The use of a
trigger tape in teaching the consultation
Trigger tapes can be used in group work as well as one-to-one teaching. they are a useful resource in the following circumstances:
∑ when learners have not brought a tape of their own consultation to the teaching session, and you need some experiential material to work on
∑ when learners are nervous of showing their own practice or being observed, say in roleplay
∑ when you want to work on a particular issue and the trigger tape demonstrates the issue well
∑ for a patient or doctor centred exercise
Trigger tapes might be:
∑ the teachers tape
∑ anybodyís tape which is known to demonstrate a section of the consultation or a skill
∑ a prepared tape eg RSM tapes with pre and post interview
∑ a tape with an actor
∑ one you have made yourself on a non-medical topic
∑ one that demonstrates a good/bad consultation
The teaching method used with a trigger tape could be
∑ watched without the sound turned up for body language
∑ Linda Gaskís method; problem-orientated analysis for demonstrating eg cues, or emotional content; facilitator/group members can stop the tape whenever they see an emotional cue
∑ the same technique can be used to demonstrate the strutcure as well as skills in the consultation; itís a good way to start new learners off with identifying and labelling skills
If ALOBA is used and the doctor is not in the room some safeguards need to be used in order to protect the doctor.
Possible exercise to use before showing the tape:
Ask the learner teachers to
think about the differences between the use of a trigger tape and a videotape in
which the doctor on the tape is offering his tape ďas a gift for the groupĒ
∑ the doctor on the tape canít defend himself
∑ the context of the consultation canít be clarified
Options for group work:
1. Role up one doctor as the patient, and one as the doctor; check with the doctor that this is a learning exercise/issue that he/she would like to work on. then proceed as for ALOBA but check that the learner is empathetic with the doctor and can make links with how that doctor actually behaved on the tape so that the learner can use the tape to work on his learning issues too.
2. Role the whole group up as the doctor (apart from one member who takes the patientís role for rehearsal later), and then take it in turns for each member of the group to work on one agenda item. Ask the doctors to really sink themselves into the role of the doctor on the tape and feedback and discuss as if they were that doctor. This will encourage empathy. ďDonít be critical - think of yourself in this situationĒ.
3. Role the whole group up as the doctor and brainstorm what each groupís agenda might be, then proceed with ALOBA
Watch the feedback about the doctor; it may be critical. Link it with how doctors might behave if there was no structure for the feedback
If using this teaching method in CME;
∑ doctors will go for content and clinical mistakes.
∑ the group may more passive
∑ roleplay may be more difficult
∑ donít use this method as the first way into video work
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