Agenda-Led Outcome-Based Analysis (ALOBA)

Principles of agenda-led outcome-based analysis

Start with the doctor’s agenda Ask what problems the doctor experienced and what help he would like from the rest of the group.
Always look at the outcome you are trying to achieve Thinking about where you are aiming and how you might get there encourages problem-solving -effectiveness in communication is always dependent on what you are trying to achieve.
Encourage self-assessment and self problem-solving first Always allow the doctor space to make suggestions before the group shares its ideas.
Involve the whole group in problem-solving The group should work together to generate solutions not only to help the doctor but also to help themselves in similar situations.
Use descriptive feedback to encourage a non-judgmental approach Descriptive feedback ensures that non-judgmental and specific comments are made and prevents vague generalisation.
Provide balanced feedback Each group member should ensure that they provide a balance in the feedback of what worked well and what didn’t work so well: this supports the learner and maximises learning -we learn as much by analysing why something works as why it doesn’t.
Make offers and suggestions, provide alternatives Make suggestions rather than prescriptive comments and reflect them back to the doctor for consideration.
Rehearse suggestions Rehearse and practise suggestions by role play -when learning any skill, observation, feedback and rehearsal are required to effect change
Be well-intentioned, valuing and supportive It is the group’s responsibility to be respectful and sensitive to each other.
Value the tape as a gift of raw material for the group The tape provides the raw material around which the whole group can explore communication issues: group members can learn as much as the doctor on the tape and should be prepared to make and rehearse suggestions -the doctor should not be the constant centre of attention.
Opportunistically introduce teaching exercises and research evidence The facilitators should opportunistically offer to introduce teaching exercises and research evidence to help to draw out principles of communication and to illuminate learning for the group as a whole.
Structure and summarise learning so that a constructive endpoint is reached The facilitators should summarise the session to ensure that learners piece together the individual skills that have arisen into an overall conceptual framework.

Agenda-led outcome-based analysis in practice

Prior to showing the tape

  • Ask the doctor showing the tape to set the scene, describing prior knowledge of the patient and listing the extenuating circumstances! We should know exactly what the doctor knew and was feeling when the patient entered the room and no more.
  • Instruct the group on noting down very specific words and actions plus their times as an aid to descriptive feedback.
  • Ask one member of the group to watch as if the patient and be prepared to role-play the patient afterwards to enable rehearsal

After showing the tape

  • Allow the group several minutes to collect their thoughts and identify the one or two most important points they would like to bring up in feedback, making sure to provide a balance.
  • Facilitator to consider where to place feedback on what worked well.
  • Acknowledge any feelings of the doctor showing the tape if necessary

Start with the doctor on the tape

  • What areas do you want to highlight as being problems for you? Tell us your agenda: has it changed on review? – write up agenda items.
  • What help would you like from the rest of the group?
  • What outcome would you like to achieve?
  • Facilitator to consider whether to add in own or group’s agenda here.
  • Negotiate with the doctor the best way of looking at the tape -choose which area to replay.
  • Get the doctor to start off looking at own agenda by showing again the relevant part of the tape and asking to use descriptive feedback to say what worked well and what didn’t work so well.
  • Elicit thoughts and feelings of doctor and possibly patient if appropriate.
  • Rehearse with one of the group role-playing the patient.
  • Encourage offers and suggestions from the rest of the group and further rehearsal

To the group as a whole

  • Summarise where we have got to back to the group and ask for their help’ prompt with SET-GO feedback.
  • Rehearse all suggestions through role-playing.
  • Add in facilitator’s ideas and thoughts.
  • Appropriately introduce generalising away into teaching areas and exercises.
  • Clarify with the doctor on tape that own agenda has been covered.
  • Ask the group for any agenda of their own that we have not covered already.
  • Be very careful to balance what worked well and what didn’t work so well by the end.

Ending

  • Ask what everyone has learned (one thing to take away) and whether the feedback was useful and felt acceptable.
  • Pull together and reflect on the ‘”what”: the structure and skills related to the Guides.

Descriptive feedback

  • Non-judgmental
  • Specific
  • Directed towards behaviour rather than personally
  • Checked with the recipient
  • Outcome-based
  • Problem-solving In the form of suggestions rather than prescriptive comments

The SET-GO method

Group members to base feedback on…

  1. What I Saw
    Descriptive, specific, non-judgemental. Facilitator to prompt if necessary with either or both of…
  2. What Else did you see?
    What happened next in descriptive terms?
  3. What do you Think, John?
    Reflecting back to the doctor on the video, who is then given the opportunity to acknowledge and problem solve.

The facilitator to then get the whole group to problem solve

  1. Can we clarify what Goal we would like to achieve?
    An outcome-based approach
  2. Any Offers of how we should get there?
    Suggestions and alternatives to be rehearsed if possible.

Source: Silverman, Draper and Kurtz: Education for General Practice vol 7 no 4 and vol 8 no 1.

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