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The consulting skills assessment
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Technicalities
Tape content:
Use full size VHS tape, recorded at normal speed and in normal format (not
super VHS). Use super high quality or professional varieties so as to optimise
picture and sound quality which can deteriorate on re-recording.
Sound quality will probably be fine using the camera's own microphone
provided that the room is reasonably sound-proofed. If there is a lot of
extraneous noise then a desk top microphone might be necessary.
Performance criteria
(P= essential for a pass, M= must be demonstrated for pass with merit).
- The doctor encourages the patient's contribution at appropriate points in
the consultation.
- The doctor responds to cues.
- The doctor elicits appropriate details to place the complaint(s) in a
social and psychological context.
- The doctor takes the patient's health understanding into account. (M)
- The doctor obtains sufficient information for no serious condition to be
missed.
- The doctor chooses an examination which is likely to confirm or disprove
hypotheses which could reasonably have been formed OR to address a patient's
concern.
- The doctor appears to make a clinically appropriate working diagnosis
- The doctor explains the diagnosis, management and effects of treatment.
- The doctor explains in language appropriate to the patient.
- The doctor's explanation takes account of some or all of the patient's
elicited beliefs. (M)
- The doctor seeks to confirm the patient's understanding. (M)
- The doctor's management plan is appropriate for the working diagnosis,
reflecting a good understanding of modern accepted medical practice.
- The doctor shares management options with the patient.
- The doctor's prescribing behaviour is appropriate.
- The patient and doctor appear to have established a rapport.
Optimising your registrar's consulting skills
Practice use of PC list, review with trainer / mentor / group, reading Record
registrar's consultations every couple of weeks and review these with you, a
partner or with peers or simply registrar alone.
Appraise performance against the PC list above and against the many other
consultation review and assessment packages around (e.g. Cambridge-Calgary,
Pendleton, Neighbour). In this way you will build on skills. The MRCGP
performance criteria should be the rule by which performance is judged in the
main.
Have a copy of the list to hand for reference in registrar's consulting room.
Reading
- Review the various consultation models: Pendleton et al Neighbour Stott
and Davies Cambridge-Calgary approach Helman Transactional analysis
Disease-illness model (McWhinney) etc!
- The Consultation: an approach to Learning and Teaching. Pendleton,
Schofield, Tate, Havelock. Oxford University Press; 1994.
- The Inner Consultation. Neighbour. Lancaster: MTP; 1987.
- The Doctor's Communication Handbook (2nd Edition). Tate. Oxford: Radcliffe
Press; 1997.
- Teaching and Learning communication Skills in Medicine. Kurtz, Silverman,
Draper. Oxford: Radcliffe Press; 1997.
- Skills for Communicating with Patients. Silverman, Kurtz, Draper. Oxford:
Radcliffe Press; 1997.
Recording lighting, sound, positioning, video surgeries, consent.
- Sound and picture quality must be adequate or it will be rejected.
- Avoid back-lighting of subjects as this will produce a silhouette effect
obscuring detail of the you and the patient.
- Intimate examinations -plan a procedure for avoiding filming. If this
involves fitting a lens cap temporarily, make sure you remove it when the
examination is complete. Best method is to perform such examinations behind
a screen. The sound recording needs to continue throughout.
- Try to get a good view of both patient and yourself.
- Don't stop the tape between patients unless there is a long delay.
- Use only the RCGP (or the approved Summative Assessment) consent forms.
- Careful briefing of the receptionist in preparation for distribution of
forms to patients helps.
- Consider booking whole surgeries for recording, and to let patients know
this at the time of booking.
- The consent forms must be submitted with the tape and workbook.
Editing tapes, work book preparation, selection of consultations
Registrar must review the consultations and decide suitability - ones which
you're pleased with and show you consulting skilfully and demonstrate as many
competencies as possible. Submit 7 consultations, each must be 15 minutes or
less in length.
- The selected consultations should show as many of the PCs as possible
- New rather than return consultations more likely to demonstrate a good
range of competencies.
- Very short consultations are unlikely to demonstrate many PCs to the level
expected.
- Look at the consultations and decide which PCs are demonstrated.
- Help registrar in this, however she must make own selection. Simple,
"safe" consultations are also less likely to demonstrate
competencies.
- Connections from camcorder to TV and second VCR allow simultaneous viewing
and copying of consultations.
- Thus make final tape of consultations for submission, leaving out unwanted
consultations from the original recording.
- Competence must be demonstrated in all of the "pass" PCs. Each
PC must be demonstrated in four separate consultations of the seven
submitted.
Complete a summary form for each consultation for inclusion in the work book.
This is best done while you are easily able to remember the consultation detail.
Thus fill in duplicate consultation summary forms and keep them to help you in
editing and making your decisions about your selections for the final tape.
Keep a copy of your final tape.
The workbook also requires registrar to keep a log of consultations.
Best to note the elapsed time from the beginning of the tape to the start of
each consultation. The actual time and date on your recording is acceptable, but
the video counter number is not since counting rates vary between machines.
Consultation summary forms give opportunity to help the examiners understand
the background, and outcomes that are not self-evident on viewing the tape.
Registrar should ensure she includes consultations that demonstrate
competence over the full range of PCs.
Problem performance criteria are:
- sharing management options
- picking up patient cues
- placing the complaint in a social and psychological context
Consulting skills critique proforma
Derek Blades:
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