Clinical Competency Skills: A Reference Manual
by Balu H. Athreya, M.D. (200 pages)

For over 20 years Dr. Balu Athreya, Emeritus Professor of Pediatrics at the University of Pennsylvania School of Medicine, taught a course called “The Art of Medicine”. Now he has created a practical reference manual based on that course. The book’s primary audience is medical students and residents, and it discusses the “practical aspects of observing, listening, helping and communicating.” Training programs, textbooks, and other resource materials for residents traditionally focus on the development of factual knowledge with little attention to the development of the skills needed to effectively apply the science to the clinical encounter. With growing acknowledgement of the importance of interpersonal relationships and effective physician communication skills, it is apparent these skills need to be taught using a systematic curriculum. Effective diagnostic skills, problem-solving skills, and clinical management skills require competency in observing, listening, communicating, caring and connecting. Clinical Competency Skills provides a valuable resource for those seeking to learn these skills. The book addresses each of these topics as individual chapters finishing with a strong recommendation encouraging the physician to “Know thyself” by incorporating time for self-reflection into each day. Dr. Athreya reminds the reader in the last chapter that developing continuous self-learning skills should not be neglected and is necessary for continued professional growth and well-being. Each chapter ends with a paragraph summarizing the major points, key references and recommended readings, tables and in some cases suggested exercises for practice laid out in clear, reader-friendly and user-friendly formats.

The book’s recurring theme is that the practice of medicine involves people who need to be treated with respect and understanding. This is not a book on humanism, however, but rather one that guides the reader in the application of humanistic competencies for the purpose of developing appropriately comprehensive differential diagnoses, clinical problem-solving, and appropriate patient-centered interventions and management. The discussions regarding distinguishing illness from disease and the importance of understanding the personal predicaments (i.e. psychosocial context) of the child and the parent are particularly well done. Dr. Athreya uses practical real-life clinical examples to illustrate how these principles affect the physician-patient encounter and the physician’s ability to deliver effective care. Children and their parents rely on pediatricians to provide the information they need in a manner they can understand. Care delivered in conflict with the social and cultural values important to patients risks being ineffective in meeting their needs. If providers are to meet these expectations patients need to be listened to with the care and attention required to truly hear their stories. Chapter 4 on listening and observational skills is one of the highlights of the book. The topic is covered comprehensively, providing specific behaviors which can be easily practiced and evaluated.

Overall, Dr. Athreya has succeeded in producing a much-needed resource for competency training in the art and practice of clinical medicine. He has integrated developing humanistic skills in tandem with developing diagnostic and problem-solving skills such that one set of skills cannot be divorced from the other. It is deceptively easy to read, but complex in its concepts. This is a book that will spend very little time gathering dust on a bookshelf because of its applicability to everyday practice and experiences. Trainees and trainers alike will find the manual an important and inexpensive addition to their educational resources. Check it out at http://booklocker.com/books/2663.html

Carol A. Miller, MD
University of California at San Francisco
400 Parnassus
San Francisco, CA 94143
Phone 415-353-2364
millerc@peds.ucsf.edu

Updated 10/24/07