2This slide show has slide notes that you may wish to refer to AIMSTo highlight the emotional issues that MUST be addressed in a consultation (GASK)This slide show has slide notes that you may wish to refer to
3OBJECTIVES GASK: To improve your Problem Detection Skills (beginning the consultation, picking up and responding to verbal and non verbal cues, demonstrating empathy, asking about health beliefs/concerns, ending the consultation)To Improve your Problem Management Skills(ventilating feelings, information giving/educating, making links, negotiating, motivating change, problem solving)
4You will soon come to see yourself in a better light. Key Point 1A common first reaction to the sight of oneself on video is that you look professionally incompetent and personally unattractive – don’t worry about this.You will soon come to see yourself in a better light.Practise, practise and practise and observe and reflect with your trainer or someone with an insight into video consulting skills.The Inner Consultation by Roger Neighbour – do the tasksMost VTS’s have a copy of the “Those things you Say” – go through it and do the tasks.
5Why Do We Need Good Communication Skills? DiagnosisGiving InformationGiving SupportThe consultation is at the heart of general practice. It is therefore appropriate that general practitioners should spend enormous time on brushing up their consulting skills.There are many ways in which a doctor may arrive at a successful outcome to a consultation. There is not necessarily one acceptable way.
6Sources of Information in the Consultation What the patient says (verbal cues)What the patient does (non-verbal cues)What the doctor perceivesHow the doctor feelsOther parties (eg in 3 way consultations)Note:What the Patient Does :behaviour in the consultation eg looking anxious still at the end of the consultationbehaviour outside the consultation eg non-compliance with medication, not attending hospital for review etc
7After Linda Gask (Psychiatrist, Manchester) Session 1 (til 3.15pm) The Gask MethodAfter Linda Gask (Psychiatrist, Manchester)Session 1 (til 3.15pm)
8The Gask MethodProblem Orientated Analysis for demonstrating cues or emotional contentFacilitator/Group members can stop the tape whenever they see a cueCan also use it to demonstrate the structure as well as skills in the consultationThe Gask Method is good at highlighting important transactions (verbal and non-verbal) in the consultation. It is designed for group work but can be used in the 1-1 setting too. Teaching consultation skills MUST address emotional issues too.As an adaptation of the Gask method, can use it to demonstrate the structure as well as the skills in a consultationA good way to start new learners off with identifying and labelling skills
9How the Gask Method Works Learners select the consultationLearners identify issues they want to focus on (agenda setting)Focus on the tapeAnyone can stop the tapeFocus on specific skills, not generalitiesFocus on consultation skills, not clinical contentCan stop the tape to draw attention to a skill which was demonstrated, or to something which could have been done differentlyIn the latter case, the person who stops the tape must have a specific suggestion for an alternative way of doing it
10Consider role-playing certain issues Additional MethodsConsider role-playing certain issuesCan use a variety of methodsOne acts as dr, one acts as ptWhole group acts as dr, one acts as ptWhere the whole group acts as a doctor, can ask each member of the group to work on one agenda itemOr alternatively get them to brainstorm doctor issuesAsk the doctors to really sink themselves into the role of the doctor on the tape and feedback and discuss as if they were that doctor (encourages empathy)
11The Video Tape PLEASE REMEMBER: The doctor on the tape is offering his/her tape “as a gift for the group”Respect that!Think of yourself in that situation before being critical
12Giving Feedback Your aim is not to destroy the other person A Balancing Act betweenBeing Too Critical Cosiness ZoneThe Most Important Part of Feedback is Offering an Alternative to the Skill or Task Being AnalysedNeed to get the right balance.Groups can often avoid areas that could be contentious or seem over critical.Unfortunately, this leads to a kind of cosiness, where feedback is restricted to broad comments on the consultation without clearly dissecting and potentially improving on the skills demonstrated.Offering an alternative to the task/skill being analysedReally important – in this way, the giver of the feedback is also open to criticism by the receiver, and a dialogue can then begin about the skills or attitudes in question.
13Giving Feedback So, feedback requires: Courage Skill Understanding Self RespectRESPECT FOR OTHERS
14Feedback – general principles revisited Focus onBehaviour which can be changedBeing accurate and clearThe behaviour, not the personObservation, not inferenceDescription, not judgementsharing ideas, not giving adviceExploring alternatives, not providing answers
15Feedback – general principles Also think about:How much to giveWhen to give it
16Feedback – Pendleton’s Rules Clarify matters of factThing that went wellHow they went wellThings that could havebeen done differentlyHow they could haveThe pair or group agree areas for developmentDoctor first, then the groupDoctor first, then the group
17What to look for in the Video Look at (behaviour/skills)PerformanceEffects on OthersBe Aware of (tasks)What (s)he doesHow (s)he does it
19Facilitator Notes – Gask 1 Facilitator’s rolesMonitor and facilitate discussion at each tape stop, summaries if appropriate. Make sure learner’s and group’s needs are both being attended toLabel/Identify the behaviour of the doctor on the tape and the alternative behaviours suggested by the groupStop the tape when the patient clearly exhibits verbal and non verbal cues, if necessary prompt group to develop own skills in identifying these by asking a hierarchy of questions like:“why do you think I stopped the tape there?”“Did you notice anything happening at that point?”“Did you notice anything about the patient’s voice?”“Did you notice her voice changed when she talked about her husband?”Make sure the group gives constructive criticism : balance between positive comments and alternative suggestionsAsk for feedback at the end from the doctor who brought the tapeGive them some praise to go home with
20Facilitator Notes – Gask 2 WHAT CAN YOU TEACH WITH GASK 1Problem Detection SkillsBeginning the consultationPicking up/responding to verbal cuesPicking up/responding to non verbal cuesDemonstrating empathyAsking about Health Beliefs/ConcernsEnd the Consultation
21Facilitator Notes – Gask 3 WHAT CAN YOU TEACH WITH GASK 2Problem Management SkillsVentilate FeelingsInformation/EducationMaking LinksNegotiatingMotivating ChangeProblem Solving
22Facilitator Notes – Gask 4 Possible PitfallsFirst time GPR’s may tend to go for content and clinical mistakesEncouraging role play can be difficult in both GPR1 and GPR2’s – don’t enforce it though, negotiate or let them decide(we don’t want to frighten them off video analysis)Think of methods of encouraging and motivating a passive group