1. Assessment of Consulting Skills in a Nutshell AKA “The Video” Ramesh Mehay MRCGP Tutor Faculty Member Yorkshire RCGP Course Organiser (Bradford VTS) GP (Bradford)

2. Consulting Skills BRAINSTORMING SESSION List any fears or concerns that you have with this module List any fears or concerns that you have with this module

3. Aims of this Session To understand the purpose of the video consultation module To understand the purpose of the video consultation module To understand what they (the examiners) are looking for To understand what they (the examiners) are looking for To alleviate your fears To alleviate your fears To increase your chances of passing the exam! To increase your chances of passing the exam! 30 minute session 30 minute session

4. Objectives of this Session At the end of this session you will : Be aware of the rules / regulations / technical requirements Be aware of the rules / regulations / technical requirements be aware of how the it is marked be aware of how the it is marked feel more confident about video consulting and the practicalities making the tape feel more confident about video consulting and the practicalities making the tape know exactly what the various performance criteria mean know exactly what the various performance criteria mean be able judge consultations, and by doing so decide which to include, and the standards needed to pass be able judge consultations, and by doing so decide which to include, and the standards needed to pass

5. Key Point 1 You will soon come to see yourself in a better light.. A common first reaction to the sight of oneself on video is that you look professionally incompetent and personally unattractive – don’t worry about this.

6. What are the Royal College Trying to Test? To test ability to consult effectively To test ability to consult effectively NOT a test of: medical knowledge medical knowledge clinical examination skills clinical examination skills It is a criterion-referenced competency test It is a criterion-referenced competency test

7. Rules, Regulations & Technical Requirements IT’S ALL IN THE WORKBOOK! Need on the Tape: 7 consultations, not > 15 mins 7 consultations, not > 15 mins At least one with a child <10 years At least one with a child <10 years At least one with a significant social or psychological dimension At least one with a significant social or psychological dimension A range of presentations and patients A range of presentations and patients

8. Key Point 2 Use challenging consultations

9. The Five Units 1. Discover the reasons for a patient’s attendance 2. Define the clinical problem(s) 3. Explain the problem(s) to the patient 4. Address the patient’s problem(s) 5. Make effective use of the consultation

10. How It’s all Organised The five units Element AElement BElement C PC1 PC2 PC1 PC2 PC3 PC1 BEHAVIOUR OUTCOMES DOMAINS

11. Performance Criteria DOMAIN DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCE DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCEOUTCOME ELICIT AN ACCOUNT OF THE SYMPTOM(S) BEHAVIOUR (=PC) (P) PC1: the doctor is seen to encourage the patient's contribution at appropriate points in the consultation (M) PC2: the doctor is seen to respond to signals (cues) that lead to a deeper understanding of the problem

12. Key Point 3 Use the Performance Criteria to your advantage

13. How It Is Marked? Pass / pass with merit / fail. Each consultation marked by a single examiner - no ‘halo’ effect - report findings to a co-ordinating examiner Need each of the 10 of PC (P)s four times

14. Who fails? ‘One third’ of candidates fail ‘One third’ of candidates fail 1. Not consulting effectively 2. Not optimising choice of consultation Pitfalls: Major omissions - if had clear opportunity to demonstrate but didn’t. Major omissions - if had clear opportunity to demonstrate but didn’t. Missing cues e.g. sharing management options Missing cues e.g. sharing management options Not choosing the right patients - may know patient too well Not choosing the right patients - may know patient too well Those who make it hard for the examiners Those who make it hard for the examiners Poor sound or picture quality Poor sound or picture quality

15. Marking the Tape You have to demonstrate that you are at your best You have to demonstrate that you are at your best Get used to video in the room. Get used to video in the room. Change consulting room if necessary. Change consulting room if necessary. Lighting / Position / Sound Lighting / Position / Sound Physical examination / Consent Physical examination / Consent Have a “video week” Have a “video week” 15 minute booking intervals 15 minute booking intervals Read the notes first Read the notes first You will have to edit the tape You will have to edit the tape

16. Pitfalls Factors associated with candidate Stage fright/nerves. Stage fright/nerves. Factors associated with location Thin walls / outside traffic noise. Thin walls / outside traffic noise. Factors have some control over Computer / printer breakdown Computer / printer breakdown Flat batteries/run out of prescriptions. Flat batteries/run out of prescriptions. Make the room yours.... Make the room yours.... Interruptions Interruptions Make a copy Make a copy Send registered post Send registered post

17. Choosing 7 Consultations Count number of PC (P)s for each consultation - choose the ones with the most in. Count number of PC (P)s for each consultation - choose the ones with the most in. Get others to help you - beware confidentiality….. Get others to help you - beware confidentiality…..

18. Key Point 4 Get your trainer, mentor in video analysis or another GPR to review your consultations

19. The Workbook Functions: Allows you to provide a context for the examiner; patients, facilities, constraints. As an educational tool: Helps you to review the tape and consider whether you have provided an adequate demonstration of competence. Helps you to review the tape and consider whether you have provided an adequate demonstration of competence. Allows you to show your ability to evaluate your own performance through self- analysis. Allows you to show your ability to evaluate your own performance through self- analysis. It will take some time It will take some time FOLLOW THE INSTRUCTIONS FOLLOW THE INSTRUCTIONS

20. A Note on INFORMED Consent Patient understands: 1. Why the recording is being made 2. The purpose for which it is being used 3. Who will see it 4. How long it will remain in existence Seek before the video recording takes place, CONFIRM after the consultation Seek before the video recording takes place, CONFIRM after the consultation Use approved forms Use approved forms NO COERCION NO COERCION A note on 3-way consultations A note on 3-way consultations

21. Summary of Key Points 1. Don’t worry about how you look (professionally or aesthetically) 2. Submit challenging consultations 3. Use the performance criteria to your advantage 4. Get someone to review your tapes

22. Overall Summary You have control. You have control. It should be difficult to fail. It should be difficult to fail. They tell you what they want. They tell you what they want. Assess own consultations with care Assess own consultations with care Main difficulty is practical: Main difficulty is practical: - Doing it - Filling it all in Technical aspects important Technical aspects important Follow the instructions check and double check all requirements Follow the instructions check and double check all requirements Don’t spend too much time on it. Don’t spend too much time on it. Keep a copy of it all Keep a copy of it all

23. SIMULATED SURGERY Or should it be stimulated surgery?

24. Simulated Surgery Available for candidates having difficulties proucing video Available for candidates having difficulties proucing video 12 standardised patients, with max of 10 minute consultations (a ‘normal surgery’... 12 standardised patients, with max of 10 minute consultations (a ‘normal surgery’... Brief medical records Brief medical records Common and important presentations Common and important presentations Hotel room Hotel room Take own equipment and BNF Take own equipment and BNF Detail on RCGP website Detail on RCGP website

25. Marking Domains (usually) 1. Data gathering 2. Doctor-patient interaction 3. Communication 4. Formation of management plan with patient 5. Anticipatory care

26. How Is It Marked? Aggregate marks for each of the 12 consultations (120 separate judgements by 24 examiners) Aggregate marks for each of the 12 consultations (120 separate judgements by 24 examiners) Final score is mean of 12 case scores Final score is mean of 12 case scores Overall mark that contributes rather than the need to pass a certain number of consultations Overall mark that contributes rather than the need to pass a certain number of consultations Pass rate 67% average Pass rate 67% average

27. How to Fail Ignore patient centred behaviour Ignore patient centred behaviour Don’t ask how patient feels about their problem Don’t ask how patient feels about their problem Don’t share options Don’t share options Don’t think about implications for patient Don’t think about implications for patient Don’t arrange follow-up Don’t arrange follow-up Don’t think about opportunistic health promotion or advice Don’t think about opportunistic health promotion or advice Don’t anticipate future problems Don’t anticipate future problems

28. END