, such as etiology or
prognosis.6 Avoiding jargon or explaining it clearly is also essential.4

To aid accurate recall and understanding, using repetition and summarizing is

effective.6 Visual methods, such as diagrams, models, or written information, can also
be employed.6 Critically, checking the patient's understanding of information given or
plans made, for example, by asking them to explain in their own words, is vital.4
Achieving a shared understanding requires incorporating the patient's perspective by
relating explanations to previously elicited ideas and concerns.6 Providing
opportunities and encouraging patients to contribute, ask questions, and seek
clarification is paramount.6 Clinicians must also pick up and respond to verbal and
non-verbal cues and elicit the patient's beliefs, reactions, and feelings regarding the
information given.6

Planning, specifically shared decision-making, involves the patient by offering

suggestions and choices and encouraging their own ideas.6 Exploring management
options, negotiating a mutually acceptable plan, determining the patient's preference,
and checking their acceptance are all crucial steps.4 Clinicians may also signpost their
own position of equipoise or preference regarding available options.6

This phase represents the culmination of the patient-centered philosophy,

empowering patients through informed partnership. It moves beyond simply delivering
information to actively "achieving a shared understanding" and "shared
decision-making".1 The explicit involvement of "negotiating a mutually acceptable
plan" and "determining patient's preference" 6, alongside the emphasis on checking
understanding (e.g., "chunking and checking," "in their own words") and eliciting
patient's feelings about the information 6, signifies a deep commitment to patient
autonomy and comprehension. This phase transforms the patient from a passive
recipient of care into an active partner. This empowerment, rooted in clear,
empathetic communication and shared decision-making, not only respects patient
autonomy but is also highly correlated with increased treatment adherence, better
self-management, and improved long-term health outcomes, as patients are more
invested in a plan they helped create.

5. Closing the Session

The final phase aims to ensure appropriate closure, summarize the session, clarify the
plan, and provide forward planning and safety netting.1 Key skills include briefly
summarizing the session and clarifying the plan of care.4 A final check involves asking
if the patient agrees and is comfortable with the plan, and if they have any final
questions or additional points.4 Forward planning encompasses contracting with the
patient regarding next steps and proposed management.8 Safety netting involves
discussing potential future symptoms or changes, and when and how to seek further
help.8 Ultimately, this phase is designed to give a sense of completeness and clarity
for the patient.2

A well-executed closure reinforces patient autonomy and reduces anxiety. This phase
is not merely about concluding the interaction; it explicitly involves "summarizing,"
"clarifying the plan," a "final check," and "forward planning/safety netting".4 The
objective is to achieve "clarity and a sense of closure for the patient," which in turn
"reduces anxiety and enhances compliance".2 A thorough closure reinforces the
patient's understanding and commitment to the plan, thereby enhancing adherence
to treatment. Safety netting empowers patients to manage uncertainty and recognize
when to seek help, reducing anxiety and potentially preventing unnecessary
emergency visits. This phase solidifies the patient's agency and ensures continuity of
care beyond the immediate consultation, contributing to better long-term health
management.

Continuous Elements

Providing Structure to the Consultation

This continuous element ensures the consultation flows logically, is well-organized,

and makes efficient use of time while thoroughly addressing patient concerns.2 Key
skills involve making the organization overt, such as "signposting" next sections or
"summarizing" at key points.4 Attending to the flow and timing of the conversation is
also crucial.4

This element acts as navigation for clarity and efficiency. The model emphasizes "a
clear pathway" 2 and "making organisation overt" through "signposting" and
"summarising".4 This is not solely for the clinician's efficiency; it is equally important
for the patient's ability to follow and retain information. A structured consultation
reduces cognitive load for both the clinician and the patient. For the patient, it creates
a predictable and understandable journey, reducing confusion and improving
information retention. For the clinician, it ensures all necessary areas are covered
systematically, preventing omissions and improving time management, ultimately
leading to a more comprehensive and effective consultation.

Building the Relationship

This continuous element aims to foster rapport, trust, and a therapeutic alliance with
the patient, which is identified as the "cornerstone of any therapeutic relationship".2
Key skills include appropriate non-verbal behavior, such as maintaining eye contact,
using appropriate facial expressions, posture, position, movement, and vocal cues
(rate, volume, intonation).4 It is also important to inform the patient when one is
occupied, for example, when making notes.7 Developing rapport involves accepting
the patient's views non-judgmentally 4, using empathy, acknowledging feelings and
predicaments 4, and providing support.4 Dealing sensitively with embarrassing or
disturbing topics or physical pain is also crucial.4 Involving the patient means sharing
one's thinking to encourage their participation (e.g., "What I'm thinking is...") 4 and
explaining the rationale for questions.4 Active listening is a foundational skill, involving
listening attentively without interrupting, using minimal verbal encouragers, screening
for other problems, picking up non-verbal cues, summarizing, paraphrasing, clarifying,
and reflecting.4

This continuous element serves as the emotional intelligence engine of patient care.
Described as "the heart of the Calgary-Cambridge Model" 2, it prioritizes empathy,
respect, and sensitivity.2 It encompasses a wide array of subtle, nuanced skills,
including non-verbal cues, active listening, and sensitively addressing difficult topics.4
These are not merely technical skills but demand significant emotional intelligence. By
prioritizing empathy and rapport, clinicians can create a safe space for patients to
disclose sensitive information, express vulnerabilities, and feel truly heard. This
deepens the therapeutic relationship, which is a powerful factor in patient healing,
adherence, and satisfaction, transcending the purely clinical aspects of care and
transforming a medical encounter into a human connection.
Table 1: Calgary-Cambridge Model: Phases and Core Communication Objectives

Phase/Continuous Element Core Communication Key Skills/Techniques

Objective

Initiating the Session Establish rapport, identify Warm greeting,

reason(s) for consultation, self-introduction, obtain
prepare patient. patient's name, attend to
comfort, appropriate opening
questions, obtain consent,
negotiate agenda.

Gathering Information Comprehensively explore Open-ended to closed

patient's problems questions, active listening,
(biomedical & patient's clarifying, summarizing,
perspective) and contextual exploring ICE (Ideas,
information. Concerns, Expectations),
exploring effects on life,
encouraging feelings,
gathering history.

Physical Examination Conduct relevant physical Explaining process, asking

assessment sensitively, permission, sharing rationale
integrated with for actions, maintaining
communication. rapport.

Explanation and Planning Ensure shared understanding Chunking & checking

of diagnosis/plan, lead to information, assessing
shared decision-making. patient's starting point,
avoiding jargon, using visual
aids, checking patient's
understanding, relating to
patient's perspective,
encouraging questions,
exploring options, negotiating
mutually acceptable plan.

Closing the Session Ensure appropriate closure, Briefly summarizing, clarifying

summarize, clarify plan, plan, final check for
provide forward planning. questions/concerns,
contracting for next steps,
safety netting (what to do if
 symptoms change/worsen).

Providing Structure Ensure logical flow, Making organization overt

organization, and efficient use (signposting), summarizing at
of time. key points, attending to flow
and timing.

Building the Relationship Foster rapport, trust, and Appropriate non-verbal

therapeutic alliance. behavior (eye contact,
posture, vocal cues),
developing rapport (empathy,
non-judgmental acceptance,
support), involving patient
(sharing thinking, explaining
rationale), active listening
(minimal encouragers, picking
up cues, paraphrasing).

Clinical Communication in Practice: A Detailed Example Applying

the Calgary-Cambridge Guidelines

To illustrate the practical application of the Calgary-Cambridge Guidelines, a common

clinical scenario in a general practitioner's office is presented.

Scenario Setup

●​ Patient: Ms. Eleanor Vance, a 48-year-old female.

●​ Presenting Complaint: New onset, persistent headaches for the past three
weeks, with recent worsening.
●​ Setting: General practitioner's office, routine appointment.
●​ Clinician: Alex Chen, a third-year medical student, supervised by Dr. Anya
Sharma.

This scenario was chosen due to its common, non-emergency nature, which allows for
a comprehensive application of all Calgary-Cambridge phases. It facilitates detailed
information gathering (both biomedical and psychosocial), a focused physical
examination, and shared decision-making regarding investigation and management,
while avoiding overly complex medical jargon to maintain focus on the communication
process.

Step-by-Step Consultation Walkthrough

Initiating the Session

The consultation begins with Alex setting a welcoming and professional tone.
●​ Dialogue/Actions:
○​ Alex: "Good morning, Ms. Vance. Please, have a seat. I'm Alex Chen, a medical
student working with Dr. Sharma today. How would you prefer I address you?"
○​ Ms. Vance: "Eleanor is fine, thank you."
○​ Alex: "Eleanor, thank you. So, what brings you in today? What were you hoping
we could discuss?"
○​ Ms. Vance: "Well, I've been having these headaches..."
●​ Calgary-Cambridge Application: Alex establishes initial rapport, obtains the
patient's name, introduces himself and his role as a medical student, attends to
Ms. Vance's comfort, and identifies the reason for the consultation with an
appropriate opening question.4 The simple act of asking for Ms. Vance's preferred
name immediately signals respect and a patient-centered approach. This small
courtesy at the outset significantly contributes to building rapport and trust,
making the patient feel seen and valued as an individual, not merely a medical
case. It sets a collaborative and respectful tone that permeates the rest of the
consultation.

Gathering Information

Alex then delves into a comprehensive exploration of Ms. Vance's headaches.

●​ Dialogue/Actions (Biomedical Perspective):
○​ Alex: "Okay, tell me more about these headaches. When did they start? What
 do they feel like?"
○​ Ms. Vance: "They started about three weeks ago. It's a throbbing pain, mostly
on one side, sometimes behind my eye. It's been getting worse in the last few
days."
○​ Alex: (Nodding, maintaining eye contact, minimal verbal encouragers like
"Mmm-hmm") "And how severe is the pain on a scale of 1 to 10?"
○​ Alex continues to ask about associated symptoms such as nausea, light
sensitivity, fever, vision changes, and any triggers or relieving factors. He
periodically summarizes: "So, to recap, throbbing, right-sided, worsening, with
some light sensitivity..."
●​ Dialogue/Actions (Patient's Perspective - ICE):
○​ Alex: "Eleanor, you mentioned these headaches have been worsening. What
do you think might be causing them?"
○​ Ms. Vance: "Honestly, I'm worried it could be something serious... like a brain
tumor. My aunt had something similar."
○​ Alex: (Leans slightly forward, empathetic facial expression) "That sounds like a
very frightening thought, Eleanor. It's understandable to feel worried when
you're experiencing new symptoms. How has this been affecting your daily
life?"
○​ Ms. Vance: "I've had to miss work, and I can't focus. I just want to know what it
is and for it to go away. I was hoping for some answers today, maybe a scan."
●​ Calgary-Cambridge Application: Alex encourages Ms. Vance to tell her story
using open-ended questions, transitions to closed questions, practices active
listening, and utilizes non-verbal cues.4 He explores the biomedical perspective
through symptom analysis and systems review, and periodically summarizes
information.4 Crucially, he actively determines and explores Ms. Vance's ideas,
concerns, and expectations (ICE) about her condition, as well as the effects on
her life, and encourages the expression of her feelings.4 By explicitly asking about
"ideas, concerns, and expectations" (ICE) and "feelings" 4, Alex uncovers Ms.
Vance's underlying fear of a brain tumor and her expectation for a scan. This goes
beyond merely collecting biomedical symptoms. If Alex had focused solely on
symptoms, he might have missed this critical emotional and cognitive context.
Addressing the patient's unspoken worries or expectations is vital. It not only
builds trust and rapport but also directly influences the patient's acceptance of
the diagnosis and management plan. By acknowledging and validating Ms.
Vance's fear, Alex can then tailor his explanation and planning to specifically
address this concern, even if the eventual diagnosis is benign. This proactive
approach prevents future dissatisfaction or non-adherence stemming from
 unaddressed anxieties.

Providing Structure & Building the Relationship (Integrated throughout)

These elements are woven seamlessly throughout the consultation.

●​ Dialogue/Actions (Structure):
○​ Alex: "Thank you, Eleanor, that gives me a much clearer picture. Just to make
sure I haven't missed anything, I'd like to quickly ask about your past medical
history and any medications you're on, then we can move on to a brief
examination."
○​ (After examination) "Okay, Eleanor, now that I have a better understanding, I'd
like to share my initial thoughts on what might be going on, and then we'll
discuss this with Dr. Sharma to decide on the next steps together."
●​ Dialogue/Actions (Relationship):
○​ Alex consistently maintains eye contact, leans forward slightly when Ms.
Vance is speaking, and nods to show engagement.
○​ When Ms. Vance expresses fear, Alex uses empathetic phrases like "That
sounds very frightening."
○​ Alex informs Ms. Vance when he is making notes: "I'm just jotting down a few
notes here, but I'm still listening."
●​ Calgary-Cambridge Application: Alex makes the organization of the
consultation overt by summarizing and signposting the next sections, attending to
the flow of the interview.4 He continuously builds the relationship through
appropriate non-verbal behavior, developing rapport through empathy and
support, and involving the patient by sharing his thinking.4 These continuous
elements form the invisible scaffolding of effective communication. They are not
distinct conversational blocks but rather the underlying framework that supports
the entire interaction. The examples demonstrate how signposting and
empathetic responses are woven into the fabric of the dialogue. Their continuous
application ensures that the patient feels guided, understood, and respected
throughout the consultation, even during challenging discussions. Neglecting
these continuous elements, even if other steps are followed, can make the
consultation feel disjointed or impersonal, thereby undermining the effectiveness
of information exchange and shared decision-making.
Physical Examination

Alex conducts a focused physical assessment.

●​ Dialogue/Actions:
○​ Alex: "Eleanor, I'd like to do a brief physical examination, focusing on your
head and neck, and check your reflexes, just to help us understand what
might be causing your headaches. Is that okay with you?"
○​ Ms. Vance: "Yes, please."
○​ Alex: "I'm just going to gently feel your temples here, checking for any
tenderness."
○​ Alex conducts a focused neurological examination, maintaining verbal
engagement and checking for comfort.
●​ Calgary-Cambridge Application: Alex explains the process of the examination,
asks for permission, and shares his thinking regarding the rationale for his
actions.4

Explanation and Planning

This phase focuses on shared understanding and preparing for shared

decision-making with the supervising physician.
●​ Dialogue/Actions (Providing Information & Achieving Shared
Understanding):
○​ Alex: "Eleanor, based on what you've told me and my examination, my initial
impression is that I don't see any immediate signs that suggest something
life-threatening like a brain tumor, which I know was a concern for you. That's
a very important thing to consider, and we'll confirm this with Dr. Sharma."
○​ Alex: "It sounds like you might be experiencing what we call tension-type
headaches, which are very common. Have you heard of those before?"
○​ Ms. Vance: "A little, but I thought they were just from stress."
○​ Alex: "That's a great point. Stress is definitely a common trigger. But they can
also be related to muscle tension in the neck and shoulders, or even
dehydration. To help me understand if my explanation is clear, could you tell
 me in your own words what you understand about tension headaches?"
○​ Ms. Vance: "So, not serious, and they can be from stress or muscle tension."
○​ Alex: "Exactly. Is there anything else about what might be causing them or
what to expect that you'd like to know?"
●​ Dialogue/Actions (Planning: Shared Decision-Making - preparing for
discussion with supervisor):
○​ Alex: "Now, thinking about what we could do, some common approaches for
headaches like these include trying over-the-counter pain relievers, like
ibuprofen, as needed. Another idea is to explore relaxation techniques or
physiotherapy for muscle tension. We could also consider a short course of a
different medication if these don't help. What are your initial thoughts on
these kinds of options?"
○​ Ms. Vance: "I'd like to try the pain relievers first, and maybe look into some
relaxation exercises. I'm not keen on more medications right now."
○​ Alex: "That sounds like a sensible starting point. What I'll do now is discuss
everything we've talked about with Dr. Sharma, including your concerns and
what you'd like to try. She'll then come in to confirm our plan and answer any
further questions you might have. Does that sound acceptable to you?"
○​ Ms. Vance: "Yes, that sounds good."
●​ Calgary-Cambridge Application: Alex relates his explanation to Ms. Vance's
previously stated concerns, providing reassurance early but framing it as an
"initial impression" to manage expectations.4 He provides information in
assimilable "chunks," avoiding jargon, and assesses Ms. Vance's starting point.6
He aids accurate recall by checking understanding and asking what other
information would be helpful.4 In planning, he involves Ms. Vance by offering
suggestions and choices, encouraging her contribution, exploring management
options, and negotiating a mutually acceptable​
initial plan to present to the supervising physician, checking for acceptance of
this process.4 This phase culminates in empowerment through informed
partnership, even with the involvement of a supervisor. It transforms the patient
from a passive recipient of care into an active partner. This empowerment, rooted
in clear, empathetic communication and shared decision-making, not only
respects patient autonomy but is also highly correlated with increased treatment
adherence, better self-management, and improved long-term health outcomes,
as patients are more invested in a plan they helped create.

Closing the Session

The consultation concludes with a clear summary and forward planning, emphasizing
the next steps with the supervising physician.
●​ Dialogue/Actions:
○​ Alex: "Alright, Eleanor, to summarize, we've discussed your headaches, and
my initial assessment is that we don't see anything immediately serious. We've
talked about starting with ibuprofen and relaxation techniques. I'll now go and
discuss all of this with Dr. Sharma. She will then come in to see you shortly to
finalize the plan and answer any remaining questions."
○​ Alex: "Do you have any final questions for me before I go speak with Dr.
Sharma?"
○​ Ms. Vance: "No, I think I'm clear for now. Thank you, Alex."
○​ Alex: "You're very welcome, Eleanor. Dr. Sharma will be in soon."
●​ Calgary-Cambridge Application: Alex briefly summarizes the session and
clarifies the plan of care, specifically outlining the next step involving the
supervising physician.4 He provides forward planning by setting the expectation
for Dr. Sharma's arrival and the finalization of the plan.8 A final check ensures Ms.
Vance has no remaining questions for him and agrees with the process, ensuring
an appropriate point of closure for his part of the interview.2

Table 2: Clinical Communication Example: Calgary-Cambridge Application

Breakdown

Consultation Phase Clinician Calgary-Cambridge Patient

Action/Dialogue Skill/Technique Impact/Rationale
Demonstrated

Initiating the Alex: "Good morning, Introduces self and Builds immediate
Session Ms. Vance. Please, role (medical rapport and trust;
have a seat. I'm Alex student), obtains patient feels
Chen, a medical patient's preferred respected and at
student working with name, attends to ease, understands
Dr. Sharma today. comfort. the student's role.
How would you prefer
I address you?"
Gathering Alex: "What do you Explores patient's Uncovers patient's
Information think might be ideas (ICE). underlying beliefs
causing them?" and potential hidden
(referring to agenda (fear of
headaches) serious illness),
crucial for tailored
communication.

Gathering Alex: (Leans slightly Demonstrates Validates patient's

Information forward, empathetic empathy, emotional
facial expression) acknowledges experience, fosters
"That sounds like a feelings, uses openness, deepens
very frightening appropriate therapeutic
thought, Eleanor. It's non-verbal behavior. relationship.
understandable to
feel worried..."

Providing Structure Alex: "...I'd like to Signposts next Guides patient

quickly ask about section, makes through the
your past medical organization overt. consultation, reduces
history... then we can anxiety about the
move on to a brief unknown, ensures
examination." efficient flow.

Building the Alex: "I'm just jotting Maintains rapport Reassures patient of
Relationship down a few notes while occupied. continued
here, but I'm still engagement,
listening." prevents feeling
ignored or rushed.

Physical Alex: "Eleanor, I'd like Explains process, Respects patient

Examination to do a brief physical asks permission. autonomy, reduces
examination... Is that anxiety during
okay with you?" physical contact,
maintains dignity.

Explanation and Alex: "...my initial Relates explanation Directly addresses

Planning impression is that I to patient's patient's greatest
don't see any previously elicited fear with appropriate
immediate signs that concerns, manages framing, provides
suggest something expectations reassurance, builds
life-threatening like a regarding definitive trust while
brain tumor, which I diagnosis. acknowledging
know was a concern student's role.
for you. That's a very
important thing to
consider, and we'll
 confirm this with Dr.
Sharma."

Explanation and Alex: "To help me Checks patient's Ensures accurate

Planning understand if my understanding comprehension,
explanation is clear, (chunking and identifies any
could you tell me in checking). misunderstandings,
your own words what empowers patient to
you understand articulate knowledge.
about tension
headaches?"

Explanation and Alex: "What are your Encourages patient Promotes shared
Planning initial thoughts on contribution, offers decision-making,
these kinds of choices, preparing increases patient
options?" (for for discussion with ownership and
management) supervisor. adherence to the
plan, involves patient
in the next steps.

Closing the Session Alex: "I'll now go and Provides forward Empowers patient by
discuss all of this with planning, clarifies outlining the process,
Dr. Sharma. She will next steps involving reduces anxiety
then come in to see supervisor. about future steps,
you shortly to finalize ensures continuity of
the plan and answer care.
any further questions
you might have."

Discussion: Best Practices for Implementation

The Calgary-Cambridge Model, despite its detailed nature encompassing 71 skills 1,

provides a robust framework that ensures comprehensive patient care by
systematically addressing both biomedical and psychosocial aspects.1 Its structured
approach promotes efficiency by providing a clear pathway 2, leading to better time
management and more focused interactions. Crucially, the model significantly
enhances patient satisfaction, trust, and adherence to treatment plans through its
emphasis on empathy, shared understanding, and shared decision-making.2

Implementing such a comprehensive model presents certain challenges. The sheer

number of skills can be overwhelming and difficult to incorporate simultaneously,
especially for clinicians new to the framework.1 To mitigate this, a practical strategy
involves focusing on the mastery of core skills within each phase first, gradually
integrating more nuanced techniques as proficiency grows. Consistent practice,
reflective exercises, and constructive feedback are essential for skill acquisition and
refinement.3 It is important to view the model as a flexible guide rather than a rigid
script.

Another common challenge lies in continuously maintaining the "Building the

Relationship" and "Providing Structure" elements while simultaneously managing the
content of the consultation. The effective approach is to integrate these elements
naturally into the flow of the conversation. For instance, signposting can be delivered
with a warm, reassuring tone, and active listening is inherently a relationship-building
behavior. While this requires conscious effort initially, it becomes more intuitive with
sustained practice.

Effective communication is a dynamic skill that necessitates ongoing development,

much like any other clinical expertise. Healthcare professionals are encouraged to
engage in continuous self-assessment, such as reviewing consultations or identifying
areas for improvement, and to actively seek constructive feedback from peers or
mentors. The adaptability of the model, as evidenced by its successful adaptation for
veterinarians 1, suggests that its core principles are broadly applicable across various
healthcare contexts and can be tailored to diverse clinical settings and patient
populations.

The mastery of the Calgary-Cambridge Model is an iterative process, not a final

destination. The observation that 71 skills are "very difficult to incorporate
simultaneously, making it more difficult to learn" 1 indicates that learning is not a
one-time event. The model's integration into "curriculum" 2 and "programme modules"
3
, and its use for "learning, practice, and reflection" 3, further supports this. Clinicians
should approach the model as a framework for continuous improvement,
understanding that initial awkwardness in application will gradually give way to fluid,
intuitive execution through repeated practice, diligent self-assessment, and invaluable
feedback. This perspective is crucial for sustained professional development and
resilience in navigating the complexities of clinical communication.

Conclusion
The Calgary-Cambridge Model remains a beacon of excellence and a gold standard
for clinical communication 2, providing a robust, evidence-based framework for
patient-centered care. Its structured yet flexible approach profoundly impacts patient
outcomes, fosters trust, and elevates the overall quality of healthcare interactions. By
embracing and continuously refining their communication skills through this invaluable
guide, healthcare professionals can contribute significantly to a more compassionate,
effective, and truly patient-centric healthcare system.

引用的著作

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