Communication Curriculum 2024 PDF

List of Contents Page Chapter I Communication principles & Communication 2 process Chapter 2 Representation system 14 Tutorial 1 Chapter 1 & 2...

List of Contents Page Chapter I Communication principles & Communication 2 process Chapter 2 Representation system 14 Tutorial 1 Chapter 1 & 2 19 Chapter 3 Prerequisites for effective communication 21 Chapter 4 The skill of communication 29 Tutorial 2 Chapter 3 & 4 34 Chapter 5 Written and oral Communication 37 Chapter 6 Non-verbal communication 52 Tutorial 3 Chapter 5 & 6 59 1  Chapter 1 Communication Principles & Communication process For Health care success, good communication ensures good working relationships, patient satisfaction, increases patient understanding of illness & treatment, and improving patient compliance. Good communication can also increase job satisfaction for staff and reduce work stress. Every person's communication skills affect both personal and organizational effectiveness. Communication Principles Objectives  Define communication.  Describe the nature of communication.  State the benefits of good communication.  Describe the components of communication.  Outline the types of communication system.  Describe the general causes of poor communication Definition of communication. Communication is the process of meaningful interaction among human beings. This definition indicates that it is a process of exchanging information and it focuses on meaningful interactions. It shows that communication is about conveying )‫ (نقل‬information to others clearly and receiving the information that others are sending. Communication means that we transmit a message to a person or to a group. If this person understands and interprets the message in the way it was intended, then one can say that communication has been effectively carried out. Transmission Reception It must be received and the receiver must show A message transmitted is the that message has been understood first half of communication Figure 1 A message is transmitted and received 2 What do we mean by encoding and decoding? The definition indicates that communication is a process and it is important to reach mutual understanding. It also pointed out to two terms in the process of exchange namely encode and decode. Encoding is how the message is conveyed to another party. The message is converted into a suitable form of transmission. The medium of transmission will determine the form of the communication. Decoding is the process where the message is interpreted for its content. It also means that the receiver thinks about the message's content and internalizes the message. The receiver will compare the message to prior experiences or external stimuli. Figure 2 Encoding and decoding What do we communicate? We communicate ideas, information, norms, feelings, attitudes values and behaviors. An attitude is a relatively constant feeling, predisposition or set of beliefs directed towards an object, person or situation( Value is a preference shared and transmitted within a community. A behavior is an action that has a purpose, frequency and duration. Why do we consider communication as a process? Communication is moving in ingredients within a process and interacts together and each ingredient affects all the others. In communication events and relationships are dynamic )lively and active(. Communication is ongoing, ever changing & continuous, does not have a beginning, and end. It is circular in nature & not static. Communication is a personal, social and emotional process that occurs between people to influence, control and motivate others, may involve changes in behavior 3 Importance of good communication Good communication helps people to:  Define and understand goals.  Receive and share information.  Build rapport.  Promote self-confidence.  Avoid negative effects of conflict and confusion. Components of the communication process  The message  The sender )source of origin of the stimulus(  The channel or medium that carries the stimulus  The responder  The context )background(  The feedback Figure 3 Components of communication process 1. The message The message is the stimulation that occurs during encoding, whether through verbal, nonverbal, or written language, should always be a clear message. The message is the information that you need to communicate 2. The sender (source): The opening speaker may be described as the: source – sender- producer- initiator- transmitter or even an encoder. To be a good source you need to be clear about what you are sending and why you are communicating. The sender should know what result is expected.The sender has to:  Use the best form of sending it in order to ensure that his message being well received.  Ensure that there are no cultural obstacles, environmental barriers, or language differences between him and the responder )s( It is important to understand that each person who hears your messages will interpret them differently based on their own expectations, opinions, perspectives and experiences. As a sender of message, if you are communicating with a person who lacks the skills to decode your message )do not understand the message(, you have to resend it in a different way or assist him in understanding it by supplying clarifying information. 4 3. The receiver (responder): The person or persons to whom communication is directed may be described as the responder, receiver, recipient, consumer or decoder. The receiver is the individual to whom the message is sent. He has his own expectations and experiences. To decode the message received, the receiver should have communication skills that include, the ability to observe, listen actively, ask as well as using clarifying questions when needed. 4. The channel or medium: It is the method or methods you use to convey your messages and the type of message you have will help to determine the channel that you should use. There are several channels that you can communicate with individuals, groups and community. These include face-to face conversations, telephone calls, or videoconferences. It also includes written communications as booklets, leaflets, reports, emails and memos. Each channel has its own advantages and disadvantages. The sender or encoder may convert the idea to a gesture- an action- a sound- written words or a picture. In this case, the channel or medium the first participant chose to carry the idea become sounds, picture or words. Figure 4 the channel or medium The channel is the method of communication one chooses 5. The context It is the background or situation in which you are communicating. It involves: a. The general environment that you and your audience are in. b. The culture of your community and organization)s(. c. The participants of the communication process. d. The relation between you and your audience, between sender and responder Context is the background or situation in which communication occurs 5 6. Feedback It is related to the circular or continual nature of interpersonal communication. The response that each participant makes to a message received results in feedback. In face to face communication you can read body language or ask questions to ensure understanding. If you are communicating via writing, this can be judged by responses obtained. Figure 5 feedback Feedback occurs when the receiver responds to the sender's message and returns the message to the sender Importance of feedback: It allows the sender to determine whether the message has been received and understood. The components in the communication process determine the quality of communication. A problem in any of these components can reduce communication effectiveness. For example information must be encoded into a message that can be understood as the sender intended. Selection of the particular channel for transmitting the message can be critical because there are many choices. Feedback is an important element to ensure that the message has been received and understood. Causes of poor communication Process barriers Because communication is a complex, give-and-take process, breakdowns anywhere in the cycle can block the transfer of understanding. Every step in the communication process is necessary for effective and good communication. Blocked steps become barriers. Process barriers include: Sender barrier. Encoding barrier. Medium barrier. Decoding barrier. Receiver barrier. Feedback barrier. Figure 6 Blocked steps become barriers. 6 Recognizing the barriers is the first step to effective communication. There are two categories of barriers, these are Environmental or personal barriers I-Environmental barriers Environmental barriers are characteristic of the organization and work setting. Communicate in an environment that is spacious, comfortable and relevant to what you will talk about!! The environment can influence the communication process positively. However environment can cause distractions, discomfort or monotony. Environmental barriers include 1. Noise 2. Competition for attention 3. Time 4. Physical barriers 5.Power status relation 1- Noise: Reception & understanding of message can be greatly affected by the mount of surrounding noise. 2- Competition for attention and distractions Encoding and decoding processes are disrupted by providing outside stimuli. Environmental distractions can be telephone call, drop in visitors and visitors talking. Emotional problems and lack of attention are personal distracters and not environmental. 3-Time The amount of time he has to assimilate )‫ (يستوعب‬the information transmitted can be a barrier. 4- Physical barriers Any number of physical distractions can interfere with the effectiveness of communication including: distances between people, walls, desks, tables, piles of files etc. 5-Power status relationship This can distort or inhibit the message transmission. It is a common barrier in organizations where a number of professionals have to interact with each )e.g. a supervisor- subordinate relationship or teacher student(. This type of relationship can inhibit the flow & content of instruction. Figure 7 Power status relationship can affect communication 7 II-Personal barriers Personal barriers arise from the nature of individuals and their interaction with others. Personal barriers exist when people communicate with each other, they include: 1. Frame of reference 2. Beliefs, Values, Prejudices 3. Status Quo 4. Semantics 5. Symbols and Actions 6. Empathy 1- Frame of reference When people encode and send message or decode and receive them they tend to do so according to their frame of reference. It is the sum of one's socioeconomic background and previous experiences which can shape the manner in which one receives and interprets communication. 2- Beliefs, values and prejudices They can cause messages to be blocked or distorted either in transmission or reception. They act as filters. The brain can:  Delete this information because it is not acceptable or not important.  Distort the message where the meaning is changed or shaded.  Generalize the information. 3- Status quo (‫)أرضاء ألخر‬ The status quo barriers denotes a conscious effort by the sender or receiver to filter out information either in sending or receiving or retransmitting that would upset the present situation. It implies the transmission of information that the sender thinks the receiver wants to hear. 4- Semantics (‫)لللت لفظية‬ Semantics is closely related to terminology or the meaning of the words we use. The words we choose, how we use them, and the meaning we attach to them cause many communication barriers. The same word can be interpreted and misinterpreted in many ways. Since words mean different things to different people and different people have different background, care must be taken to communicate in a way that it is understood by all. Example The word right can have different :‫ مثال‬، ‫كلمة ضرب لها أكثر من معنى فى الستخدام‬ meaning examples of these are: )‫ (ضرب بمعنى عاقب‬.‫ضرب الطفل القطة‬ You were right. ‫ (ضرب‬.‫ضرب الطباخ مكونات الطعام‬ Make a right turn at the light )‫بمعنى خلط‬ Access to clean water is a basic human )‫ (ضرب بمعنى أخبر‬.‫ضرب الرجل مثل‬ right. If people don't understand the words, they cannot understand the message. 8  5- Symbols and actions Symbols are important and play a major role in communication. Physical things, pictures and actions can characterize them. The uniform of the doctor serve a functional purpose. Visual presentation can greatly increase understanding. Figure 8 the uniform of doctors serve a functional purpose Action is a symbol that can be used in communication. A friendly smile can have a meaning. Being at one's desk has a meaning but being away also has a meaning. Figure 9 Smile and being at one's desk are 6- Empathy actions that have a meaning Means being sensitive to the other person's frame of reference or state of emotions. Communicators should show concern about receiver's problems, hopes and expectations. It can promote better understanding, help sender to decide how to encode the message and help the receiver to decode and interpret it. A lack of empathy impairs communication. NOTE To find a solution for a patient and their family, it is essential to have a shared understanding of the problem. This involves understanding the patient's emotions, expectations, desires, and worries 9  Communication Process Objectives  Illustrates how information moves through the brain.  Describes the different inputs.  Describes the different filters that will affect how the input reaches the brain.  Explains how information is processed. All human interactions are a form of communication. It is important to understand the actual mechanisms of communication and how one can use the information to improve his communication abilities. The steps of processing information in the brain are: Figure 10 How information moves through the brain I. Input The communication starts with input. The brain receives the information in the form of input which is what I say to you, or the email I send to you or even the angry look of face or the change in my tone. Some input we process consciously, some we process subconsciously and some we ignore because it is not important or it may lead to information overload. The brain receives input through the five main channels that are represented by the five senses.  Visual: what we see.  Auditory: what we hear.  Kinesthetic: what we feel, touch, sense, or experience.  Gustatory: what we taste.  Olfactory: what we smell. In general, one usually communicates at work with the first three types of input namely visual, auditory and kinesthetic "VAK". 10 "What happens once the brain receives the input"? The way we will interpret the information is dependent on our own personal filters. Filters differ from one person to another, they will affect how the input reaches the brain. These filters will cause the brain to do one of the following: 1. Delete the information received. Information will not be processed as it is filtered out as not acceptable or of least importance. 2. Distort (‫ )يشوه‬information. Here the meaning is shaded, changed or added by or filtered. So, the meaning the receiver applies to the input is not the same meaning that input would have for a different receiver. 3. Generalize the information. Here, our filters identify input as being similar to something we have experienced in the past. II. Filters Filters come from a number of different sources that comprise the total sum of our experiences. Several things act as filters when processing information. These include: i. Values:(‫)ألقيم‬ Values are things that are important to us in life and determine our choices and decisions. Values can be moral, social and religious values e.g. The value of being honest and fair, in living safe and free Family, success, others' view of our image as seen by patients and medical team, our reputation are all values etc. Persons will interpret input in the light of their values and make judgments about the input based on values. ii. Beliefs (‫)ألمعتقدأت‬ A belief is a statement declared )‫ (معلن‬or implied )‫(ضمني‬, intellectually )‫ (ذهني‬and or emotionally accepted as true by a person or group. Beliefs are predisposing factors for behavioral change and help us to understand how the world works. We might believe that there will be a reward for hard work or for being patient. Some of the medical profession may believe that the most important aspect of their profession is the humanitarian aspect of what they do. Persons will look at the input received through their own beliefs and attempt to make that input fit into his beliefs. If this input does not fit, the input is likely to be negative. iii. Past experiences The past experience will influence the current communication in one way or another. You may see someone running down the hall and automatically you expect something urgent to occur. Your experience may make you prepare for a lecture before attending it because this will help you to participate actively etc. 11  iv. Prejudices (‫)ألتحيز‬ Prejudices are partly due to culture and partly due to personal preference or experience. When one encounters messages that trigger our prejudices, one will make judgments or assumptions that may color our communication. You may be prejudiced against women at work, or persons whose religion differs from yours, or prejudiced a homosexual person at work or those working at the lowest job level. If one is communicating to a person through a perceived prejudice, this is greatly limiting the chances of communicating successfully. Not all prejudices are negative, some may be positive. Example you may consider all of one group smart. v. Feelings Ones' feelings can influence the communication with another person in two ways.  The way you feel on a given day, You might be ill or under physical pressure. If you feel well and you are in a good mood you will communicate in a different way than when you are not.  The way you feel about a specific person. Surely the way one communicates with someone one likes differs completely from the way one communicates with a person one dislikes. vi. Environment  The social environment can affect your communication. If the environment is informal one communicates differently than when it is formal. - You talk to strangers differently than with friends. - Power-status relationship can also inhibit or distort the transmission of information.  The physical environment can affect your communication. The reception and understanding of a message can be greatly affected by environmental barriers III. Creating internal map Once the input has been filtered, it will be processed by the brain to gain meaning from it, )a process called creating an internal map). It`s like your brain dissects and organizes the information into pattern or picture that it can understand. If the brain sees a pattern that it recognizes, it will automatically apply meaning to the input based on the existing pattern. If it does not recognize the input or the pattern it will create a new map and apply the most likely meaning based on past experience of similar input. The interpretation of meaning leads to a change in the internal state which then generates a behavior or a response. The input you received, filtered, and interpreted will determine how you respond or behave. Example: If you hear bad news, you would respond with sympathy, empathy, cry or scream etc. You may have a physical response to the meaning such as a quick pulse or tightening of the chest. 12 IV. Creating an internal state What picture we generate in mind when you read the word Camel!? The chances are that you have pictured a large brownish animal in your head with fat filled lump and long tail (visual). Also you can imagine the sound (auditory). You can even describe in detail the animal if you have ever touched a camel or have any feelings about your imaginary camel you can share those as well (kinesthetic). This shows that VAK is the order in which the brain processes communication. You can visualize something before we can put words to it or describe it. We represent our experiences in our unique way even if we observed same events & receiving same sensory inputs )sights, sounds, touch, tastes and smells(. We filter them according to our experiences. So the model in our minds will be different for each of us &all models will be different from reality. When we think of an experience, we create the sights, sounds and feelings that we originally perceived. We also have the ability to create inward sensations that we have never experienced. This will make our internal world visible, audible and tangible )‫ (ملموس‬to others. It allows us to share a world of experience and to communicate abstract ideas, to understand and be understood. Role of language in internal representation Language communicates events and experience in ways that come from the construction of the language itself rather than from the experience itself. However, words used can lead to misunderstanding in two ways: 1. Words used may be inadequate to describe our thoughts and feelings. 2. Other people may not give the same meaning to the words that we give because they have different experiences. 13  Chapter 2 Representation system Objectives  Discuss the internal representation system.  Explain the meaning of auditory digital system )AD(.  Describe persons according to their specific representation system.  List verbs and phrases that people use in each form of internal representation thinking. Studying internal representation & different representation systems will help you to understand how to communicate with another person & to respond to him correctly. As we see, hear, taste and smell the outside world, we recreate those same sensations in our mind. We represent the world to ourselves and use our senses inwardly. We may either remember past experience (recall) or imagine possible future experience (construct one). There is a representational system for each of our five senses. What we actually perceive are representations of what each sensory organ transmits to us. Language is added to the other representative systems, it is attached to our experiences. Collection of word symbols and the rules that govern their use make up a distinct sixth representational system which is called Auditory Digital (AD) system or how we talk to ourselves. Each of us has a preferred channel through which we best receive input )visual, auditory or kinesthetic(. This is a general preference, however, and may change in response to the environment or the particular situation at hand. Knowledge about the preferred channel of the receiver of your message can help you to communicate skillfully. One area in which it is easy to understand this preference is “learning”. Every individual has a preferred learning style. 14 Example: o Do you prefer learning by trying it yourself? Then you are a kinesthetic learner. o Do you prefer learning by showing a practice? Then you are a visual learner. o Do you prefer to learn by listening to lectures, listening to instructions or reading loudly? Then you are auditory learner. Knowledge of the preferred style of learning will help you to:  Deliver the input in the way that works best.  Be on the same wave length as your receiver.  Communicate more skillfully.  Maximize your potential for learning. Being able to communicate well will help to build a rapport and improve relationships. Verbal clues and phrases We can determine a person's preferred sensory channel for receiving input by verbal clues ‫))دللة‬ (The words that someone uses( which show to which mode they are thinking: visual, auditory or kinesthetic. This help you to be in the same wavelength by responding in similar language. Figure 11 Verbal indications of thinking modes Visual Auditory Kinesthetic See ‫مرسوم‬-‫انا شايف‬-‫شوفت‬ Hear -‫ نغم‬-‫كانه لحن‬ Feel -‫ فركوك= دائم الحركه‬-‫مابيثبتش‬ Look ‫ واضح‬-‫ منور‬-‫قدامى‬ Listen ‫سامع الرعد‬ Touch ‫حمامه‬-‫بفهمها و هي طايره‬ Show -‫وضوح الشمس‬ Sound -‫صمت و ل القبور‬ Grasp ‫فيه‬ ‫حركتش‬ ‫ ما‬-‫طياره= حاسس‬ ‫البرق‬ ‫زي‬ -‫القمر‬ ‫وشك و ل‬ -‫همس – بيدوي‬ ‫ بيحبي‬-‫ اتخشبت في مكاني‬-‫شعره‬ Reveal Silence Unfeeling -‫–رسمت له صورة‬ ‫ زي‬-‫كلمه بكلمه‬ ‫و سلحفاه= اتحكم في نفسك – بدأ‬ Focused Loud Concrete ‫ زي‬-‫امسك نفسك‬-‫من الصفر‬ ‫ من وجهه‬- =‫حتصورني‬ ‫البغبغان= الله علي‬ - ‫ زى النسمه‬-‫العقده في الزور‬ -‫ الظاهر‬-‫ وريني‬-‫نظري‬ ‫ بيرن زي‬-‫التكرار‬ ‫اوصف لي شعورك – لمس اوتار‬ ‫تحت النظر‬ - ‫الجرس – احكيلي‬ ‫ ايدي في ايدك‬-‫ اكشف ورقك‬-‫قلبي‬ 15  Verbs that indicate action correspond to the way in which the person perceives that action. You may encounter some additional phrases that a person might use in each mode of thinking. Figure 12 Common phrases used in each mode of thinking Visual Auditory Kinesthetic Show me what you Clear as a bell Control yourself mean In view of Let us make it loud and You would at least want to clear what we mean ------ get a feel for it ----- Well defined Word for word Start from scratch Picture this….. I hear what you are saying, We need to stress the and it sounds to me like ---- pressure we are under ----- Let us focus on….. What you are saying rings Once we get a grip on these true ------ numbers you will be in good hands ----- It appears that….. If this sounds good to you I think you are getting a we will go ahead and handle on it ----- discuss ----- Example: talking to a Example: talking to an Example: talking to a visual person auditory person Kinesthetic person "If it looks good to "Tell me more about your "If this feels good to you you we will start pain." we will go ahead and set a constructing a diet date for surgery." together. Characteristics of persons preferring a specific representation system in their communication: a. Persons preferring visual representation system The visual representation system involves the process used to translate communication into pictures in the mind. You can determine whether a person tends to prefer this form of communication by the following behavioral cues:  They feel that a picture is worth a thousand words. Memorize by seeing pictures.  Must see things to understand them.  Use picture descriptions during conversation.  Like visually based feedback.  Use gestures that may be high and quick.  They are less distracted by noise.  Often have trouble remembering verbal instructions.  Appearance is important to them trying to be neat )‫(أنيق‬, well groomed )‫ (مهندم‬and organized.  Often sit forward with their bodies erect and their eyes up. 16  b. Persons preferring the auditory representation system The auditory representation system involves the process used to translate communication into sounds in the mind. Indications that a person prefers this system include:  Can repeat things back to you easily )words, instructions etc.(.  Learn by listening.  Memorize by steps, procedures and sequences.  Respond to a certain tone of voice or set of words.  Are easily distracted by noise.  Are medium to fast talkers.  They talk to themselves.  Usually like music and talking on the phone.  They move their eyes sideways. c. Persons preferring the kinesthetic representation system. The kinesthetic representation system involves the process used to translate communication into feelings in the mind. Indications that a person prefers this system include:  They respond to physical rewards and touching.  They stand closer to people.  They look down and to their left.  They check out their feelings before expressing their opinion.  They use gestures that are low and smooth.  They will be interested in the idea forwarded if it feels right. d. Persons preferring the auditory digital representative system It is not an analogue system like the other representational systems and not related to any specific sensory organ. This system means checking communication internally by talking to ourselves. Auditory Digital people need to understand why something is important; instructions have to make sense, everything must be ordered and logical. They need printed details and flow charts. People functioning in this system also exhibit some indications that include:  Spending a fair amount talking to themselves & are dissociated from feelings.  Wanting to know if your idea makes sense.  Speaking in clipped, crisp monotone (‫)رتيب‬.  They like mysteries, doing things one at a time… in sequence.  They love to make sense of complex concepts.  They like to analyze things and solve problems.  They like order, structure, planning and preparing. They hate chaos. We can guess the way the persons are constructing their thoughts by looking at their eye movements. We may either remember past experience (recall) or imagine possible future experience (construct one). Figure 13 shows how eye movements can indicate the way a person is recalling and constructing his thoughts. 17 - If people are looking up to their left or right: They are visualizing: they are recalling )remembering( or constructing. - If people look horizontally to their left or right: They are recalling or constructing a sound - If people look down and to their left: They are talking to themselves. - If people look down and to their right: Figure 13 The interpretation of eye movements They are assessing their feelings So what do we mean by recall and construct? a. Visual recall : When we are seeing images from the past) recalling and remembering them from memory(,your eyes will go up and to the left. You are using this type of thinking when you are answering a question like: "What did you look like when you were weighing 90 Kg?" b. Visual construct When you are visualizing something you have never seen before or you are making something up in your head,the eyes will go up and to the right. You use visual construct to answer a question as: "What would you look like if you lost 20 kg in weight"? c. Auditory recall When one remember sounds or voices that you have heard before or things that you have said to yourself before, eyes look horizontally& to the left. You use this mode to answer questions as "Do you recall hearing the systolic murmur?" or "What was the last thing I said?" d. Auditory construct When you are making sounds up that you have never heard before,eyes look horizontally &to the right. You use this when you answer questions as: "What would I sound like if I were fluent in German?" e. Feelings (Kinesthetic) When you are assessing your feelings you tend to look down and to the right. You use this type of thinking when you answer a question like: "What does it feel like to be happy?" f. Auditory Dialogue When you are having internal dialogue and talking to yourself your eyes will go down and to the left. You can demonstrate this for yourself by answering: "What do you say to yourself when you diagnose a difficult case?" Knowledge of internal representation can help you to understand how to communicate with another person and to respond to him correctly. 18  Tutorial 1 (Chapter 1&2) I) Individual exercises Exercise 1 List 5 environmental barriers that you should remove before communicating. List 6 personal barriers that one should avoid when one is communicating. Exercise 2 (Filters) Values, beliefs, past experiences, feelings and environment act as filters Respond to the following questions 1. What he/she value most in his/ her work? 2. What are the beliefs he/she had encountered related to health and disease? 3. Feelings on a given day or towards a specific person can affect how the input reaches the brain. Indicate how this is encountered giving an example: 4. Give examples of how environment can affect the communication process:  Social environment.  Physical environment. Exercise 3(Prejudices) Complete the following sentences from your own experience or previous information received: - Young pregnant women )15 years old( are------ - Women as Supervisors at work are----- - Homosexuals in workplace are------- - Jews in workplace are------ - Disabled people in workplace are------ Exercise 4 Preferred learning style: Select your preferred learning style : I prefer to learn by showing steps of a task: I am probably a……. I prefer to learn by listening or reading loudly: I am probably a……… I prefer to learn by trying it or doing: I am probably a………… II) Group discussions Topic 1: Causes of poor communication between doctor and patient Discussion guidelines 1. Who is responsible for communication breakdowns? 2. What are the factors related to physicians? 3. What are the factors related to the patients? 19  Topic 2: Main differences between a physician and an illiterate person that can affect their communication Topic 3 Meaning of words“Different definitions of the same word exist indicating how a single word can have multiple meanings.” Topic 4 How information moves through the brain Discussion guidelines 1. What are the different steps carried out when information moves through the brain? 2. What are the types of inputs? 3. What are the different types of filters? 4. How can filters affect input? 5. What do we mean by creating an internal map? 6. What is the result of interpretation of a meaning to the input? 7. What is the result of creating an internal state? Topic 5 : Verbal clues and common phrases III) CASE STUDY  Dr. Ameer is a young lecturer who arrived to work at 9.30. The secretary of department told him that his professor is unable to give his section on medical interview to post graduate students. She emphasized that he is too late as the section should have started at 8.30. The subject he has to cover was far away from his own interest as well as he considered himself a surgeon rather than a teacher. This was not what he had planned for his day. He was supposed to attend a conference on new trends in cancer colon management at 11.0 o'clock today.  Dr. Ameer arrived at the lecture room where 20 post graduate students were waiting for him. The room was small, hot and humid. He told them that today the section will be short as he will attend an important conference at 11.0 o'clock. One of the students told him that they were waiting for him since 8.30. Dr. Ameer was furious. He scolded )‫ (وبخ‬him and told the group that they should appreciate that he had spared the time for this section.  He said that as doctors they know now what a medical interview is and how to carry it. He explained that any medical interview should have a beginning- middle and end. At this point he received a telephone call reminding him of the conference. He started explaining how to open an interview by establishing goals of the interview, obtaining patient consent, establishing initial rapport and lastly by establishing patient comfort. At this point Dr. Kassem another lecturer dropped in and reminded him about the conference.  Dr. Ameer looked at the group and told them that they should attend the conference covering new trends in cancer colon management which will be of more benefit to them and left the room. Questions What are the barriers encountered to effective communication? 20  Chapter 3 Prerequisites for effective communication A good relationship with people goes hand in hand with developing communication skills. Gaining trust from others is by respecting them regardless of their identity, beliefs, or backgrounds. This can be done by listening to them and by encouraging them to develop their own strengths. Your personality and actions also influence the type of relationship you can have with people. Different behaviors may be expected of a person according to his age, sex, religion, ethnic background or the work he or she does. What are the prerequisites for effective communication? The prerequisites for effective communication covers: a- Establish good relationships. b- Build rapport. c- Identify preferred representation systems. d- Remove barriers. a- Establish good relationship To start a good relationship, you should: Introduce yourself. Explain who you are, and what your job is. Your personality and actions influence the communication. Thus you have to be friendly , respectful and honest Use name of the person Show concern, )‫(اهتمام‬ Behave according to the culture you are working in. Figure14 Personality and actions carried out must be acceptable How to promote the good relationship?  Become available whenever needed.  Make people see that you are doing what they expect from you.  Develop an understanding and acceptance to person's feelings )empathy( but not pity )sympathy(. 21  b- Building rapport Rapport is defined as a ‘harmonious relationship’ and relates to collaboration and parity between patient and physician.. Rapport is being attuned to )‫ (متناغم مع‬other people verbally or nonverbally so that they are comfortable and have trust and confidence in you. Building rapport is important for effective communication. A person has to try to see and feel as the other person or group sees and feels. It is easy to communicate with persons who are similar in posture and voice tone, or who share in your beliefs and values because they are like you in certain ways, When they are not it is more difficult to have any sort of relationship with that person. This does not mean that people or groups always agree, but that they understand the other's point of view 93% of all communication is by way of the tonality of your voice and your body language. Rapport means "I am with you" and represents empathy. I am with you Figure 15 Patient rapport is a prerequisite How to build rapport? The six steps of building rapport. )1( Matching the persons' representation system )sensory modality(. )2( Mirror the persons' body language. )3( Matching their voice. )4( Matching their breathing patterns. )5( Matching how they deal with information "chunk size". )6( Matching experiences. Step1. Match the person's representation system (sensory modality) Identify the type of representational system the person prefers by listening to verbal clues and observing eye movements. Then you respond in the same way. Step2. Mirror the person's body language 22  Figure 16 matching and mirroring the person's body language Body language is a tool for sending messages, you can mimic another's body language when you want to express support to them. If they lean forward or cross one foot over their knee or standing, do the same. This automatic response enhances communication and give a sign that you are on their side irrespective of your opinion of the discussed topic. You should critically observe your audience to realize if verbal words coincides with nonverbal signs or they contradict each other? For example the persons you are communicating with are using words that express agreement, but sitting with crossed arms and legs. Step 3: Match the person's voice Matching the tone of voice and the speed at which a person talks. If he is talking fast try to speak faster yourself, if he speaks slowly, slow your tone down.. Step 4: Match the person's breathing Everyone has his own rate and depth of breathing. Try to match the person's breathing in pace and depth. Breathe in and exhale when he does. This indicates support or agreement with him. Step 5: Match the way the person deals with the information Match the "chunk size" of information that the person is comfortable with. Does he prefer to deal with small details at a time? Or to have an overview? Or to deal with large amount of information? Step 6: Match common experience Match some experiences, interests or background. If these steps are carried successfully one will reach powerful rapport levels 23  How do we rapport behaviorally in a clinical setting? 1. Develop nonverbal rapport. 2. Shape the space of the encounter. 3. Address mixed messages. 1. Develop nonverbal rapport When we are communicating with another we are using words, nonverbal signs as body language and tone of voice. In face to face communication 7% of it is in the form of words Figure 17 Face to face communication Verbal behavior can be deceptive )‫ (خااع‬and misleading. People can lie. On the other hand nonverbal behaviors speak the truth. Signs of nonverbal communication Nonverbal signs can help in building rapport. It is important to study these signs by observing: a. Facial expressions, gestures, touch, body tension, position and angulations. b. Spatial relations )‫ (العلقات المكانية‬and barriers. c. Paralanguage as voice tone, rhythm, volume, emphasis and rate of speech. d. Autonomic output as flushing, blanching, sweating, tearing, swallowing and dry mouth as well as changes in breathing and pupil size Figure18 facial expressions The basic behaviors of persons Feeling safe is a basic human need involving self- protection and self-preservation. Feelings of safety are reflected by body signals of engagement and relaxation. These include low general body tension and relaxation of facial muscles, with arms and legs relaxed and uncrossed. The person who feels safe shows more variety in both gestures and voice because a sense of safety gives rise to freer expression. Figure 19 Feeling unsafe 24 Feeling unsafe demonstrate other responses (a fight response) as a defense against feeling unsafe. Typical nonverbal signals of fighting feeling include a forward lean and jutting jaw, clenched fists, and a narrowing of eyes with inner brows lowered and tense mouth. The patient may also have a flushed face, flaring nostrils, increased voice volume, and deeper breathing. Some persons may show disengagement and withdrawal as a (flight response). In this case they lean away, push back in their chair, or turn the head down and away. The voice flees as the volume diminishes; the breath flees as it becomes shallower or is held, and facial color flees )blanching). Putting up physical barriers as crossed arms and legs and averting the eyes or turning the head away. Some persons may show conservation withdrawal. This refers to the person's reaction to feeling overwhelmed with excessive input and being unable to mount a defensive response. The person reacts this way when he or she receives unacceptable news, suffers irretrievable loss, or becomes significantly depressed. The person typically demonstrates a nonverbal pattern of disengagement and relative immobility. The body is slumped rather than relaxed with a sagging face, slack jaw and slow, shallow breathing. Usually the person does not appear to use the arms and legs as protective barriers. ALWAYS . Observe the person)s( reaction to communication: - Is the person comfortable with what you are saying or doing? If yes: You are building a rapport!!  Look and observe the following: These nonverbal signs can - His eye movement indicate whether you are - The muscles around his eyes building a rapport or not!! - Their lip movement - The twitches or changes in breathing - The tone and pace of the voice Rapport behaviorally consists of two parts namely matching and leading To develop nonverbal rapport by carrying matching )moving as the other moves or doing what others do, know or assume to be true ( and leading )the use of interactional synchrony i-e getting other people to match or pace with you.  Matching Matching is the process of moving as the other person moves in such a way as to acknowledge aspects of the other person’s behavior as a reflection of his or her emotional state. The physician can match any aspect of the patient’s behavior: facial 25 expressions, voice volume and rate, body angulations, or gestures. Figure 20 matching As the physician begins to create synchrony with the patient, he or she begins to enter the patient’s world. Patients unconsciously recognize this nonverbal engagement. Their conscious recognition is typically through a feeling of being understood by the physician, which can occur even before or without the transmission of verbal information The skilled physician matches the patient’s nonverbal behavior without conscious awareness of what he or she is actually doing. (Figure 21) The physician is matching a withdrawn patient’s posture by leaning forward, with his head slightly down and the shoulders drawn slightly inward. He is doing matching to facilitate building rapport & helps the patient feel understood Figure 21 Matching (pacing) Figure 22 shows highly guarded patient whose arms and legs are crossed tightly and whose body is tense. This means that the physician will have rapport problems and mismatching may occur. Figure 22 Mismatching What should the physician do? The physician should interact with his own arms )and perhaps legs( loosely crossed, nonverbally acknowledging and accepting the patient’s guardedness. Too close leaning forward, the patient may interpret this as an invasion of personal space and an intrusive response, the guarded patient may respond to this nonverbal intrusion by withdrawing into an even tighter presentation..  Leading Leading refers to the use of interactional synchrony that has been set by matching. Synchrony is present if the patient follows these leading motions. Patients who feel increased rapport are motivated to maintain that feeling. Leading invites the patient to move with the physician rather than to feel rushed into responding. 26 The physician's leading motion can be a behavioral shift such as a movement, a gesture, or a change in voice or breathing. Screening questions, recommendations as medication procedures and referrals all create a new point in the interaction. If the physician leads the patient too fast the rapport will be broken. If this happens the physician has to return back to matching. Figure 23 the Match- Lead Process Matching Leading 2. Shape the physical space of the encounter The physical space of an encounter sets the quality of relations. How the physician arranges the spatial relations in the room frequently parallels how he views the interpersonal relation with the patient. Specific components of the space: a. The amount of interpersonal distance between people )too far or too close is discouraging( b. The vertical height differences )as lying, sitting and standing( c. The presence of physical barriers )as a desk, chair sizes, charts and bed rails( d. The angles of facing each other Figure 24 the physician is too close to patient The patient will feel that his space has been encroached on Try always to shift your position to be at the same level as the patient or even below him. 27  Figure 25 Physician is too high Figure 26 Equal vertical height Figure 27 Physical barriers Sitting facing each other directly changing the angle to ease the tension Figure 28 the angles of the facing Figure 29 a side- by- side position supports Collaborative effort c- Identify preferred representation systems This knowledge help to encode-decode-understand and therefore interpret correctly your message.  If the person you are communicating with is a visual person use illustrations, flow charts, photographs etc.  If the person is an auditory one, move around, use a varying voice speed. 28   If he is a kinesthetic person, sit down, talk to them from a relaxed nonthreatening position.  If he is a digital one you have to define terms, and provide order and sequence to the information given. d. Remove barriers A prerequisite for efficient communication is to ensure the removal of barriers whether these are environmental or personal. These barriers can block, filter or distort the message as it is encoded and sent as well as when it is decoded by the receiver. Chapter 4 The skill of communication Objectives  Describe the steps required to communicate skilfully.  List steps that help a person to learn how to listen more effectively. How to communicate skillfully? Figure 30 communicating skilfully Talk and present message clearly. Listen and pay attention. Observe carefully. 29  Discuss and clarify. Summarize and repeat briefly. Give feedback. I. Talk and present message clearly It is important to talk, write or present your message clearly and simply. This will ensure that people hear, see, and understand the message that is being shared with. So: a. Give one message at a time. b. Use simple common words to explain the idea to be shared. c. Use few words as possible. d. Avoid speaking foreign language or words that are not understood by your receiver. e. Avoid medical terminology and scientific jargon )‫(المصطلحات العلمية‬. f. Use body language )gestures, body and voice( as it reinforces messages and regulates conversation. g. Use educational methods and aids effectively to visualize your message and supports it as symbols, artwork, posters, photographs, films II- Listen and pay attention (attentive listening) If you are not a good listener, you will be a less effective communicator!! Communication involves both sending and receiving messages. So listening is important for skillful communication. Listening is a big challenge because we spend much time listening namely 45%of communication time. You have to listen carefully to understand the interests, ideas, opinions that individuals are communicating to you. By listening you can realize if the receiver has understood your message or not. Receiver will pay attention when he feels that you are listening. Listening means respect. A good listener a. Pays attention to what is being said! b. Respects the speaker. c. Shows genuine )‫صااق‬/‫ (حقيقي‬interest in what he hears. d. Makes use of what he has heard. Figure 31 active listening It is important to note the following while listening:  Do not look around the room or to anything.  Look at the responder and keep eye contact.  Do not allow anyone to interrupt you to minimize distractions  Avoid any action while he is talking to you. 30   Take notes of important key points.  Give the speaker the chance to express himself.  Prepare questions or counter arguments. Being silent does not mean you are listening!! How to listen effectively? To be able to listen effectively you have to carry out these steps: 1. Develop your interest. 2. Look at the content of message. 3. Use appropriate note system. 4. Recognize that speech is slower than your thoughts 1- Develop your interest  Show your interest and concern by:  Establishing eye contact.  Having proper posture and facial expression  Examine every bit of information in terms of how you can use it. 2- Look at the content of message  Look at the message rather than the speaker.  Do not judge the message until you know the whole story.  You must listen even if you feel you cannot accept the ideas stated.  Try and consider new ideas.  Do not focus on details )Focus on: Main ideas, Principles. Concepts. )‫(مفاهيم‬ 3- Use appropriate note system  Develop a flexible )‫ (مرن‬system of recording what is important.  Note taking may prevent the receiver from hearing &observing the speaker  Note taking distracts the speaker. 4- Recognize that speech is slower than your thoughts We speak at a rate of about 150 words per minute. But we can hear at a rate of about 1000 words per minute. This gives us a lot of extra time. So, what should you do with this extra time?  Use the time difference to evaluate the facts and evidence  Anticipate what the other is going to say,,  Realize that the speaker's attitudes and emotional reactions may be more important than what he actually says. III- Observe carefully Communicating face to face with others include verbal and nonverbal communication. Both verbal and nonverbal communication are inseparable & should be viewed as complementary dimensions. We receive messages on three basic levels: non-verbal behaviours, voice inflections, and vocabulary )figure 17(. Vocabulary messages consist of the actual words we use to communicate with others. Voice inflections consist of the way that someone says something. This would include tone, speed, emotions, pace, volume, etc. It can dramatically change the meaning of the words being spoken. 31 Nonverbal behaviors include body language, facial expressions, gestures, etc. More powerful messages are conveyed through non-verbal clues than through words. Nonverbal messages reveal emotions and attitudes. Nonverbal communication can be transmitted through the eyes, eyebrows, mouth, head, hands and feet, sitting position, vocal cords, volume and tone of the voice. A good communicator observes as well hears. The position of body reflects feeling. When someone feels nervous, he may shrink his head as though hiding, fold his arms across his legs or above his abdomen. Folding arms sometimes means that a person does not want to accept another's point of view, or it may mean he is frightened and is defending himself. Figure 32 A frightened patient Always look for nonverbal clues or messages!! Individuals tend to respond to nonverbal than verbal messages. So, try to use nonverbal behaviors correctly. Be sure that nonverbal messages indicate your concern, attitudes and other good feelings. IV Discuss and clarify After listening and observing carefully, you have to make sure you heard the speaker correctly and also find out if he has understood your message )message has been correctly decoded(. Making sure that both of you has understood each other is extremely important for successful communication, the followings should be carried out: 1. Repeat what was said using different words. 2. Paraphrase the message to the speaker: Paraphrase means reflection or summarizing what someone say to confirm your understanding. 3. Clarify any points that you might not completely understand. 4. Prioritize and summarize points of importance. 5. Always look for information by using questions and answers technique when you are probing for missing information. Ask questions that are directly related to what the person has said, not questions on a new topic. Questions are the main means of communication interaction between people. We use questions to direct receiver`s attention to something we want to know. Questions can make communication between two persons more accurate: They give feedback and receive feedback You have to use questions that are open ended and closed questions.  Open ended questions These are questions that lead to open comments. 32  EXAMPLES  What is the problem?  How did the accident occur?  Why did it happen?  What do you think?  Closed questions Closed questions or simple direct questions are usually questions that start by who, when, where, how much or are answered by yes or no or by few words. EXAMPLES  Where did it happen?  When did it happen?  Who was affected? DO NOT EVER USE THE FOLLOWINMG QUESTIONS a. Leading questions: These questions make people give one sided answers. )Do not you feel that this course is extremely interesting?( b. Embarrassing or sensitive questions )Have you ever been beaten by your parent?( c. Double barrel questions )Do you like eggs or beans?( V-Summarize and repeat briefly In providing the message verbally, summarize the information that you need to share. In the summary you have to repeat what was said. You can ask the other person, if you have understood his/her ideas and meanings correctly. Encourage him/her to summarize your words. VI-Give feedback Feedback is an essential component of the communication process which is a circular process. Feedback is not evaluation. It tells the sender and receiver that the message was understood. Clear and direct feedback reduces uncertainty, solves problems, builds trust, strengthens relationships and improves work quality In face to face communication you can read body language or ask questions to ensure understanding. If you are communicating via writing, this can be judged by responses obtained. How one acquires skills of feedback?  Be specific.  Give immediate feedback.  Be descriptive rather than evaluative.  Deal with facts instead of opinions.  Be aware of non-verbal communication.  Ensure privacy and allow time for discussion. How to ask for feedback? 33  - Ask open questions. "What diet do you consume?" - Ask suppose questions: "Suppose this is your problem how would you deal with it?" - Listen: People say more & better when they believe that someone is really listening to them. - Echoes: )‫ (صدى‬Echoing is a repetition of the speaker's words followed by a pause. It encourages the speaker to elaborate on a point. For example: "You are saying that students have difficulty in understanding this subject?" - Reassure: (‫)يطمئن‬ Reassurance is letting the speaker know that you understand his or her problem. "I really understand clearly your problem." - Reflect: Reflection is neutral observation of the feelings you see in someone else. "You seem very concerned about your condition?" Tutorial 2 Chapter 3 & 4 I) Individual exercises I- Based on what you have learned in, respond to the following questions: 1. List the prerequisites for effective communication 2. Explain how to start a good relationship with the patient 3. What are the six steps of building rapport? 4. What are the basic responses of persons when feeling unsafe? 5. Describe the nonverbal characteristics of fight and flight responses? 6. What are the specific components of the space? 7. How to communicate skillfully? 34 8. How to present message clearly 9. How to listen effectively? 10. Explain how a communicator can discuss and clarify when he is presenting his message. 11. Explain how one acquires skills of feedback? 12. How can you ask for feedback? CASE STUDY 1 Objectives By the end of the case, learners will be able to  Identify nonverbal behaviors  Interpret )discover( the positive and negative behavior )steps( done by the physician in building rapport with his patient.  Construct what should the physician do to build a rapport  Read carefully the Case Study and answer the following questions: Dr Ibrahim is a family doctor. He is now in his office sitting behind his desk. In front of him was a huge pile of files and two huge medical books. He has just received the results of laboratory investigations related to his patient Lila. The results indicated that she developed diabetes. Dr. Ibrahim knows that Lila is an extremely sensitive person. Her father was diabetic who suffered before his death several diabetic complications 35  including diabetic retinopathy and diabetic foot that led to limb amputation. He knew that it will not be easy for her to accept the results. Dr Ibrahim greeted Lila while standing behind his desk and invited her to sit down. She responded with a very low voice. She sat down leaning forward with her head slightly down and evaded looking at him. Lila was tense, her facial expressions showed anger and she was sweating. Dr. Ibrahim stood up looked at her, and then started to walk in his office. He returned back sat down and crossed his arms Questions Q.1 what are the nonverbal behaviors carried out by Lila? Q.2 what are the mistakes that Dr Ibrahim has done? Q.3: Is there any positive action in Dr Ibrahim's interview? Q. 4 how can Dr Ibrahim build rapport with Lila? CASE STUDY 2 Objectives  By the end of the case, learners will be able to match predicates of representation system. The setting: Examination room in a private clinic Doctor is sitting in front of the patient and the desk is behind them. Patient: "I am really hazy about the diet I should eat". Doctor: "I will give you the facts that you can use in constructing your diet". Patient:" I need you to illustrate what I should eat in every meal". Doctor:" This sounds good. Let us be objective and logic. What are the foods you most like?" Questions 1. Identify the preferred representational system of the patient and physician. Physician 36  Patient 2. Criticize the physician's ability to match the preferred representation system. 3. Rewrite the dialogue in a way that the physician correctly matched the predicates. Chapter 5 Written and oral Communication PART 1 Verbal: Written Communication Objectives  Explain the differences between written and oral communication.  Enumerate the utilities and limitations of written communication.  Describe essentials in writing e-mails and power point slides.  Describe how to use a flip chart and white board.  Describe essentials in writing patient's prescription.  Explain why medical records are needed.  Describe the basic principles of writing reports effectively. Verbal communication 37  Verbal communication is used to convey our needs and share information. Clarification is important in verbal communication. It can be used to correct misunderstanding, persuade others, encourages thinking, creativity, strengthens relationships and initiate debates. Verbal communication can be carried out orally or written. Written verbal communication as letters, memos, patient’s instructions or forms, reports or snail mail )‫ (البريد العااي‬or emails. The effectiveness of written communication depends on: The style of writing. Vocabulary used. Grammar. Clarity and precision of language. Effective writing involves careful choice of words! Written communication requires the presentation of clear, logic thoughts!! Written material is a primary way to spread information, persuade, and entertain. Written material is especially important for sharing research findings. Being able to effectively and accurately communicate through writing is an important skill for employees in any organization and in healthcare facilities. Writing clear and accurate messages is advantageous in a professional setting Comparison between written and oral communication Written communication is:  A permanent means of communication.  More valid and reliable than speech.  More precise )‫ (اقيق‬and explicit )‫(واضح‬.  More formal and unique than speech Advantages and disadvantages of written communication Advantages Disadvantages a. Message can be revised several times a. Sender has no control over when, where, or even whether the message is read. b. Message stays the same even if relayed a. Sender does not receive immediate through several persons. feedback. c. Receiver has more time to read and interpret b. Receiver may not understand the message or the message. part of it. d. It is a permanent record that can be kept. Written communication formats used in health services Written communication is widely utilized in health care management and can take various forms. a. Written notes between departments. b. Written communication between supervisors and employees 38  c. Written instructions to health team members d. Patient discharge instructions. Now electronic communication is becoming standard practice. Example of these is: a. E-mails. b. Electronic lab results. c. Procedure and operative reports. d. Patient documentations. Utilities of written communication Written communication skills can help in: 1. Enhancing the image )‫ (تعزيز الصورة‬of health services. 2. Laying down )‫ (إرساء‬apparent principles, policies and rules for running the services. 3. Assisting in proper delegation )‫ (تفويض‬of responsibilities. 4. Instructing health team and patients. 5. Improving reports of managerial issues and scientific research and findings. 6. Minimizing confusion. 7. Leading to better patient care. 8. Providing ready records and references. 9. Providing valid records for legal matters. 10. Determining the quality of healthcare delivery and life. Limitations of written communication 1. Unsuitable for illiterate people. 2. Slow, lengthy, expensive and time consuming. 3. Lacks personal touch. 4. Lacks confidentiality. 5. Needs efficient filing system. Writing an Effective E-mail Many people prefer to send written messages rather than make phone calls. Email is a great option for sharing well-organized and easily understandable information, allowing the recipient to understa nd the message without needing any additional clarification. When to use e-mails? E-mails can be used to communicate: Meeting notices and events. Answers to quick questions, or quick clarifications. When to avoid e-mails? E-mails can be inefficient for more than reason. 39  First, the data may be too complex to organize. Complex topics may lead to misinterpretation or lack of understanding. It may need lengthy explanations. This means sending many follow-up emails or phone call. Second, lengthy discussions by e-mails are not efficient. Conversations or controversial subjects and decision making need lengthy discussions. The longer you allow the exchange to continue via e-mails, the more you are risking that someone will not understand your message. Each exchange risks the loss of the meaning of the message. Writing an e-mail 1. Include a specific subject line. It calls your attention to know what it is about. It will allow the receiver of the e-mail to prioritize (‫ )تحديد اولوية‬which e-mails to open first. Example URGENT! “Change in the date of your final presentation”. 2. Put the main point first. This will pull the reader's attention to the main topic, request or instruction. You can follow with background information after stating the reason for your e-mail. 3. Keep your message focused. E-mails are meant to be short and to the point. 4. Identify yourself. Include your name, job )if you are a student state the course name and section number( 5. Identify to whom you are writing. This will help you to target the communication in order to make it as effective as possible. 6. Be polite (‫)مهذب‬ Be polite whenever you ask for assistance or requesting a response. 7. Do not include any private information Your message can be easily intercepted )‫(يخترقها‬. 8. Avoid sending angry messages. Being angry may let you state messages that you will regret sending them later. 9. Avoid any fancy)‫ (مزخرف‬fonts This will ensure a clear message. Example: Use Times New Roman. 10. Proofread your e-mail. Make sure that you have expressed yourself with excellent spelling and grammar. Power Point 40  Tips to prepare power-point 1. Be clear and specific Use keywords )bullet points( rather than long sentences. A common standard is the 6/7 rule: no more than six bulleted items per slide. And not more than seven words per item. 2. Avoid putting too much information in one slide. 3. Use a LARGE FONT. Avoid font size smaller than 24. Use Arial font The text on your slide should only 4. Use contrasting COLORS to emphasize )‫(يؤكد على‬. provide an outline Use a dark text on a light background or a light text on a dark background. to what you will be saying. Use 5. Avoid red/green combination. illustrations, figures This combination is the most common form of colour blindness. and pictures 6. Use illustrations to get across )‫ (يوضح‬key concepts. Illustrations are effective means to make your written communication more clear 7. Use pictures and figures whenever needed. 8. Use limited animation Animations may distract the audience. 9. Revise; refine )‫ (ينقح‬and practice. Using flipcharts Flipchart is a series of visual sheets )papers( attached together as a display unit. The name comes from the fact that you flip the separate sheets into view as you progress through the presentation. You can use them with groups. You use them to give instructions and information. Tips to prepare flipcharts (These tips apply as well to using white or black boards) 1. Write information for greatest visual impact. So write in large letters. )7cm. Lettering(. Use less than five words per line. Use several colours of pens for variety and high-lightening. Do not have more than three columns. Use space: do not use vertical line. Use large symbols and abbreviations. Condense information. Eliminate every unnecessary word or figure. 2. Prepare your chart earlier. You can use a white board or another flipchart for spontaneous comments. 41  Patient's prescriptions and instructions These should be written clearly, readable, and complete. Patient's instructions should be written in simple language and the physician should avoid writing jargon )‫(مصطلحات علمية‬, medical terms, symbols or abbreviations. Figure 33 Badly written prescription Figure 34 a good prescription Now compare between figure 33 and figure 34 Filling records Records are usually written information kept in notebooks or files or computerized. They consist of the information kept in the health facility about work done, health conditions in the community, patients data and administrative matters such as staff, equipment and supplies. 42  Figure 35 Example of a medical record Records are needed to: Learn what is taking place. Make effective decisions. Assess progress towards objectives. Make sure that your records are filled: Clearly, Accurately, Completely, Timely. Records are the administration's memory- information should not be recorded unless it is accurate and needed! Written reports Reports are a mean of sharing information within an organization and are valuable for guiding future actions. 43 In the healthcare field, reports may include statistics on births, deaths, and illnesses, as well as feedback on program activities and challenges. Some countries provide printed or computerized reporting formats to health facilities in advance. Written material is the main way in which research findings are shared, leading to new ideas and progress in future studies. As a physician you also may write a report on the health condition of a patient. Figure 36 reveals a badly written medical report. Figure 36 A badly written medical report To overcome poor writing, one can use the computer as in figure 37 Figure 37 a good example of a medical report Basic principles of writing reports effectively 1. Come straight to the point and keep it simple. 2. Be specific 3. Use short sentences 4. Write coherent )‫ (مترابط منطقيا‬sentences and paragraphs.  This is an example of incoherent paragraph: 44 "I like surgery and pediatric. My father is a surgeon and he convinced me of the merits of being a surgeon. Working with children is fun. It is very rewarding to make a child smile again."  To be coherent he can say instead: "I can be pediatric surgeon. I like to work with children." 5. Avoid jargon, medical terms, abbreviations and symbols. 6. Use active and not passive voice. For example: Practice the exercises regularly )active voice(, “the exercises should be practiced regularly )passive voice that you should avoid(. 7. Reread what you have written. 8. Seek feedback. 9. Organize and have a clear logic flow Part 2 Speech (Oral) communication 45  Objectives  List utilities and limitations of oral presentation.  State types of presentations.  Describe the five rules of conveying messages.  Describe how to plan an oral presentation.  Describe how to deliver an oral presentation.  Explain how to maintain the attention of the audience. Oral communication refers to the spoken words in the communication process. It can be a talk with or without illustrations. The audience listens and watches the verbal presentation of information given by the speaker. Oral communication can either be face to face, or a conversation over the phone or, on the voice chats over the internet. Spoken conversations or dialogs are influenced by voice modulation, pitch, volume and even the speed and clarity of speaking. Oral presentations provide a chance to enhance communication and leadership abilities, which are crucial for doctors who need to speak skillfully with patients and their healthcare team. Oral communication is fast )it can pass information quickly and get immediate responses( and Meaningful )the use of nonverbal communication to support and enforce the meaning and the use of voice to add feelings to your word( Types of presentations There are several types of presentations. These include:  Quick 1 minute talk "what I do".  Health talks )15-30 minutes(.  Scientific lectures and seminars.  15- 25 minutes conference paper presentation.  Project and assignment presentation.  Thesis defence. Utilities of oral presentations 1. Cover large number of audience. 2. Allows for disseminating information. 46 Limitations of oral presentations 1. Audience is passive 2. Requires skilled speaker. 3. Does not allow checking the learning process. 4. Does not teach manual or intellectual skills. Rules of conveying messages orally The speaker has to be sure of five rules while conveying his message namely: 1. Clear (‫)وأضح‬:  Clearly state your message.  Avoid expressions such as "The former", "the latter" and "respectively".  Allow questions from the responder to your message to ensure being understood. Use words and expressions that are clear to the ear! 2. Concise (few words) (‫)مختصر‬:  Use few words so that your important message will not be lost. If you have too much material you will be forced to speak quickly. This will lead also to the loss of your message. 3. Consistent (‫)ثابت‬:  State the message in a consistent and accurate manner all the time for all persons.  This will help the audience in remembering your key points. Make the take home message persistent! 4. Credible/Reasonable (‫ موثوق به‬/‫)معقول‬:  Make sure your message is real. Use reliable resources. Be careful with internet sources. 5. Courteous (Polite):  Always be polite and considerate in your wording.  Words and phrases such as:"hello", "thank you", "please", "excuse me" and "I' am sorry" are easy, effective ways to demonstrate respect. How to plan an oral presentation? Prepare yourself. Structure your plan. Finalize and polish your plan. I. Prepare yourself  Know your audience well: their backgrounds, their knowledge level and what they hope to get from your presentation and the number of attendants 47   Select the topic that is appropriate to the group.  Create your core message which is your central idea.  Be sure that you have the correct and update information from books, journals and websites. II. Structure your plan A good oral presentation should be well structured. )Figure 38( This makes it easier for the listener to follow. Most talks are divided into three parts: A- Introduction )beginning(, B- Body)middle(, C- Conclusion)end(. Figure 38 Structure of oral presentation (1) Start by writing the body. State a simple sentence that introduces your topic. "I am going to explain the importance of avoiding smoking!!" Cover major points. Any unnecessary points should be excluded. You have to evaluate each one in terms of its contribution to your purpose. Decide about the pattern you will use or )sequences that are commonly used(. Ideas should be organized logically in sequence and clear Try to anticipate possible questions your audience might ask. Think of proverbs, poetry, new events etc. Think of power point slides, posters, pictures and other audio-visual materials that can attract your audience There are several patterns or sequences that are commonly used namely: 1. The topical pattern Information is selected and arranged according to importance. Example: If you are discussing treatment of a disease you have to start first by treatment then discuss prevention of complications. 2. The time pattern or chronological order )‫(تسلسل زمني‬: The organization is based upon the chronological relation between main points. Example: If you are giving a talk on how to prepare oral rehydration salt you should explain steps in the order in which they happen. 3. The comparison pattern: This pattern permits the speaker to describe similarities or differences between two items or events. 48  Example: If you are discussing written communication versus oral communication. 4. The classification pattern: In this pattern you classify events, causes or people. Example: You can classify types of research or agent of diseases. 5. The cause-and-effect pattern: In this pattern you have to view causes and effects as they are related to each other. Example: You can discuss risk factors as diet, smoking, stress and lack of exercise and coronary heart disease. 6. The problem solving pattern: You start by analysing the problem, then what should be done to solve the problem. Example: You can use this pattern when you are discussing causes of population growth and how to manage this problem. (2) Plan well your introduction. Your introduction sets the stage for the rest of your speech. A well planned introduction marks your initial impression and gets you started. It also helps you to gain the attention of your audience. In your introduction tell them exactly what information you plan to cover. You want them to understand why the topic is important. Your introduction should help you to build rapport with your audience and grab their attention. Use:  A starting statement.  A shocking statistics.  A current event.  A story.  A proverb. )‫ مقولة‬- ‫(مثل‬  A question.  A vivid )‫ (حي‬dramatic illustration or picture. (3) Plan well your conclusion. In your conclusion you should remind your audience again of the meaning and purpose of your oral presentation. It should include the main points covered in your speech but do not restate them word for word. Also in your conclusion tell your audience why your message is important. The conclusion should summarize the message, drive it home and bring the talk to a close. III. Finalize and polish your plan Create effective notes for your presentation. 49  Write down an outline or brief reminders of what you want to say. Record your presentation and review it. You may notice that you are pausing incorrectly, talking too fast or using distracting gestures. Practice and time your presentation. This is essential. The more you practice, the more comfortable you will become with the material. Practice in front of peers and get their comments on your delivery and content. How to give a good presentation? A. Introduction This is the opening of your presentation. It should take only 10% of your talk. 1. Start well.  Stand in a balanced position, facing your audience, feet apart, it helps you to appear confident.  Do not shuffle about or lean against the furniture.  Take a deep breath and wait for the audience to focus on you.  Greet the audience and smile. The audience will react positively.  Introduce yourself even if they already know you. People will identify you and you will establish your authority on the subject. (State name, position and organization)  Treat the floor as a stage. Presentation should be entertaining. A good entertainer will captivate )‫ (يأسر‬the audience and increase the likelihood that your audience will remember the messages delivered. 2. Introduce the subject.  Explain exactly what you are going to talk about and stating the title  Explain its importance in relation to the audience "The subject of my presentation is..." 3. State your objectives (purpose, aims) clearly. The main purpose of is “To give essential background data……” 4. Focus on what the learners are expected to accomplish. An important purpose of the speech is what you want the audience to take away with them after listening to your speech. Know exactly what you want them to do and what they should remember. 5. Announce your outline. The body of content should be outlined, material could be broke into short sections. Two or three main points are usually enough. Example: "I have broken my speech down into 4 parts" 6. Provide any necessary background information or definition of terms. B. Main body The body of your presentation is where you will present your main points and present examples and evidence. This should cover 70% of your presentation. 50  Explain your points clearly.  Use verbal "signposts" )‫ (علمات ارشااية‬to guide your audience through the presentation. These will highlight your key points and indicate the different sections of your presentation. "Another point is.."  Move from one point to the next smoothly. Example use phrases such as: "Firstly.., secondly.... and lastly..."  Give sufficient evidence to be convincing. (e.g. Professor Salah states....")  Emphasise important information and explain to the audience why these are important.  Use audio-visuals )Power point slides, overhead transparencies, white boards, posters or videos( whenever needed to augment what you are saying., to illustrate items that are difficult or time consuming, to show reality in ways that words alone cannot )as photos, maps(. and to add colour and interest to your presentation.  Question your audience. At the end of each unit or section, ask questions and give immediate feedback. This will make your audience alert and you will be able to check if they have understood your message or not. C. Conclusion. The closing of your speech should cover 20% of your total presentation. The conclusion is a summary of the main points made &do not introduce new information Restate the purpose of the presentation and say that you have achieved your aim: "I think it's now clear that....." In your summary restate the main points and re-answer questions you have asked. Thank the audience and invite questions and give feedback. Invite audience to ask questions. You may have anticipated some of them in your plan. Questions are unpredictable in nature. You should: -Acknowledge the question:" Good question!!"This polite acknowledgment shows your interest. -Rephrase the question: Rephrasing makes you sure that you understand the question and allows you time to think of an answer. -Break up the question into sections if it is long. -Answer the question as clearly and concisely as possible. -Check for comprehension (‫فهم‬/‫ (استيعاب‬with the