Tips on joint consulting

The reasons for joint consulting

  • Allows hot discussion of hot issues, particularly relating to consultation skills and attitudes
  • An alternative tool to video, for activists particularly!
  • Allows the GPR to become comfortable with having another person in the room, watching. They will then feel more used to this when they come to the CSA exam.
  • Enables the trainer to very rapidly appraise the GPRs knowledge, behavioural, motor and consulting skills, and attitudes.
  • Allows the GPR to see the trainer in action, realise that nobody can consult perfectly, and develop and practice critical appraisal skills and giving feedback.
  • The trainer learns loads! And the more you do it, the more comfortable it gets.

Setting it up

  • Plan the surgeries in advance.
  • Discuss the issues with the reception staff and the GPR so that everyone is clear what the process entails.
  • Plan the learning objectives with the GPR. Together, you may choose to focus on one particular issue eg agenda setting for the whole session.

The problems

Possible solutions

“We just see all my chronic patients” Book the surgery under the GPRs name, not the trainers.
Leave the surgery unbooked until the day, to see patients with perceived acute problems.
“Patients don’t follow the rules” Tell the patients what the rules are. Inform the patients when making the appointment that this is a joint surgery, that they may be consulting with either the GP or the GPR, and  that the other doctor is in the room to observe the doctor during the consultation. A leaflet on the reception desk or on the waiting room seats is helpful, such as:

Today, Dr x and Dr y are consulting in a joint surgery. This means that you will consult with one of these doctors, while the other doctor observes thedoctor’s behaviour during the consultation. The second doctor will play no part in the consultation, normally.

You are, of course at liberty to ask the other doctor to leave if you wish. If you wish to see a particular doctor, you may prefer to book a routine appointment with that doctor

Thank you for helping with this valuable training experience for our doctors in training.

“There isn’t time to discuss things” Book each patient for an appropriate length of time: eg for a new GPR, 15 mins of consultation time may be needed, whereas 10 mins may be more appropriate for a GPR at the end of training. In addition, add an extra 10 mins for discussion. If the consultation regularly runs into discussion time, there is an opportunity to discuss time management. The discussion should be limited to issues that are worth discussing “hot”, such as consultation skills and attitudes. Knowledge issues can be flagged away to another time and becomes a learning task for the GPR.
“I get exhausted” Build some housekeeping time into the middle of the surgery. Don’t make the surgery too long – 6 patients is probably ample.
“Patients always speak to me rather than the GPR” If you are observing, position your chair out of the line of direct vision of the GPR and the patient.
Keep still and quiet during the consultation, avoid eye contact with the patient apart from a brief recognition at the beginning of the consultation. There is little need to look closely or stare, you can hear and (more importantly) feel what is going on in the consultation – those emotions mean something, and are worth discussing.
Make notes about what the other doctor is saying, what works, what doesn’t work, how you feel.
“The GPRs don’t follow the rules” Make the rules explicit, and follow them yourself. Ensure that the GPR understands that you are there purely as an observer, and that you will not interrupt or answer questions. In practice, you may occasionally have to rescue the GPR, but this is rare. It is very unlikely that the trainer will have to intervene because of patient safety.
If the GPR asks you a question during the consultation, flag it away  and deal with it later.
“The trainer doesn’t follow the rules” It is easy to fall into the trap of didactic teaching and recounting your favourite patient incidents.
Clarify the learning objectives with the GPR at the start of the session, summarise the main ponts covered and the issues which need further development at the end.
Remember the basic rules offeedback, 10;1, the feedback sandwich. i.
Remember that the GPR will be anxious, and their previous experiences of being watched while consulting may not have been positive.

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