Transcript Summative Assessment

Consultation Analysis
VTS 22/9/04
Consultation Models
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Stott & Davis
Pendleton et al
Roger Neighbour
Cambridge-Calgary
Stott & Davis - The unique potential
of each primary care consultation
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Dealing with the acute problem
Dealing with chronic problems
Opportunistic health promotion
Modification of help-seeking behaviour
Stott & Davis, BJGP, 1979
Pendleton et al – 7 tasks of
the consultation
Why did the patient attend?
Consider other problems
Choose appropriate action(s)
Share understanding
Involve patient – management and
responsibility
 Effective use of time & resources
 Establish/ maintain relationship with patient
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Roger Neighbour - The Inner
Consultation
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Connecting
Summarizing
Handing Over
Safety-netting
House-keeping
Cambridge-Calgary 1
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Initiating the session
Gathering information
Explanation and planning
Closing the session
Cambridge-Calgary 2
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Start with the learner’s agenda
Look at the outcomes learner and patient are trying to achieve
Encourage self-assessment and self-problem solving first
Involve the whole group in problem solving
Use descriptive feedback to encourage a non-judgmental approach
Provide balanced feedback
Make offers and suggestions; generate alternatives
Rehearse suggestions
Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning
Communication Skills in Medicine. Radcliffe Medical Press ( Oxford)
Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating
with Patients. Radcliffe Medical Press (Oxford)
Summative Assessment
Passing the video……..
What they look for…..
 A doctor who is competent to practise
independently as an unsupervised GP
 Evidence of skills which show patientcentred behaviour
 Further insights in the log diary
Four key areas:
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Knowledge
Problem-solving ability
Clinical and communication skills
Attitudes
Knowledge
 Does the doctor have enough knowledge
to manage the consultation as a whole?
 Think about history, diagnosis,
management, language, explanations,
patterns of the consultation
Problem solving ability
 Are you making reasonable working
conclusions and diagnoses?
 Do you manage the patient’s problems
appropriately?
 Do you investigate and refer
appropriately?
Clinical & communication skills
 Do you discover why the patient has
attended?
 Do you take an adequate clinical history?
 Do you examine appropriately?
 Do you explain and negotiate a credible
and acceptable management plan?
Attitudes
 The skills the examiners look at are:
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Listening
Rapport
Empathy, verbal and non-verbal
Picking up cues
Showing interest, care, concern and respect
Humility
MRCGP Video
 Think about Single route video
– low risk, most pass SA even if
fail MRCGP module
 Possibly easier to prepare for
as uses clear Performance Criteria
Competencies (units)
 Discover the reason for the patient’s
attendance
 Define the clinical problem
 Explain the problem(s) to the patient
 Address the patient’s problem(s)
 Make effective use of the consultation
Performance Criteria
 These were developed from the skills
needed to fulfil the competencies
 There are 10 performance criteria for a
pass plus 4 more for merit
 Each performance criterion must be
present at least four times over seven
consultations to pass
 Selection is the key
Performance Criteria 2
 1: Encourages patient’s contribution
 2: Responds to signals (merit)
 3: Appropriate use of psychological and
social information
 4: Explores patient’s health understanding
 5: Obtains sufficient information to include
or exclude significant conditions
Performance Criteria 3
 6: Physical /mental examination to confirm or
disprove hypotheses
 7: Makes clinically appropriate working
diagnosis
 8: Explains in appropriate language
 9: Incorporates patient’s health beliefs
 10: Confirms patient’s understanding of
diagnosis
 11: Appropriate management plan
Performance Criteria 4
 12: Patient involved in management
decisions
 13: Prescribing concordance enhanced by
exploring and responding to patient’s
understanding
 14: Specified conditions and intervals for
follow-up
Choosing consultations
 For SA – you need at least 8, in a video lasting
2 hours
 For MRCGP – you need 7 (the first 7). The
examiners will stop watching consultations after
15 minutes
 Include at least one where the patient is under
10 years
 Include at least one with a significant
psychological or social dimension
Other tips
 Read the examination regulations
carefully
 Test the technology - the better the
quality, the easier it will be for the
examiner to mark
 Use the log to add insight and reflection,
not duplicate what is on the video