Videoing The Consultation
Richard de Ferrars
Videoing the Consultation – Why?
Videos are tedious and boring!!
I do loads but non-one looks at them
Aim today:
What various ways can we use video?
What can I do with the video all by myself…
Why video?
Tool for looking at consultation skills & linguistics skills
Other tools? Joint Surgery, SIMS sessions.
What’s the Plan?
• Some theory
• Some practical (2 videos of yours truly)
– Watching one consultation looking at skills
– Marking one consultation formally
What Should I do with my Video?
(Polite answers only)
Formative vs. summative assessment
– Summative = mark it
COT
CSA
– Formative = use it to help development of skills
Simple feedback
Complex feedback - Consultation skills
- Linguistic content
Consultation – Formative Assessment
Formative = use it to help development of skills
That means giving feedback:
Meaningless free-for-all
Useful & structured feedback
How do you make it useful and structured?
- Rules
- Consultation models
Simple Feedback - Rules
• Pendleton’s Rules
– Confusingly nothing to do with consultation model
– Respect the bringer (owner) of the material
• Owner – what did they like?
• Group – what did they like?
• Owner – what would they change/ improve?
• Group – what would they change/ improve?
• Good simple rules, but lack substance
• Use these whenever looking at someone else’s work
Complex Feedback - Consultation Skills
• Usually linked to a consultation model
Consultation Models
What is a Consultation Model?
A framework for understanding more about how a doctor &
patient interact
Why bother?
• The consultation is pivotal to everything we do as GP’s
• By studying other’s models, we can develop our own style
• Gives us an insight into doctor-patient relationship &
patient’s perspective
• If done well, leads to better patient understanding &
concordance and fewer complaints
They are a tool – the “correct model” does not exist...
Name Some.....
• Disease - illness model (Stewart & Roper)
• Pendleton
• Neighbour
• Calgary-Cambridge
• (CSA marking model)
Complex Feedback - Consultation Skills
• Usually linked to a consultation model
– Disease Illness Model
– Pendleton’s
– Neighbour
– Calgary-Cambridge
• Today – “Disease Illness Model”
Disease Illness Model
• Simple & understandable
• Links well into COT marking
• Helps with CSA preparation & pacing
Patient presents problem Phase 1
Information gathering
Parallel search of two
frameworks Phase 2
Patient’s Agenda (illness) Doctor’s Agenda (disease)
Ideas History
Concerns Examination
Expectations Investigation
Patient’s understanding Diagnosis
of the illness Treatment
Integration of the two
frameworks
Phase 3
Explanation & planning
Shared understanding
Shared management
Consultation – Formative Assessment
Formative = use it to help development of skills
1) Simple feedback
2) Complex feedback - Consultation skills
- Linguistic content
Practical Exercise 1
Watch a video consultation
Feedback using Pendleton’s Rules
Feedback using Disease Illness Model
Practical Exercise - 2
• Summative assessment (meaning?....)
– COT marking system
– CSA marking system
Overview of these marking grids…
COT Marking System
COT - in pairs, commit yourself to paper...
• Based on Pendleton’s Model:
1. Define the reason for attendance
2. Consider other problems
3. Choose an appropriate action
4. Achieve a shared understanding
5. Involve the patient in management.
6. Use time and resources appropriately
7. Establish or maintain a relationship
• Look at a COT marking Grid
COT Marking Grid
• Look at a COT marking Grid
• Can you see the link to Disease-Illness Model?
Phase 1 = Reasons for attendance (patient –centred)
Phase 2 = Defines the problem (doctor-centred)
Phase 3 = Explains & addresses problem (shared management)
Feedback after summative marking on COT grid will be very
similar to formative feedback on Disease-Illness model.
CSA Marking Grid
Every case has a unique marking grid
Marked in three domains:
1. Data Gathering
2. Clinical Management
3. Interpersonal Skills
Scored 0-3 in each domain using a marking grid
(Clear fail, marginal fail, marginal pass, clear pass)
Total score for the case 0 - 9
Practical Exercise - 2
• Summative assessment
– COT marking system
– CSA marking system
Watch a video consultation
- half mark as COT
- half mark as CSA
Amusing Yourself with Videos
• By yourself
– Do-Re-Mi (Let’s start at the very beginning)
• Look at Phase 1 & patient’s expectation
• Look at time spent (& relevance) in Phase 2
• Phase 3 – only when good at phase 1 and 2
– Look at Phase 3 & look who’s talking (fun to count)
• In pairs/ groups
– Remember Pendleton’s Rules.
Amusing Yourself with Videos
• By yourself
– Do-Re-Mi (just start at the beginning)
• In pairs/ groups
Complex Feedback - Linguistics
Questions to ask whilst watching a video:
– What worked?, What did not work?, How can things improve?
If something did NOT work, was the problem with:
1. The direction the doctor was trying to take (= intent)
2. Right idea, but it just did not deliver the goods (= effect)
Combination of linguistics & consultation skills. Which is at fault?
Faulty intent = poor consultation planning
Faulty effect = linguistics issue.
Intent vs. Effect
Intent vs. Effect
Fluency
Examples of problems with intent/ effect:
Accuracy
• I think you have the goat.
• We are not going to cut off all tonsils in every Appropriacy
single person Pronunciation
• You say your little boy is not himself - who is he
Intonation
then?
• I am going to explore you now Pace/ volume
• Have you got any idea what’s wrong with you? Use of silence/
• You have a tumour. Sorry about that. interruption
• You are 35 - it’s time you started your family. Body language/ facial
expression
Others
Intent vs. Effect
Fluency
Less dramatic examples: Accuracy
• Misinterpreted ‘confirming expectation’
Appropriacy
“What do you think is wrong?”
Pronunciation
“You tell me, you’re the doctor”
• Trying to share options Intonation
• Trying to confirm understanding Pace/ volume
Use of silence/
interruption
Body language/ facial
expression
Others
Amusing Yourself with Videos
• By yourself
– Do-Re-Mi (Let’s start at the very beginning)
• Look at Phase 1 & patient’s expectation
• Look at time spent (& relevance) in Phase 2
• Phase 3 – only when good at phase 1 and 2
– Look at Phase 3 & look who’s talking (fun to count)
• In pairs/ groups
– Remember Pendleton’s Rules.
• Think linguistics – intent and effect
– Right intent, wrong effect, how could I have done it better?
In Closing….
• Understand the task:
– Summative
– Formative
• Don’t think that you cannot do it alone…
• Start at the very beginning – Phase 1,2,3
• ST2 and into ST3, start to work in pairs &
groups