Consultation Analysis VTS 22/9/04

Consultation Models z Stott & Davis z Pendleton et al z Roger Neighbour z Cambridge-Calgary

Stott & Davis - The unique potential of each primary care consultation z Dealing with the acute problem z Dealing with chronic problems z Opportunistic health promotion z Modification of help-seeking behaviour Stott & Davis, BJGP, 1979

Pendleton et al – 7 tasks of the consultation z Why did the patient attend? z Consider other problems z Choose appropriate action(s) z Share understanding z Involve patient – management and responsibility z Effective use of time & resources z Establish/ maintain relationship with patient

Roger Neighbour - The Inner Consultation z Connecting z Summarizing z Handing Over z Safety-netting z House-keeping

Cambridge-Calgary 1 z Initiating the session z Gathering information z Explanation and planning z Closing the session

Cambridge-Calgary 2 zStart with the learner’s agenda zLook at the outcomes learner and patient are trying to achieve zEncourage self-assessment and self-problem solving first zInvolve the whole group in problem solving zUse descriptive feedback to encourage a non-judgmental approach zProvide balanced feedback zMake offers and suggestions; generate alternatives zRehearse 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….. z A doctor who is competent to practise independently as an unsupervised GP z Evidence of skills which show patient- centred behaviour z Further insights in the log diary

Four key areas: z Knowledge z Problem-solving ability z Clinical and communication skills z Attitudes

Knowledge z Does the doctor have enough knowledge to manage the consultation as a whole? z Think about history, diagnosis, management, language, explanations, patterns of the consultation

Problem solving ability z Are you making reasonable working conclusions and diagnoses? z Do you manage the patient’s problems appropriately? z Do you investigate and refer appropriately?

Clinical & communication skills z Do you discover why the patient has attended? z Do you take an adequate clinical history? z Do you examine appropriately? z Do you explain and negotiate a credible and acceptable management plan?

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

MRCGP Video z Think about Single route video – low risk, most pass SA even if fail MRCGP module z Possibly easier to prepare for as uses clear Performance Criteria

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

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

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

Performance Criteria 3 z 6: Physical /mental examination to confirm or disprove hypotheses z 7: Makes clinically appropriate working diagnosis z 8: Explains in appropriate language z 9: Incorporates patient’s health beliefs z 10: Confirms patient’s understanding of diagnosis z 11: Appropriate management plan

Performance Criteria 4 z 12: Patient involved in management decisions z 13: Prescribing concordance enhanced by exploring and responding to patient’s understanding z 14: Specified conditions and intervals for follow-up

Choosing consultations z For SA – you need at least 8, in a video lasting 2 hours z For MRCGP – you need 7 (the first 7). The examiners will stop watching consultations after 15 minutes z Include at least one where the patient is under 10 years z Include at least one with a significant psychological or social dimension

Other tips z Read the examination regulations carefully z Test the technology - the better the quality, the easier it will be for the examiner to mark z Use the log to add insight and reflection, not duplicate what is on the video