Abstract
Each month we review a different RCGP curriculum statement, giving ideas to help with achieving wide ranging coverage across the ePortfolio and work place based assessment. Having completed the clinical modules we now move onto the four professional modules and this month we look The GP consultation in practice.
Professional module 2.01: The GP consultation in practice
This statement focuses on one of the main components of general practice – the consultation. Having a clear understanding of the consultation, its importance and its delivery is vital to providing excellent patient-centred care. The consultation underpins most of what we do as general practitioners and links with many of the other RCGP curriculum statements and overarching competencies. The statement in general aims to focus on a commitment to patient-centred medicine, and although there are many individual curriculum components, it recognises three key areas of importance. These incorporate understanding the wider context of the consultation (including entering the patient’s world considering social, educational and cultural differences and remembering the patient is a real person), a recognition of the structure of the consultation (including understanding that good consultations often follow particular styles but that these may vary) and being committed to a reflective attitude with ethical considerations that allows a GPs practice to develop.
Learning log
The learning log is an integral part of Workplaced-based Assessment (WPBA), being a trainee’s learning record allowing them to show progression throughout training. Entries should be made regularly (although the focus should be on quality rather than quantity) and be appropriately reflective, showing both learning and aims for the future. They can be commented on by the clinical (CS) and educational (ES) supervisors once shared and can then be validated against competency areas providing the entry is of good quality. Trainees link the entries to curriculum statements but supervisors can unlink any inappropriate areas. In the context of this statement, there can be a temptation to link every log entry about a clinical encounter to ‘The GP consultation in practice’, however, trainees should ensure the entry actually demonstrates and reflects specifically on something contained in the statement before doing this.
Suggestions of relevant entries regarding Professional module 2.01: The GP Consultation in Practice include:
A tutorial focusing on a review of the differing consultation models, their role and application and the subsequent reflection on this A review of a difficult set of consultations where perhaps you feel that progress is not being made using transactional analysis and an interpretation of ‘The Games People Play’ A consultation with a patient who did not speak English where a relative insisted on interpreting, and a reflection on this and the importance of consulting using an independent interpreter Reflection on the setting up or joining of a local Balint group designed as a way of analysing consultations and doctor–patient relationships focusing on their emotional content through a small group A tutorial analysing consultations through different methods, such as the RCGP consultation observation tool (COT) or the consultation analysis tool created by the educationalist Damian Kenny (see references) and the subsequent learning and improvements from this, as well as the demonstration of competencies from across the whole curriculum statement The management of an elderly patient throughout the course of a GP attachment who was not coping at home where there were also family disagreements, and the reflection on aspects of her care including capacity, consent, confidentiality and ethics, as well as the importance of continuity of care
Patient satisfaction questionnaire
The patient satisfaction questionnaire (PSQ) is designed to help provide feedback on empathy and relationship-building skills during the consultation through questionnaires completed by patients. A minimum of one PSQ should be completed during ST1/2 (during a primary care placement) and one during ST3. Questionnaires should be handed out by receptionists to consecutive patients and continued until at least 40 responses have been received. These should then be entered onto the ePortfolio through a local arrangement (usually by a member of the practice team). Results are then summarised providing a series of scores for each question and, once authorised by the ES, can be released to the trainee. They should be discussed during a feedback session and the results reflected on by the trainee through a learning log entry and used as part of personal development.
Personal development plan
The personal development plan (PDP) should be updated regularly throughout the course of training as learning needs evolve and change. Trainees should ensure their entries are SMART (specific, measurable, attainable, relevant, time-bound) and relevant to the trainee’s point in training.
Suggestions of relevant learning aims:
Completing a log of referrals and subsequent analysis of their outcome to ensure that referrals are being made appropriately based on available evidence with a meaningful outcome for the patient Improving understanding of the consultation through completing the e-learning resources available on the RCGP online learning environment, as well as on e-learning for health (e-GP); in particular, e-GP has a large variety of modules (25 at present) covering areas from various techniques and skills for the consultation, through to topics, such as the difficult consultation, telephone consultations and ‘running late again’ Reflecting on differing consultation styles by aiming to sit in and observe a variety of different GPs towards the end of a GP placement (as opposed to the beginning) when more experience has been gained Aiming to develop specific aspects of the consultation, such as exploring a patient’s health understanding or time management through simulated consultations, observed consulting with formative feedback or by attending a variety of consultation courses that exist; this may also apply to developing skills in different consultation types, such as telephone consultations
Consultation observation tool
In the context of this curriculum area COTs are an excellent way of analysing consultations and learning from these. COTs are also a WPBA with trainees required to perform a minimum of six per year during primary care placements in ST1/2 and 12 during ST3 (half prior to each 6-month review). COTs can be performed on videoed consultations or following a joint observed surgery or home visit, and trainees should be encouraged to try each of these as feedback and learning can be different. For example, videos can be rewound to focus on a section of interest or repeated to aid learning. It is useful to choose cases for analysis reflecting a wide range of different clinical areas and with different types of patients. For WPBA, the RCGP stipulate that at least one COT should involve a child under ten, an older adult over 75 and a patient presenting with a mental health problem. COTs and consultation analysis are a valuable source of learning around the consultation and can easily lead on to teaching and reflection. Trainees are therefore encouraged to view the numbers of COTs officially required as a minimum.
Case-based Discussion
Case-based discussions (CbDs) are structured discussions around an actual case and involve questioning of a trainee across usually two or three competency areas. The questioning is based on what actually occurred rather than hypothetical actions or a test of theoretical knowledge, and as such can be a useful technique, not only for assessment through WPBA when they should be done formally, but also for random case analysis to focus on how a consultation proceeded and what learning needs there may be.
It should be noted that the above are only suggestions and not an exhaustive list of what to include in the ePortfolio. If you have any comments/ideas on how to improve Crammer’s corner please email us at editorialoffice@innovaitjournal.co.uk.