1 / 22

Consultation Analysis

Consultation Analysis. VTS 22/9/04. Consultation Models. Stott & Davis Pendleton et al Roger Neighbour Cambridge-Calgary. Stott & Davis - The unique potential of each primary care consultation . Dealing with the acute problem Dealing with chronic problems

paniz
Télécharger la présentation

Consultation Analysis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Consultation Analysis VTS 22/9/04

  2. Consultation Models Stott & Davis Pendleton et al Roger Neighbour Cambridge-Calgary

  3. Stott & Davis - The unique potential of each primary care consultation • Dealing with the acute problem • Dealing with chronic problems • Opportunistic health promotion • Modification of help-seeking behaviour Stott & Davis, BJGP, 1979

  4. Pendleton et al – 7 tasks of the consultation • Why did the patient attend? • Consider other problems • Choose appropriate action(s) • Share understanding • Involve patient – management and responsibility • Effective use of time & resources • Establish/ maintain relationship with patient

  5. Roger Neighbour - The Inner Consultation • Connecting • Summarizing • Handing Over • Safety-netting • House-keeping

  6. Cambridge-Calgary 1 • Initiating the session • Gathering information • Explanation and planning • Closing the session

  7. Cambridge-Calgary 2 • Start with the learner’s agenda • Look at the outcomes learner and patient are trying to achieve • Encourage self-assessment and self-problem solving first • Involve the whole group in problem solving • Use descriptive feedback to encourage a non-judgmental approach • Provide balanced feedback • Make offers and suggestions; generate alternatives • Rehearse suggestions Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine.  Radcliffe Medical Press ( Oxford) Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients.  Radcliffe Medical Press (Oxford)

  8. Summative Assessment Passing the video……..

  9. What they look for….. • A doctor who is competent to practise independently as an unsupervised GP • Evidence of skills which show patient- centred behaviour • Further insights in the log diary

  10. Four key areas: • Knowledge • Problem-solving ability • Clinical and communication skills • Attitudes

  11. Knowledge • Does the doctor have enough knowledge to manage the consultation as a whole? • Think about history, diagnosis, management, language, explanations, patterns of the consultation

  12. Problem solving ability • Are you making reasonable working conclusions and diagnoses? • Do you manage the patient’s problems appropriately? • Do you investigate and refer appropriately?

  13. Clinical & communication skills • Do you discover why the patient has attended? • Do you take an adequate clinical history? • Do you examine appropriately? • Do you explain and negotiate a credible and acceptable management plan?

  14. Attitudes • The skills the examiners look at are: • Listening • Rapport • Empathy, verbal and non-verbal • Picking up cues • Showing interest, care, concern and respect • Humility

  15. MRCGP Video Think about Single route video – low risk, most pass SA even if fail MRCGP module Possibly easier to prepare for as uses clear Performance Criteria

  16. Competencies (units) • Discover the reason for the patient’s attendance • Define the clinical problem • Explain the problem(s) to the patient • Address the patient’s problem(s) • Make effective use of the consultation

  17. Performance Criteria • These were developed from the skills needed to fulfil the competencies • There are 10 performance criteria for a pass plus 4 more for merit • Each performance criterion must be present at least four times over seven consultations to pass • Selection is the key

  18. Performance Criteria 2 • 1: Encourages patient’s contribution • 2: Responds to signals (merit) • 3: Appropriate use of psychological and social information • 4: Explores patient’s health understanding • 5: Obtains sufficient information to include or exclude significant conditions

  19. Performance Criteria 3 • 6: Physical /mental examination to confirm or disprove hypotheses • 7: Makes clinically appropriate working diagnosis • 8: Explains in appropriate language • 9: Incorporates patient’s health beliefs • 10: Confirms patient’s understanding of diagnosis • 11: Appropriate management plan

  20. Performance Criteria 4 • 12: Patient involved in management decisions • 13: Prescribing concordance enhanced by exploring and responding to patient’s understanding • 14: Specified conditions and intervals for follow-up

  21. Choosing consultations • For SA – you need at least 8, in a video lasting 2 hours • For MRCGP – you need 7 (the first 7). The examiners will stop watching consultations after 15 minutes • Include at least one where the patient is under 10 years • Include at least one with a significant psychological or social dimension

  22. Other tips • Read the examination regulations carefully • Test the technology - the better the quality, the easier it will be for the examiner to mark • Use the log to add insight and reflection, not duplicate what is on the video

More Related