2. DOVs – Everything You Need to Know!
Dr Helen Mullner, Dr Simon Hay and guests
Hello. We are going to spend the next session talking about external DOVs at GPEx. No you probably don’t want to hear from me so GPEx ME Dr Helen Mulllner registrar visit expert and supervisor is going to co facilitate this session. However, it doesn’t stop there - we are also going to hear from a panel and you.

3. Welcome To Panel Members
Jacky Genesin – Practice Manager
Dr Tim Bromley
Dr Chrissy Psvedos
So I am going to welcome up the panel.

4. Structure of Today’s Session
Why do we do DOVs?.
How do we manage External DOVs at GPEx?
Who Will You Be Visiting?
Recommendations – How to set up and structure a DOV.
Starting the DOV - Setting the Scene.
The Observation Itself
What are YOU Happy to be Asked?
When to take over the consultation.
The do’s and don’t’s of DOVs.
Reporting of DOVs.
What about ACRRM Registrars?
Troubleshooting.
Simon

5. Why do we do DOVs?
“Provide an opportunity to observe registrars working in their practices and seeing first hand the relationships between the registrar, staff, patients and other health professionals and the community in general.” RVTS Guide to Conducting Clinical Teaching Visits
Helen
“Provide an opportunity to observe registrars working in their practices and seeing first hand the relationships between the registrar, staff, patients and other health professionals and the community in general.” RVTS Guide to Conducting Clinical Teaching Visits
Provides an independent assessment of the registrar
Provides the opportunity to the registrars to be taught by another GP
Provides the opportunity to learn about the approach of another GP from another clinic – with another way of approaching general practice
Provides an opportunity to gain information about how the clinic is performing as a training post
It is a college requirement.

6. How do we manage ‘External’ DOVs at GPEx?
Simon – with help of Vicky and/or Holly

7. Who Will You Be Visiting?
Senior registrars
Shouldn’t have a conflict of interest e.g.
Family or friend
Close colleague in past
Previous supervisor
Poor relationship with registrar, their supervisor or their practice
Usually in your region
Simon etc

8. Recommendations on How to Set Up and Structure a DOV.
Call or the practice
Organise a date and time
Most DOVs take 3 hours
Discussion with the registrar
Observation of the registrar
Debriefing with the registrar and supervisor
Simon
Bring attention to copies of instruction sheets.

9. Recommendations on How to Set Up and Structure a DOV.
Activity
People Involved
Arrival
Discussion with Registrar
Visitor and Registrar
30 minutes
Consultation 1
45 minutes
Consultation 2
60 minutes
Consultation 3
75 minutes
Debrief on 3 consultations
90 minutes
Consultation 4
105 minutes
Consultation 5
120 minutes
Consultation 6
135 minutes
150 minutes
Overall Debrief with Registrar
160 minutes
Meet with Supervisor
Visitor and Supervisor
170 minutes
Meet with Registrar and Supervisor
Visitor, Registrar and Supervisor
180 minutes
Finish DOV
Visitor
Simon

10. Starting the DOV – Setting the Scene!
Helen
Ask the panel for comments on how they set the scene
Introduce yourself and thank registrar for allowing you to come
Reassure them that you are there to help them become a better GP
Check that the DOV schedule has been set up as requested
Discuss how they are feeling their placement is progressing – do they have any concerns?
Have they integrated into the community (if rural)
What are their Exam plans? When are they sitting? What study are they doing?
Advise the registrar to obtain patient consent before the patient enters the room. Occasionally patients will say no.
Discuss with the registrar how they should introduce you.
Discuss where to sit in the room.
Advise the registrar that if they conduct sensitive physical examinations e.g. PR or vaginal examination/Pap smear, to draw the curtain around the patient as you will not be observing the examination. Registrars need to advise patients about this.
Discuss how much you are happy to be involved in the consultation itself.
Ask the registrar to brief you on the patient before they call the patient in.

11. The Observation Itself
Helen and Simon
Panel discussion regarding what happens in the observations of consults. What they always need to be mindful of.

12. The Observation Itself – Key Points
Try and be out of the line of sight of patient
Ask the registrar for a summary of the next patient
Observe and try not to participate
Make notes during the consultation
Note quotes if possible for feedback
Helen
Will probably come up in discussion
Add more
Some people use laptop during observations, I prefer paper and pen, head down, silent!

13. Two Questions To Discuss.
What are you happy to be asked by the registrar?
When should you take over the consultation?
Helen – brainstorm at tables these two questions

14. What Are You Happy To Be Asked?
You are there as an observer
Use your discretion – quick questions may be ok
Whenever possible do not get involved in the consultation
It is important to observe registrar- supervisor dynamics
Helen
After the table discussions

15. When Should You Take Over The Consultation?
Never take over the consultation completely
You may need to stop a registrar from making an error
When do you step in? Depends upon the situation. Do you
Talk to registrar after?
Speak up during the consultation?
Simon
After the table discussions

16. The Dos and Don'ts of DOVs!
Simon and Helen
Panel
Need to add some, I think we can ask the panel, of reflect on things already raised!

17. Reporting of DOVs. Discussion with registrar
Discussion with supervisor
Discussion with registrar and supervisor
Written report – nothing in the report should be a surprise to the registrar or supervisor
What if there is something that you don’t want to put in the report? Well….
There are avenues open to you – talk to GPEx
Speak to their Medical Educator
Speak to their Program Training Advisor
Speak to a Senior Medical Educator at GPEx
Simon
I will go through these steps

18. What about ACRRM Registrars?
DOVs are much the same but ….
Mini CEX
Report on an individual consultation
ACRRM registrars have to do 9 across their training
3 different observers
5 different physical examinations
At least one new patient
Can be performed by any FACRRM, an ACRRM approved supervisor or an ME with an ACRRM approved RTO
Simon
Again
I will go through this.

19. Troubleshooting. What if things aren’t ‘right’.
DOV not booked in at all?
Not the correct structure?
Not enough patients?
Too ‘easy’ patients?
Suggestions for activities if there are insufficient patients
• ?Role play cases from your own practice and give the registrar feedback
• ?Discuss exam(s) and give tips if you are familiar with the process
• ?Do a chart audit - discuss patient management and/or look at the quality of the record keeping
• ?Discuss practice management topics e.g. IT, billing Medicare, recall and reminder systems, dealing with conflict, human resource management
• ?Discuss current patients that they are concerned about and management strategies
• ?Provide the opportunity to debrief on past concerns
• ?Visit the local shop if in a remote community and discuss relevant public health issues with the registrar, including the cost of food, its quality and placement
• ?Discuss possible ways of improving the public health of the community. Encourage the registrar to consider community relevant activities that could be initiated
• ?Discuss the registrar’s career aspirations and their feeling about working in a remote community, if applicable
• ?Discuss online resources and systems in clinics

20. Questions
Simon and Helen