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Some of the common problem patterns which occur in consultations are as follows
- the learner does not discover all the issues or problems the patient wishes to discuss
- the learner does not listen, often not asking open-ended questions initially or interrupting with closed questions
- the learner does not elicit the patient’s ideas, concerns, expectations and feelings; or establish a collaborative relationship, and instead takes a doctor-centred position throughout the interview
- the learner develops little rapport or is not responsive to the patient
- the learner misses important cues from the patient
- the learner obtains an inaccurate or incomplete clinical history because of failure to get the balance right between open and closed questions, summarising, checking, or sharing his thinking process
- the learner forgets to find out what the patient already knows before giving an explanation
- the learner gives too much information at once and uses jargon
- the learner does not negotiate with the patient and check that the patient is agreeable to the plan
- the learner makes inadequate follow up arrangements or none at all
A useful set of questions to ask yourself as the facilitator as you are watching any consultation are:
- can you recognise any patterns here?
- have you seen this problem before?
- how might the learner who performed the consultation be feeling?
- how might the “patient” be feeling?
- what does the group already know?
- how could you “generalise away”?
- when would the best time be to do it?
- what area or what research and theory would be relevant to teach on?
- do you have the knowledge? do any of the learners have the knowledge?
- is the overall balance of experiential work with didactic material from the literature right for the group?
- ‘have you got an aide-memoire/handout for the group?