Guide to the Medical Interview Calgary–Cambridge Guide

Effective communication is fundamental to achieving good health outcomes and is central to every doctor–patient interaction. Communication skills are not innate alone but are teachable, evidence-based competencies that form a core component of medical education worldwide. To support this, structured communication models have been developed through extensive research to guide clinicians in gathering information, building rapport, and planning management in a patient-centred manner.

One of the most widely adopted frameworks is the Calgary–Cambridge Model, developed by Kurtz and Silverman. Originally designed for use in tertiary clinical education, the model has since been adapted across multiple health disciplines and remains a foundational guide for conducting effective medical interviews. Its enduring strength lies in its integration of clinical content (what information is gathered) with communication process (how the interaction occurs), rather than treating these as separate skills.

Structure of the Calgary–Cambridge Model

The model conceptualises the medical interview as a five-stage process:

Initiating the session
Gathering information
Physical examination
Explanation and planning
Closing the session

Importantly, two core elements—providing structure and building the relationship—run continuously throughout the entire consultation rather than occurring at fixed points. This reflects the reality of clinical practice, where rapport and organisation evolve dynamically as the encounter progresses.

Unlike traditional approaches that separate subjective history-taking from objective examination, the Calgary–Cambridge Model explicitly integrates the physical examination into the communication framework. This highlights the interdependence of verbal communication, non-verbal cues, and clinical assessment in real-world consultations.

Gathering Information: Integrating Disease and Illness

The information-gathering phase is designed to explore both the biomedical perspective (disease) and the patient’s perspective (illness), recognising that effective care requires understanding both.

Process Skills

Key communication processes used to explore the patient’s problems include:

Encouraging the patient’s narrative
Using an open-to-closed questioning style
Attentive listening and facilitative responses
Picking up verbal and non-verbal cues
Clarification and time-framing
Internal summarising
Appropriate, patient-centred language

These skills allow clinicians to maintain openness while still guiding the consultation in a structured and efficient manner.

Content Domains

Information gathered includes:

Biomedical perspective: sequence of events, symptom analysis, and relevant systems
Patient perspective: ideas, beliefs, concerns, expectations, emotional responses, and effects on daily life
Background context: past medical history, medication and allergy history, family history, social and personal circumstances, and review of systems

This dual focus ensures that the clinician does not merely identify pathology but also understands the meaning of illness for the individual patient.

Internal Summarising and Signposting

Two key skills that support both clarity and patient-centredness are internal summarising and signposting.

Summarising allows the clinician to:

Pull together and review information gathered so far
Organise data into a coherent clinical pattern
Identify gaps or areas needing clarification
Pause and consider the direction of the consultation
Distinguish between disease-focused and illness-focused information

Signposting complements summarising by explicitly indicating transitions within the consultation. It signals changes in direction, explains what will happen next, and invites the patient to think alongside the clinician. This preserves transparency and shared understanding while maintaining structure.

Explanation and Planning: From Information to Shared Decisions

The explanation and planning phase focuses on translating clinical findings into information and management plans that are meaningful and acceptable to the patient.

Providing the Right Information

Clinicians aim to provide information that is:

Comprehensive but not overwhelming
Tailored to the patient’s existing knowledge and preferences

This is achieved by:

Delivering information in manageable chunks
Checking understanding regularly
Assessing the patient’s starting point and desire for detail
Timing explanations appropriately, avoiding premature advice or reassurance

Supporting Recall and Understanding

Understanding is enhanced through:

Logical organisation and clear sequencing
Explicit signposting
Repetition and summarising
Simple, jargon-free language
Use of visual aids and written information
Active checking of patient understanding

Incorporating the Patient’s Perspective

Effective explanation is interactive rather than one-way. Clinicians:

Relate explanations to the patient’s ideas, concerns, and expectations
Encourage questions and clarification
Respond to emotional and non-verbal cues
Explore and address patient beliefs and reactions

Planning and Shared Decision-Making

The model strongly emphasises shared decision-making, recognising that patient engagement improves adherence and outcomes. This involves:

Sharing clinical reasoning and uncertainty when appropriate
Offering choices rather than directives
Exploring management options
Clarifying how involved the patient wishes to be
Negotiating a mutually acceptable plan that incorporates both clinical evidence and patient preferences
Confirming acceptance and addressing remaining concerns

Closing the Session

The consultation concludes with:

Clear agreement on next steps for both patient and clinician
Safety-netting, including advice on what to do if symptoms change or the plan is not working
A brief summary of the consultation and agreed plan
A final check that the patient understands, agrees, and has no outstanding questions

Conclusion

The Calgary–Cambridge Model provides a practical, structured, and patient-centred framework for clinical communication. By integrating communication process with clinical content, and by balancing disease-focused assessment with the patient’s lived experience of illness, the model supports effective information gathering, shared understanding, and collaborative decision-making. Its adaptability across disciplines and enduring relevance reflect its value as both a teaching tool and a guide for everyday clinical practice