One to One



Assessment  Reading


One to one teaching in general practice 

The focus here is on video teaching, but this plan could be adapted for any consultation observed by the trainer

Initiating the session:                                                          

Establishing initial rapport


       Explore and discuss how this session might fit in with the registrarís overall learning

       Outline a temporal plan for the session, explain the aims and signpost methods of the session

Really helpful to have the plan of the session on a paper so that the learner can keep a structure in their heads and what happens when

         Demonstrate interest and concern 

Identifying the learnerís ongoing agenda

 Learner-centred exercise

        Is there anything you would particularly like to cover/look at/rehearse today?

        Anything from the last session, problems arising from last session which you would like help with?

+-Patient-centred exercise

       Any particular problems that your patients might be experiencing in relation to your consulting at the moment 

Introduce/revise the framework/structure/objectives and skills of the Calgary-Cambridge guide

        Is there anything here you would like to focus on today?

        Introduce trainerís agenda if appropriate 

The experiential work                                             


Set the scene for the experiential work

         Registrar and trainer together negotiate which consultation to look at depending on whether the learner has watched the tape

     (if not look at a random consultation) 

Option to identifying the individualís agenda

Ask the learner if they would like to tell you about the problem for them on the tape now, or whether they would rather discuss their agenda after watching the tape. 

If they do want to talk about the consultation first; the following questions may be helpful

         What would be the particular issues or difficulties for you here that you would like to work on? (try to get the learner to hone them down)

         What would you like to practice and refine and get feedback on

         What are your personal objectives for this session Ė put on flip chart/paper

         How can I help you best

         What would you like feedback on

Watching the tape or consultation

         Set up room, and make sure the equipment is working

         Suggest, if appropriate, that one of you might look at the consultation from the patientís point of view

         Both you and the learner write down specific words and actions as an aid to descriptive feedback; if using video, jot down exact times or counter numbers

         After watching the interview, allow the learner several moments 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 between what worked and what was problematical

         Check/clarify any matters of fact; eg. points at which the tape was inaudible

         Trainer to consider where to place feedback on what worked well 

Acknowledge the learnerís feelings

         how do you feel? 

         how did that go? 

Refine the individualís agenda and desired outcome

         can we go back to your agenda on the flipchart before the role-play? has it changed?

         how do you feel in general about the role-play in relation to your desired outcome?

         Facilitator to listen, clarify, summarize, check

Allow time for this Ė it may lead naturally onto the learnerís agenda 

Feedback and re-rehearsal

         Start with the learner: options

o        tell me what went well, specifically in relation to the objectives that you defined? 

o        what went less well in relation to your specific objectives? 

o        or "you obviously have a clear idea of what you would like to try." 

o        would you like to have another go?

o        what do you want feedback on? 

       Trainer give descriptive feedback

       If the learner  makes a suggestions, ask them if they would like to try this out or if

o        practise and re-rehearse new techniques after your suggestions

you can try out mini roleplays or just specific phrases here

o        make sure to balance positive and negative feedback

o        try reverse role play

o        offer suggestions yourself/demonstrate the skills yourself when appropriate 

Tape review, skills spotting, generalising away

       use the tape to demonstrate specific phrasing/behaviours

       look at the micro-skills of communication and the exact words used 

Introduce trainerís agenda/teaching points

       Add in trainerís ideas and thoughts

       Appropriately introduce theory, research and wider discussion 

Check learnerís agenda has been covered

       Clarify with learner that his agenda has been covered

       Be very careful to balance what worked well and what didnít work so well by the end

Continue the process with the next consultation 


          Rounds of what learnt
         Summary from trainer, relate to structures/guides
bulletWhat to practice for the next week

Copyright  SM Kurtz, JD Silverman. J Draper Teaching and Learning Communication Skills in Medicine 2nd edition In  press



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