Consultation Analysis

VTS 22/9/04

Consultation Models

Stott & Davis Pendleton et al Roger Neighbour Cambridge-Calgary

Stott & Davis - The unique potential of each primary care consultation

Dealing with the acute problem Dealing with chronic problems Opportunistic health promotion Modification of help-seeking

behaviour

Stott & Davis, BJGP, 1979

Pendleton et al – 7 tasks of the consultation

Why did the patient attend? Consider other problems Choose appropriate action(s) Share understanding Involve patient – management and responsibility Effective use of time & resources Establish/ maintain relationship with

patient

Roger Neighbour - The Inner Consultation

Connecting Summarizing Handing Over Safety-netting House-keeping

Cambridge-Calgary 1

Initiating the session Gathering information Explanation and planning Closing the session

Cambridge-Calgary 2

Start with the learner’s agenda Look at the outcomes learner and patient are trying to achieve Encourage self-assessment and self-problem solving first Involve the whole group in problem solving Use descriptive feedback to encourage a non-judgmental

approach Provide balanced feedback Make offers and suggestions; generate alternatives Rehearse suggestions

Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine.  Radcliffe Medical Press ( Oxford)Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients.  Radcliffe Medical Press (Oxford)

Summative Assessment

Passing the video……..

What they look for…..

A doctor who is competent to practise

independently as an unsupervised GP Evidence of skills which show patient- centred behaviour Further insights in the log diary

Four key areas:

Knowledge Problem-solving ability Clinical and communication

skills Attitudes

Knowledge

Does the doctor have enough knowledge

to manage the consultation as a whole? Think about history, diagnosis, management, language, explanations, patterns of the consultation

Problem solving ability

Are you making reasonable working conclusions and diagnoses? Do you manage the patient’s problems

appropriately? Do you investigate and refer appropriately?

Clinical & communication skills

Do you discover why the patient has attended? Do you take an adequate clinical

history? Do you examine appropriately? Do you explain and negotiate a

credible and acceptable management plan?

Attitudes

The skills the examiners look at are: Listening Rapport Empathy, verbal and non-verbal Picking up cues Showing interest, care, concern and

respect Humility

MRCGP Video

Think about Single route video – low risk, most pass SA even if fail MRCGP module

Possibly easier to prepare for as uses clear Performance Criteria

Competencies (units)

Discover the reason for the patient’s attendance Define the clinical problem Explain the problem(s) to the patient Address the patient’s problem(s) Make effective use of the consultation

Performance Criteria

These were developed from the skills needed to fulfil the competencies There are 10 performance criteria for a pass plus 4 more for merit Each performance criterion must be present at least four times over seven consultations to pass Selection is the key

Performance Criteria 2

1: Encourages patient’s contribution 2: Responds to signals (merit) 3: Appropriate use of psychological and social information 4: Explores patient’s health understanding 5: Obtains sufficient information to include or exclude significant conditions

Performance Criteria 3

6: Physical /mental examination to confirm or

disprove hypotheses 7: Makes clinically appropriate working diagnosis 8: Explains in appropriate language 9: Incorporates patient’s health beliefs 10: Confirms patient’s understanding of diagnosis 11: Appropriate management plan

Performance Criteria 4

12: Patient involved in management decisions 13: Prescribing concordance enhanced

by exploring and responding to patient’s understanding 14: Specified conditions and intervals for follow-up

Choosing consultations

For SA – you need at least 8, in a video lasting 2 hours For MRCGP – you need 7 (the first 7). The examiners will stop watching consultations

after 15 minutes Include at least one where the patient is under 10 years Include at least one with a significant psychological or social dimension

Other tips

Read the examination regulations carefully Test the technology - the better the quality, the easier it will be for the examiner to mark Use the log to add insight and

reflection, not duplicate what is on the video