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