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Table 2 Codebook with criteria for points allocated to each item

From: Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide

DomainsItem 1: Identifies problems the patient wishes to address
Initiating the sessionMicro-skillsDemonstrated micro-skills /criteriaPoints
1. Greets patients
2. Introduces oneself, one’s role and the nature of the interview
3. Demonstrates respect and interest; attends to patient’s physical comfort
4. Uses an appropriate opening question/listens attentively
5. Confirms issues to be discussed/screens for further questions and negotiates the agenda
Micro-skill 1 and micro-skill 2One
Micro-skill 1 and micro-skill 2 together with one of the other micro-skills.Two
Micro-skill 1 and micro-skill 2 together with two of the other micro-skills.Three
All micro-skills are demonstratedFour
 Item 2: Clarifies the patient’s prior knowledge and desire for information
Gathering informationMicro-skillsDemonstrated micro-skills /criteriaPoints
1. Listens attentively, allowing the patient to complete statements without interruption and leaving space for patient
2. Encourages the patient to tell the story of the problem(s) from when it/they first started to the present in his/her own words
3. Uses open and closed questioning techniques, appropriately moving from open to closed questions
4. Clarifies patient’s statements that are unclear or need amplification
5. Periodically summarizes, invites the patient to correct the interpretation or provide further information
One micro-skillOne
Two or three micro-skillsTwo
Four micro-skillsThree
All micro-skills are demonstratedFour
 Item 3: Uses easily understood language, avoids jargon
Building a relationshipMicro-skillsDemonstrated micro-skills /criteriaPoints
No micro-skillsUsed ten or more medical wordsOne
Used between four and nine medical wordsTwo
Used two to three medical wordsThree
Used one or none medical wordsFour
Item 4: Uses appropriate non-verbal behaviour
Micro-skillsDemonstrated micro-skills /criteriaPoints
1. Calm speaking paces
2. No interruptions
3. Leaves space for the patient to talk
4. Pausing
One micro-skillOne
Two micro-skillsTwo
Three micro-skillsThree
All micro-skills are demonstratedFour
Item 5: Provide support: expresses concern and willingness to help
Micro-skillsDemonstrated micro-skills /criteriaPoints
1. Accepts the legitimacy of the patient’s views and feelings; is not judgmental
2. Uses empathy to communicate understanding and appreciation of the patient’s feelings
3. Provides support: expresses concern, understanding, and willingness to help.
Some support provided, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
 Item 6: Structures the interview in a logical sequence
Providing structureMicro-skillsDemonstrated micro-skills /criteriaPoints
Progresses from one section to another using
1. Signposting
2. Transitional statements
3. Rationale for the next section
Some structure is present, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
Item 7: Attends to timekeeping, and keeps the interview on track
Micro-skillsDemonstrated micro-skills /criteriaPoints
1. Structures the interview based on the C-CG
2. Attending to timing
3: Keeping the interview on track
Some structure is present, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
 Item 8: Shares thoughts and reflections with the patient
Explanation and planningMicro-skillsDemonstrated micro-skills /criteriaPoints
1. Assesses patient’s starting point (preferably using tailored explanations and illustrations)
2. Provides information in manageable chunks, assesses understanding uses patient’s responses as a guide for the best way to proceed
3. Providing the correct amount and type of information to individual patients
Some thoughts/reflections are provided, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
Item 9: Checks the patient’s understanding
Micro-skillsDemonstrated micro-skills /criteriaPoints
1. Organizes the explanation (uses summarizing)
2. Assesses the patient’s understanding (asks the patient to summarize the information he/she was provided)
3. Asks the patient what other information would be helpful, addresses patient’s needs for information
A question was asked, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
Item 10: Negotiates a mutual plan of action
Micro-skillsDemonstrated micro-skills /criteriaPoints
1. Explores options with the patient
2. Involves the patient in decision making
3. Negotiates a mutually acceptable plan
Some negotiation occurs, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
 Item 11: Contracts with the patient about next steps
Closing the sessionMicro-skillsDemonstrated micro-skills /criteriaPoints
1. Contracts with the patient about the next steps
2. Safety nets, e.g., phone number and other lifelines
One micro-skill is initiated but not completedOne
One micro-skillTwo
One micro-skill is completed and the other is initiatedThree
All micro-skills are demonstratedFour
Item 12: Summarizes the session briefly and clarifies the plan of care
Micro-skillsDemonstrated micro-skills / criteriaPoints
1. Final confirmation of patient understanding
2. Summarizes the session briefly and clarifies the plan of care
3. Finally confirms that the patient agrees and is comfortable with the plan
Some type of summary is provided, but no micro-skill is demonstratedOne
One micro-skillTwo
Two micro-skillsThree
All micro-skills are demonstratedFour
  1. Be very precise about coding the demonstrated skills in the domains in which they occurred
  2. Zero points were recorded if an item was not apparent
  3. If the audio recording stops before all information is provided, items 8, 9 and 10 were coded as “not applicable”
  4. The structure was coded if the audio recording did not stop during “Initiating the session” and “Gathering information”