Communication Skills for NZREX

Communication skills will play a very important role in deciding the outcome of your NZREX exam.

So make sure that you don't fall short of their expectations during the exam. The exam is pretty stressful and it may be very difficult to keep all these points in mind during the exam. The best way to go about it is to find a study partner and practice as much as possible.

The dummy patients during the exam are good actors and if they feel something is wrong, they will make sure you know about it. So look for facial expression as you speak. Go slow as you speak, speak clearly, be expressive, let the patient talk too, never blame the patient or be judgmental.

The following are so important aspects of 'Communication Skills' for NZREX:

1. Clear language
Coming from different countries, most of us have a non-kiwi accent. It is important that the patient (and the examiner) understand your accent. No, you don't have to develop a Kiwi accent. Just make sure you are slow and clear when you speak. Something that can only come with practice.

2. Comfortable pace
Ten minutes for each station could mean very little time for certain questions. Especially the ones where they expect a brief history followed by counselling. That doesn't mean you run through your task. Doing it the right way takes more preference over doing it all (but in a hurry). So time yourself when you practice with your friends. Time management can only be perfected with practice.

3. Refrain from interrogation
This usually applies to the history taking stations. You may seek clarification (as mentioned in point 6) but interrogation can certainly cost you a few points.

4. Sequenced approach
Mnemonics can be your best friend here. They can make history taking a breeze (only if you remember them during the exam). A sequenced approach can make your history look very professional and impressive. The only time you may want to alter your sequence is if the patient makes you do it. Be prepared to alter you routine, because thing don't always go the way you want them to!

5. Involve the patient
This is a big one! If at the end of the station it feels like the patient didn't get to speak much, thats just not right. Let the patient talk. Ask open ended question. Not just one, atleast a few. For counselling stations, even if you know what to say (thanks to the recalls),  let the patients ask you questions, then answer them. That would make you look smarter ;)

6. Seek clarification
It is just as important that you understand what the patient has to say. Sometimes they don't reveal important information unless you ask for it (patients are asked to do so by the examiners). You may get points for extracting such information from the patients.

7. Manage patient emotion

This is not restricted to offering a tissue when the patient cries. Its a good idea to acknowledge when the patient talks about pain. As an example "Oh, i am sorry that you have such terrible pain. Let me ask you some quick questions so that we can come up with a plan to relieve your pain" - not only shows empathy but also tells the patient that you heard em! Make a sad or concerned face whenever required. Don't smile when discussing pain! So empathize, show concern, acknowledge their symptoms. Be ready with a bunch of phrases

8. Summarize
Lets the patient and the examiner know that you are paying attention. It would be ideal to provide a short summary at the end of 'history of presenting illness' and another summary at the end of history taking. Mention only important, positive history.

9. Tackle difficult patients
Know how to handle difficult patients, especially depressed, suicidal, angry, anxious or crying patients. For example, if you get an angry patient, let them vent out the anger, talk in a friendly low voice, listen and do not interrupt, accept and acknowledge the reasons, suggest a solution or ask them to suggest a solution, respect their decision. If the person is quiet/depressed and isn't answering questions, start with basic, general, non medical questions, just a conversation to get the patient to talk, then go on to history taking.

Its pretty obvious that you need a lot of practice to master these skills. A partner who can act as a patient and point out your mistakes (ideally a NZREX candidate). Make sure you time yourself and be prepared with a bunch of phrases to use during the exam. Here are a few to get you started.

"Are you comfortable?"

"I am sorry to hear that"

"Do you need a glass of water?"

"How has this condition impacted your daily life?"

"Do you have any questions or concerns?"

"Do you want someone to be with you right now?"

"Do you want me to talk to someone else in your family?"

"Do you need a chaperon in the room while i examine you?"

"Could you tell me a little more about your condition"

"We can give you some leaflets or handouts explaining your condition"

"I can also refer you to a social support group where you can meet people with similar problems and also people who have successfully been through this stage"

I hope these tips help you all pass the exam.

Good luck to you all!

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