AGENDA-LED OUTCOME-BASED ANALYSIS: Group work format with pre-recorded videotape of a real patient and with no 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       Demonstrate interest and concern

·      Thank the group for bringing their tapes. The interviews provide a gift of raw material around which we can explore communication problems and issues together. We shall try not only to help the specific doctor on the tape with their agenda but also to generalise away from the tape to look at specific areas of communication to the benefit of us all.

·      Group and facilitator together negotiate which consultation to look at first. The most nervous may wish to go first or pick one at random.

Option to identify the individual’s agenda

·      In this situation, it can be helpful to watch the video without prior knowledge of the learners’ agenda and appreciate the interview without pre-conceptions. 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 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 make sure the equipment is working

·        Here it is important that we know exactly what the learner knew and was feeling when the patient entered the room (and no more). Ask the learner showing the tape to set the scene, describe his prior knowledge of the patient and list the extenuating circumstances.

·        As there is no simulated patient, elect one of the group to look at the consultation from the patient’s point of view and be prepared to act as the patient for rehearsal

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

Watch the interview

·        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 e.g. at points at which the tape was inaudible

·        Facilitator to 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 desired outcome

Either (if the agenda has already identified)

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

·        Or do initial agenda setting here

<       What areas would you like to focus on, tell us your agenda (try to get the learner to be as specific as possible)

<       What help would you like from the group

<       Write up or summarise agenda items

<       What outcome for yourself and the patient would you like to achieve

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

·        Facilitator to listen, clarify, summarize, check

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

·        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

Feedback and re-rehearsal (whole group)

·        Start with the learner: options 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? 

·      Then get descriptive feedback from the group

·      Practise and re-rehearse new techniques after suggestions with one of the group role-playing the patient

·      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.

·      Ask the learner playing the patient for insights

·      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       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