Assessment of Consulting Assessment of Consulting Skills in a NutshellSkills in a Nutshell

AKA “The Video”AKA “The Video”

Ramesh MehayRamesh MehayMRCGP TutorMRCGP Tutor

Faculty Member Yorkshire RCGPFaculty Member Yorkshire RCGPCourse Organiser (Bradford VTS)Course Organiser (Bradford VTS)

GP (Bradford)GP (Bradford)

Consulting SkillsConsulting Skills

BRAINSTORMING SESSIONBRAINSTORMING SESSION

List any fears or concerns that List any fears or concerns that youyou have have with this modulewith this module

Aims of this SessionAims of this Session

To understand the purpose of the video To understand the purpose of the video consultation moduleconsultation module

To understand what they (the examiners) To understand what they (the examiners) are looking forare looking for

To alleviate your fearsTo alleviate your fears To increase your chances of passing To increase your chances of passing

the exam!the exam! 30 minute session30 minute session

Objectives of this SessionObjectives of this Session

At the end of this session you will :At the end of this session you will :

Be aware of the rules / regulations / Be aware of the rules / regulations / technical requirementstechnical requirements

be aware of how the it is markedbe aware of how the it is marked feel more confident about video consulting feel more confident about video consulting

and the practicalities making the tapeand the practicalities making the tape know exactly what the various performance know exactly what the various performance

criteria meancriteria mean be able judge consultations, and by doing be able judge consultations, and by doing

so decide which to include, and the so decide which to include, and the standards needed to passstandards needed to pass

Key Point 1Key Point 1

You will soon come to see yourself in a better You will soon come to see yourself in a better light.light.

A common first reaction to the sight of oneself on video is that you look professionally incompetent and

personally unattractive – don’t worry about this..

What are the Royal College Trying to What are the Royal College Trying to Test?Test?

To test ability to consult effectivelyTo test ability to consult effectively

NOT a test of:NOT a test of: medical knowledgemedical knowledge clinical examination skillsclinical examination skills

It is a criterion-referenced competency testIt is a criterion-referenced competency test

Rules, Regulations & Technical Rules, Regulations & Technical RequirementsRequirements

IT’S ALL IN THE WORKBOOK!IT’S ALL IN THE WORKBOOK!

Need on the Tape:Need on the Tape: 7 consultations, not > 15 mins7 consultations, not > 15 mins At least one with a child <10 yearsAt least one with a child <10 years At least one with a significant social or At least one with a significant social or

psychological dimensionpsychological dimension A range of presentations and patientsA range of presentations and patients

Key Point 2Key Point 2

Use challenging consultations

The Five UnitsThe Five Units

1.1. Discover the reasons for a patient’s Discover the reasons for a patient’s attendanceattendance

2.2. Define the clinical problem(s)Define the clinical problem(s)

3.3. Explain the problem(s) to the patientExplain the problem(s) to the patient

4.4. Address the patient’s problem(s)Address the patient’s problem(s)

5.5. Make effective use of the consultationMake effective use of the consultation

How It’s all OrganisedHow It’s all Organised

The five units

Element A Element B Element C

PC1 PC2 PC1 PC2 PC3 PC1

BEHAVIOUR

OUTCOMES

DOMAINS

Performance CriteriaPerformance Criteria

DOMAINDOMAIN DISCOVER THE REASONS FOR THE DISCOVER THE REASONS FOR THE

PATIENT'S ATTENDANCEPATIENT'S ATTENDANCEOUTCOMEOUTCOME

ELICIT AN ACCOUNT OF THE ELICIT AN ACCOUNT OF THE SYMPTOM(S)SYMPTOM(S)

BEHAVIOURBEHAVIOUR(=PC)(=PC)(P) PC1: the doctor is seen to encourage (P) PC1: the doctor is seen to encourage the patient's contribution at appropriate the patient's contribution at appropriate points in the consultationpoints in the consultation

(M) PC2: the doctor is seen to respond to (M) PC2: the doctor is seen to respond to signals (cues) that lead to a deeper signals (cues) that lead to a deeper understanding of the problemunderstanding of the problem

Key Point 3Key Point 3

Use the Performance Criteria to your Use the Performance Criteria to your advantageadvantage

How It Is Marked?How It Is Marked?

Pass / pass with merit / fail.Pass / pass with merit / fail.

Each consultation marked by a single Each consultation marked by a single examiner - no ‘halo’ effect - report findings examiner - no ‘halo’ effect - report findings to a co-ordinating examinerto a co-ordinating examiner

Need each of the 10 of PC (P)s Need each of the 10 of PC (P)s fourfour times times

Who fails?Who fails?

‘‘One third’ of candidates failOne third’ of candidates fail1. Not consulting effectively1. Not consulting effectively2. Not optimising choice of consultation2. Not optimising choice of consultation

Pitfalls:Pitfalls: Major omissions - if had clear opportunity Major omissions - if had clear opportunity

to demonstrate but didn’t.to demonstrate but didn’t. Missing cues e.g. sharing management Missing cues e.g. sharing management

optionsoptions Not choosing the right patients - may know Not choosing the right patients - may know

patient too wellpatient too well Those who make it hard for the examinersThose who make it hard for the examiners Poor sound or picture qualityPoor sound or picture quality

Marking the TapeMarking the Tape

You have to demonstrate that you are at You have to demonstrate that you are at your best your best

Get used to video in the room.Get used to video in the room. Change consulting room if necessary. Change consulting room if necessary. Lighting / Position / SoundLighting / Position / Sound Physical examination / ConsentPhysical examination / Consent

Have a “video week”Have a “video week” 15 minute booking intervals15 minute booking intervals Read the notes firstRead the notes first

You will have to edit the tapeYou will have to edit the tape

PitfallsPitfalls

Factors associated with candidateFactors associated with candidate Stage fright/nerves.Stage fright/nerves.

Factors associated with locationFactors associated with location Thin walls / outside traffic noise.Thin walls / outside traffic noise.

Factors have some control overFactors have some control over Computer / printer breakdownComputer / printer breakdown Flat batteries/run out of prescriptions. Flat batteries/run out of prescriptions. Make the room Make the room yoursyours........ InterruptionsInterruptions Make a copyMake a copy Send registered postSend registered post

Choosing 7 ConsultationsChoosing 7 Consultations

Count number of PC (P)s for each Count number of PC (P)s for each consultation - choose the ones with the consultation - choose the ones with the most in.most in.

Get others to help you - beware Get others to help you - beware confidentiality…..confidentiality…..

Key Point 4Key Point 4

Get your trainer, mentor in video analysis or another GPR to review

your consultations

The WorkbookThe Workbook

Functions:Functions:Allows you to provide a context for the Allows you to provide a context for the examiner; patients, facilities, constraintsexaminer; patients, facilities, constraints

..As an educational tool:As an educational tool: Helps you to review the tape and consider Helps you to review the tape and consider

whether you have provided an adequate whether you have provided an adequate demonstration of competence.demonstration of competence.

Allows you to show your ability to evaluate Allows you to show your ability to evaluate your own performance through self-analysis.your own performance through self-analysis.

It will take some timeIt will take some time FOLLOW THE INSTRUCTIONSFOLLOW THE INSTRUCTIONS

A Note on INFORMED ConsentA Note on INFORMED Consent

Patient understands:Patient understands:1.1. Why the recording is being madeWhy the recording is being made2.2. The purpose for which it is being usedThe purpose for which it is being used3.3. Who will see itWho will see it4.4. How long it will remain in existenceHow long it will remain in existence

Seek before the video recording takes Seek before the video recording takes place, CONFIRM after the consultationplace, CONFIRM after the consultation

Use approved formsUse approved forms NO COERCIONNO COERCION A note on 3-way consultationsA note on 3-way consultations

Summary of Key PointsSummary of Key Points

1.1. Don’t worry about how you look Don’t worry about how you look (professionally or aesthetically)(professionally or aesthetically)

2.2. Submit challenging consultationsSubmit challenging consultations3.3. Use the performance criteria to Use the performance criteria to

your advantageyour advantage4.4. Get someone to review your tapesGet someone to review your tapes

Overall SummaryOverall Summary

You have control.You have control. It should be difficult to fail.It should be difficult to fail. They tell you what they want.They tell you what they want. Assess own consultations with care Assess own consultations with care Main difficulty is practical:Main difficulty is practical:

- Doing it- Doing it- Filling it all in- Filling it all in

Technical aspects importantTechnical aspects important Follow the instructions check and double Follow the instructions check and double

check all requirementscheck all requirements Don’t spend Don’t spend tootoo much time on it. much time on it. Keep a copy of it allKeep a copy of it all

SIMULATED SURGERYSIMULATED SURGERYOr should it be stimulated surgery?Or should it be stimulated surgery?

Simulated SurgerySimulated Surgery

Available for candidates having difficulties Available for candidates having difficulties proucing videoproucing video

12 standardised patients, with max of 10 12 standardised patients, with max of 10 minute consultations (a ‘normal surgery’...minute consultations (a ‘normal surgery’...

Brief medical recordsBrief medical records Common and important presentationsCommon and important presentations Hotel roomHotel room Take own equipment and BNFTake own equipment and BNF Detail on RCGP websiteDetail on RCGP website

Marking Domains (usually)Marking Domains (usually)

1. Data gathering1. Data gathering

2. Doctor-patient interaction2. Doctor-patient interaction

3. Communication3. Communication

4. Formation of management plan with patient4. Formation of management plan with patient

5. Anticipatory care5. Anticipatory care

How Is It Marked?How Is It Marked?

Aggregate marks for each of the 12 Aggregate marks for each of the 12 consultations (120 separate judgements by consultations (120 separate judgements by 24 examiners)24 examiners)

Final score is mean of 12 case scoresFinal score is mean of 12 case scores

Overall mark that contributes rather than Overall mark that contributes rather than the need to pass a certain number of the need to pass a certain number of consultationsconsultations

Pass rate 67% averagePass rate 67% average

How to FailHow to Fail

Ignore patient centred behaviourIgnore patient centred behaviour Don’t ask how patient feels about their Don’t ask how patient feels about their

problemproblem Don’t share optionsDon’t share options Don’t think about implications for patientDon’t think about implications for patient Don’t arrange follow-upDon’t arrange follow-up Don’t think about opportunistic health Don’t think about opportunistic health

promotion or advicepromotion or advice Don’t anticipate future problemsDon’t anticipate future problems

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