In this first chapter, we are going to focus on the foundations of your performance in the CASC exam, however the skills outlined here should not just be restricted to preparing for the exams, as they form the basis of effective communication with anyone.

You may in fact be using some or all of these techniques already without realising it. They appear relatively simple, but mastering them can be difficult as this requires a conscious monitoring of your own body posture, tone of voice and choice of phrase or words; all of which can feel awkward and uncomfortable at first.

These techniques require practice. To allow them to become as natural as possible, you should not just practise them in clinical settings but play with them in every interaction. As when learning any new skill, there is a transition from unconscious incompetence, through the awkward phase of conscious incompetence (where it might seem like every word you choose seems forced), to a phase of conscious competence. With time, the aim is to develop unconscious competence, at which point these techniques will be at their most powerful (Howell, 1982). So why are these techniques important? They work on an unconscious level to affect how others perceive the quality of your communication and interactions. This is not only true of the patient or actor you are talking to, but also of the examiner observing you. Done well, no one will notice them unless they are specifically looking out for them; but an observer is likely to see that rapport is established rapidly between the doctor and the patient and that communication is sympathetic and fluid.

Time to act: recognising different aspects of communication

The CASC can be seen as a series of performances and, as such, taking on the behaviours of a performing actor can help. Throughout their training, actors learn to use their voices and become comfortable with the ranges and variations they may effect. To use the techniques outlined on the following pages it is useful to begin to get a sense of how you may vary your voice.