The
tutorial in general practice - key stepsInitiating the session
Establishing initial rapport
- Welcome, attend to setting, comfort, protected time
- Demonstrate interest and concern, respect and sensitivity
- Check out for any immediate problems, issues, personal or professional, which need addressing before the session starts eg hot topic/on call issue
Identifying and agreeing the learner's and the trainer's agenda
- Identify the topic agreed from last meeting
- Explore if this is the topic that both registrar and trainer wish to address on this occasion
- Screen for any other problems
- Is there anything else you would particularly like to cover
- Anything from the last session, problems arising from last session which you would like to share/have help with?
- Prioritise and agree the agenda, taking both the learner's and trainer's needs as well as time factors into consideration
Clarify the domain for the tutorial where appropriate ie that this is an educational session
The experiential work
Set the scene for the experiential work
- Registrar and trainer together negotiate where to start, which topic to begin on
Exploring the issue
- Using the skills for gathering information, explore and clarify both the issue/problem and the learner's perspective of it - the "disease" and the "illness", without interruption initially. Open ended questions, encouragement, picking up cues and acceptance are important skills to use in this section of the tutorial.
Acknowledge the learner's feelings
- how do you feel?
- how did that go?
These are useful direct questions to use to uncover the learner's perspective, particularly when the learner has unperceived needs. Use the empathic response to what comes out.
Refine the individual's agenda and desired outcome
- can we go back to your agenda again, has it changed, what would you like to sort out, what do you need to know/what skills do you need here
Allow time for this - it may lead naturally onto the learner's unperceived needs. Socratic questioning, prompting, challenging and interpreting are useful skills to use here.
Feedback, exploration of learner's suggestion for change, acquiring new skills/ knowledge
- Give constructive feedback on work done so far
- Identify the appropriate teaching method to help learner achieve desired outcome
- Identify the learner's suggestion for change/new cognitive approaches and discuss
- Assess learner's starting point before you respond to enquiries, give opinion, provide facts.
Check knowledge, share information, working at the learner's level and pace, checking as you proceed ie. this should be a two way interaction. Again, Socratic questioning used appropriately will help to expand learning
Introduce trainer's agenda/teaching points/generalising away
- Add in trainer's ideas and thoughts and suggestions, and learner's unperceived needs
- Appropriately introduce theory, research and wider discussion
Check learner's agenda has been covered
- Reflect on the process and outcome(s) from the exploration of the issue under discussion
- Clarify with learner that his agenda has been covered
Identify further needs, plan future learning/exploration
- Work out together next learning steps
Continue the process with the next issue
Closing the session
- Summarise and record what learned
- Clarify and record future learning plans/tasks, what to look up, what skills to practise
- Check for acceptance and rapport Share learner and trainer evaluation of the session
The tutorial in general practice - overall plan
Copyright SM Kurtz, JD Silverman. J Draper Teaching and Learning Communication Skills in Medicine 2nd edition