Video Consultations Trainers workshop 21/05/15

How do we use videos Summative- COTs as part of WPBA Formative- identifying and addressing learning needs

Summative A quick reminder on COTS= Consultation Observation Tool Needs to be formal we are the Examiners now! The GP trainee records a number of consultations on video and selects one for assessment and discussion i.e. they have decided that this submission is the best of the bunch. Hence what are the quality of the videos like that have NOT been selected. Protected time is set aside for both GP trainee and trainer to view the consultation together During which time the trainer grades each of the areas indicated. At the end of the assessment a global rating is made. The trainer then formulates and offers formal feedback on the assessment conducted and then advises on recommendations for further work and development by the GP registrar.

How many consultations should be viewed? One consultation at each assessment sitting. The training period (12m in general practice ) could have THREE interim (or review) periods (ie every four months), but this is up to the trainer/StR to organise between them. Before each 30- and 36-month review, six one-consultation assessments should have been made = 12 individual consultations by the end of the training year (12 months) While the registrar’s trainer may well conduct several of these assessments it is recommended that at least one other rater is involved during this year.

Consultation case selection Consultations should be selected across a range of patient contexts and over a year should include at least one case from each of the following areas: Children Older adults Mental health Palliative Care/Cancer The maximum duration of the consultation to be viewed is not specified although this should be taken into consideration in the rating of the consultation.

Quick discussion few minutes in small groups How formal a process do trainers make this? Do we tend to blur this assessment and does it become more like a debrief? Do we only do 1 assessment at a time or do we bunch them to ease the process of evidence collection for both trainee and trainer? Do we ask others in our practice to carry out a COT on trainees? What do we do if there is only 1 trainer in a practice? How strict are we about checking patient selection- child, elderly, mental health and palliative cases during their attachment?

Formative assessment Supportive and developmental Need to identify any areas of learning or improvement Based on the observation of the consultation- use the COT form to identify any specific indicators not met and discuss how these could have been addressed Can use ALOBA- Agenda-Led Outcome Based Analysis

Set the scene for the experiential work Identify the interviewer’s initial agenda Watch the interview Acknowledge the interviewer’s feelings Feedback and re-rehearsal (whole group) Tape review, skills spotting Introduce facilitator’s agenda/teaching points: generalizing away Close the session Prepare the whole group to watch the interview Refine the interviewer’s agenda and desired outcome(s)

How else can we use video material? A video consultation is an invaluable source for further learning opportunities. There are a myriad of other areas available for discussion I would like to explore some of these now. Have a look at the following video- and make a list of what other areas you could discuss with the trainee. Trainee has consented for me to use this video and patient has consented for us to use recording of her consultation for teaching purposes Remember we are all bound confidentiality.

Trainee video Use the COT form to assess this consultation up to the end of the examination Also make a list of any areas that you could use as source material for future tutorials or further discuss with the trainee

Brainstorm What further areas of potential learning have you produced from seeing this video of the trainee consulting.

Some specific areas Underperformance There is a document available describes the - Indicators of potential underperformance. Developed by the RCGP and is very applicable to an assessment of a trainee that you feel isn’t even meeting the standards of NFD Available from deanery website or RCGP

RelationshipCommunication and Consulting Skills This competency is about communication with patients, and the use of recognised consultation techniques. IPU Does not establish rapport with the patient Makes inappropriate assumptions about the patients agenda Misses / ignores significant cues Does not give space and time to the patient when this is needed Needs Further Development – meets or above expectations Develops a working relationship with the patient, but one in which the problem rather than the person is the focus. Competent Explores the patient’s agenda, health beliefs and preferences. Elicits psychological and social information to place the patient’s problem in context. Excellent Incorporates the patient’s perspective and context when negotiating the management plan. The approach is inappropriately doctor- centred Produces management plans that are appropriate to the patient’s problem. Works in partnership with the patient, negotiating a mutually acceptable plan that respects the patient’s agenda and preference for involvement. Whenever possible, adopts plans that respect the patient’s autonomy. Uses stock phrases / inappropriate medical jargon rather than tailoring the language to the patients’ needs and context Provides explanations that are relevant and understandable to the patient, using appropriate language. Explores the patient’s understanding of what has taken place. Uses a variety of communication techniques and materials to adapt explanations to the needs of the patient. Has a blinkered approach and is unable to adapt the consultation despite cues or new information Is unable to consult within time scales that are appropriate to the stage of training Achieves the tasks of the consultation but uses a rigid approach. Flexibly and efficiently achieves consultation tasks, responding to the consultation preferences of the patient. Appropriately uses advanced consultation skills such as confrontation or catharsis to achieve better patient outcomes

RelationshipPractising Holistically This competency is about the ability of the doctor to operate in physical, psychological, socio-economic and cultural dimensions, taking into account feelings as well as thoughts IPU Treats the disease, not the patient Needs Further Development – meets or above expectations Enquires into both physical and psychological aspects of the patient’s problem. Competent Demonstrates understanding of the patient in relation to their socio-economic and cultural background. Excellent Uses this understanding to inform discussion and to generate practical suggestions for patient management. Recognises the impact of the problem on the patient. Additionally, recognises the impact of the problem on the patient’s family/carers. Recognises and shows understanding of the limits of the doctor’s ability to intervene in the holistic care of the patient. Uses him/herself as the sole means of supporting the patient. Utilises appropriate support agencies (including primary health care team members) targeted to the needs of the patient Organises appropriate support for the patient’s family and carers

Cues I would have looked at cues both verbal and non verbal I would have tried to incorporate the lack of addressing many of the cues with failing to address the patients Ideas, Concerns and Expectations- so called ICE

Some of the numerous cues missed Non-verbal cues nervous laugh in the beginning Slumped onto the chair heavily Facial expression- looked depressed and fed up Blows out air and sighs heavily on a number of occasions Sitting forward on edge of seat Scratching right knee constantly Tone of voice Shaking of head Verbal cues “I haven’t had a good end of year” “there all sorts of stuff….going on” “feeling TATT” “is it normal to fall asleep..easily” “totally on my own!” “the garden looks a mess” “I cant cope…..” “I haven’t the energy” “I cant go outdoors anymore” “my brother is stressed” “he has had an aneurysm. Is this genetic?”

ICE

The perfect consultation!