One to One



Assessment  Reading


 Aim of this session for facilitator/participants

·        To enthuse and hook participants into accepting the value of consulting effectively from both the patients’ and the professionals’ points of view

 Objectives for this session for the facilitator/participants

1.      To engage with the participants

2.      To flag up that:

·        There are problems between practitioners and patients in the medical interview, but that there are solutions at all levels

·        There is a body of evidence which supports the view that improving communication skills improves the outcome for both practitioners and patients

·        There are models/frameworks of teaching and learning which lead to improvements in practice which are effective

(have on an overhead)


Pre-course reading can help to orientate and inform, but keep it short and easily accessible; otherwise participants tend not to read the gems you send them!

 Hook the participants

Use a clip of a video or a story from your own practice if possible

 Setting the scene

Introductions need to be succinct and “sparky”

Keep the aims and objectives of the session/course short and clear

Summarise what you intend to cover in the next 25 minutes, eg:

What are the big communication issues in the medical interview?

bulletWhy is it important to teach and learn them
bulletAre there problems between practitioners and patients in the medical interview?
bulletAre there solutions which improve outcomes – both in terms of satisfaction/physical and psychological parameters?
bulletWhat should we teach and what is the evidence?
bulletHow should we teach this subject and what is the evidence?

(Have on an overhead)

 1.                  Why is it important?

 What is the importance of studying this subject, what are the potential gains?

 We will probably conduct about 200,000 consultations in a professional life-time

The prize on offer: improved clinical competence, not just patient centredness.

 Clinical competence = knowledge base, communication skills and problem-solving ability (the essence of good clinical practice)

Communication skills turn theory into practice: a core clinical skill, as important as the physical examination (have on an overhead)

The goals of effective communication: accuracy, efficiency, supportiveness - not just being nice, a much bigger prize on offer. (Have on overhead)

 2.                  Are there problems/solutions?

You could spend half an hour on this topic!

Have one or two bits of evidence which you know well up your sleeve and signpost that you will mention more research evidence at appropriate moments in the course. If time ask participants if they know any of the research.

The main message to get across is that there is an evidence-base to this subject.


3.                  What should we teach and learn?

 Importance of a basic but comprehensive framework for the medical interview

bulletIt helps to have a road map/box of tools with compartments, so that you know where you are where you are aiming for

 and then to work out:

bullethow you are going to get there

 Introduce the importance of having objectives when you are consulting

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Structure;       where am I, and what do I want to achieve

Skills:              how do I get there, what do I need to say

Behaviour:      how do I find a way that works for me and fits with my style; what precise phrase would work here


Models of the consultation

Quick brainstorm of any models that participants know (if time)

Then ask participants for a basic framework or landmarks/staging posts in time for any consultation

(If time you can get them to construct the whole model; but here is a short way to do it)

What points do we cover in any consultation; think of a simple consultation you have done recently eg sore throat or cystitis?

All consultations have a

·        Beginning

·        Middle 

·        End 

Show(or have on an overhead) page 1 of the C/C guides and add in the all important features of:

bulletExplanation and planning
bulletProviding structure
bulletBuilding the relationship

And how the latter two need to be overt throughout the interview


What are the main objectives for both you and the patients in any consultation?

 Flip chart quickly

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Show pages 2 of the guides, (or have on an overhead) and include the Disease/Illness model

Explain that there are many other excellent models of the consultation; this one aims to be comprehensive, and to include process as well as content. It includes other important models such Neighbour, and Pendleton, and importantly enables the clinician to work towards mutuality with the patient in the explanation and planning section. Models for change in behaviour graft well onto this section of the guide.

 Brainstorm the skills which will achieve these objectives


bulletWhat are the most useful/vital skills we need to use in the consultation?


bulletWhere do they fit?


Show pages 3,4,5 and 6 of the guides

 4.                  How should we teach? 

There is evidence that you need the following steps in the pathway to change behaviour:

    bulletA framework
    bulletObservation of actual practice
    bulletWell-intentioned and constructive feedback
    bulletOpportunity to practise/rehearse
    bulletFurther feedback

( have on an overhead)

 and the opportunity to practise again

 First, however in order to teach, we need to be able to analyse a consultation in depth and fit what happens into a framework and label the skills

 Second, we need to be able to help the learner to focus on what they would like to achieve and give specific feedback

 Third, we need to be able to focus on a method, which is learner-centred, outcome based, and where the facilitator can also introduce their agenda

 Agenda-led, outcome-based analysis is a method of teaching which encompasses all these teaching and learning objectives; ALOBA

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5.                  How you proceed next will depend on time and the plan for the whole teaching session!

 Some options:

Show a short video and get the participants to label the skills and start fitting them into the C/C framework 

Find out which methods of analysis participants are already familiar with; eg Pendleton.

Go through the principles of ALOBA briefly before looking at a consultation with a learner

Depending who your group are, eg trainers, registrars, specialists, multi-professionals,

move on to working out participants’ agendas

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