Sunday, 29 April 2012

Ice, Ice baby- the hidden curriculum around communication skills

A few years ago I wrote a post about the challenges of teaching "communication skills". The YouTube video above is about the Clinical Skills Assessment (CSA)  that doctors training as GPs in the UK take. It emphasised the need to ask patients about their ideas, concerns and expectations (ICE) during a consultation. But it frames the need to do this as a requirement of an exam rather than something that will benefit patients. For example, the first clinical episode described is about a doctor feeling that they have to ask a patient who has symptoms very suggestive of a heart attack about their ideas and expectation of the consultations. This is something that the doctor seems to feel is delaying the patient's care and they may well be right about that.

So what is the take away message? What does this song tell us about how our assessments frame doctors understanding of communication skills?


  1. And in the words of Willy Wonka himself, "Never, never doubt what no one is sure about."

    Of course, I'm not sure if that helps. Thought it might loosely fit here.

  2. Short but sweet, thanks for sharing the video too! In Manchester we examine students ability to illicit ICE from v early on, and the sad thing is when you hear them say "and eat are your ideas concerns and expectations of coming here today?". I think its a few things- desperation to pass the course, knowing that it is tickbox marking; communication skills teaching from people who don't teach it with the subtleties intended; and the hidden curriculum when the students go on placements. If they get told on lots of placements 'oh there's no time for that, you need to ask more about the drug history' then it will undermine the importance. Is it too GP focused to teach ICE at student level, I don't think so. I've heard an extension with StAR - strengths aspirations resources - which was created by Ed Peile and colleagues who are moving towards values based practice in Warwick . I wonder how the tutors/ students find it?

  3. If we can't laugh at ourselves, then someone else will. This is a brilliant piece by someone who has realised not that asking about ICE is unimportant, but that every consultation is a conversation and none of those ever go by rote. Not ALL consultations will include any direct questioning about ICE in real life and not all should in the exam. Body language, knowledge of the patient, freely volunteered information... they all count too. Time to convince students and trainees, and examiners, of that.

  4. I really enjoyed this! Especially as I'm going into finals and need to remember that there are OSCE marks for ICE.

    I was told by one GP tutor that what matters is not whether you ask ICE, but how you respond to it. That seems true in scenario practice, when I've seen scenarios such as
    student: what are your concerns:
    patient: this pain's so awful I'm worried it's something serious, maybe it's cancer
    student: right, ok. [thinks] Do you have any other medical problems?

    It seems like the marks shouldn't just be there for ticking the boxes by asking the questions!

  5. Not sure if my attempt at a trackback worked, if not just posting my own post on this!

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