AGENDA-LED OUTCOME-BASED ANALYSIS: Group work format working with a simulated patient

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

 Set the scene for the experiential work

·        Establish initial rapport via

o       Welcome, introductions

o       Explore and discuss how this session fits in with learners’ overall learning

o       Outline the timing of  the session, explain the aims and methods of the session

o       Demonstrate interest and concern

·        Provide exercises re the topic for today: learners’ issues, patients’ issues, introduction of frameworks

·        Explain that this is a chance to practice important areas before doing so in real life.  It is not a judgmental exercise but an opportunity to practice and rehearse in safety, and as many times as they need, some of the skills that might be helpful in a situation with which they will almost certainly be faced in the future

·        Describe the specific scenario in enough detail to orientate the group (setting, information already known, medical records etc.)

·        Specifically explain who the learners are and what their role is in the scenario

e.g. The learner is him or herself, going onto the wards for the first time to clerk a patient. Its the afternoon and the resident has suggested you talk to a patient who has just been admitted, Joan Henderson. He says that the patient has been admitted with a chest infection. This morning, we shall just concentrate on beginning the interview and discovering from the patient what has been going on to bring them into hospital.

·        Ask the group to discuss the general issues that the scenario provides first, before the first learner doing the interview sets their own objectives as below

Identifying the learner’s initial agenda

·        Encourage one of the learner’s to start the process – each person in turn will give us the raw material to work on when they perform the interview, a gift for the group:

<       What would be the particular issues or difficulties for you here that you would like to work on (try to get the learner to be as specific as possible)

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

<       What are your personal objectives for the interview – put on flip chart/board

<       How can the group help you best

<       What would you like feedback on, anything in particular you want us to watch for


Prepare the whole group to watch the interview

·        Set up room and equipment, make sure all ready and roles worked out

·        Ask if anything else the interviewer would like to know about the scenario to make it real, to work?

·        Emphasize to the interviewer that it is OK to stop and start and break for help whenever they would like. Negotiate the chunk of interview that learner will undertake. State when the facilitator should stop the interview if the learner doesn’t e.g. at a specific point in the interview.

·        Instruct the group to write down specific words and actions as an aid to descriptive feedback; jot down exact times or counter numbers

·        One of the group can be set the task to record the content of the interview rather than the process


Watch the interview

·        After watching the interview, allow the group 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

·        Facilitator: consider where to place feedback on what worked well

Acknowledge the learner’s feelings

<       How do you feel?  How did that go?

Refine the individual’s agenda and identify the desired overall outcome(s)

<       Can we go back to your agenda on the flipchart before the role-play? Has it changed? Did new areas of difficulty crop up? Can we identify the problems?

<       What would you like to have achieved differently? Given the problems we have identified, what different outcomes would you like to explore?

·        Facilitator to listen, clarify, summarize, check

·        Facilitator to consider whether to add in his own or the group’s agenda here

Feedback and re-rehearsal (whole group)

·        Negotiate with the learner the best way to look at the interview - choose which area to focus on or part of tape to replay first

·        Start with the learner: options here include

<       Have you already got some thoughts about how you might approach this differently now that you are clear about the outcome you’d like to get to?

<       You obviously have a clear idea of what you would like to try……..

<       You’ve defined the problem and made a suggestion……...would you like to have another go?

<       Tell me what went well, specifically in relation to the objectives that you defined? 

<       What went less well in relation to your specific objectives? 

·      Be explicit about the outcome for specific areas under discussion:

<       What are you and the patient trying to achieve, what were you getting at with that question

·      Then get descriptive feedback from the group

·      When participants make suggestions, ask prime learner if they would like to try this out or if they would like the other group member to have a go.

·      Invite the patient to add their insights and further rehearsal: ask actor in role questions that the group has honed down to specifics

·      Elicit thoughts and feelings of learner and patient, including the outcomes they wanted to achieve at various points in the interview

·      Remember to:

o       practise and re-rehearse new techniques after suggestions from the group

o       make sure to balance positive and negative feedback

o       utilise actor feedback

o       demonstrate the skills yourself when appropriate

o       use the Calgary-Cambridge guide

Skills spotting, tape review

·      Look at the micro-skills of communication and the exact words used

·      Use the tape to demonstrate specific phrasing/behaviours


Introduce facilitator’s agenda/teaching points: generalising away

·      Add in facilitator’s ideas and thoughts

·      Appropriately introduce theory, research and wider discussion

Closing the session

·      Clarify with learner that his agenda has been covered

·      Be very careful to balance what worked well and what didn’t work so well by the end

·      Rounds of what learnt: ask what everyone has learned (one thing to take away), whether the feedback was useful and felt acceptable

·      Summary from facilitator: pull together and reflect on the “what”: the structure and skills of  the Calgary-Cambridge Guide

·      Handouts