Cumberland Lodge Trainee Videos Dr Richard de Ferrars January 2011

Videos - What’s It All About? Domain of Competence – Communication & Consultation Skills Needs Further Development Develops a working relationship with the patient, but one in which the problem rather than the person is the focus. Produces management plans that are appropriate to the patient’s problem. Provides explanations that are relevant and understandable to the patient, using appropriate language. Achieves the tasks of the consultation but uses a rigid approach. Competent Explores the patient’s agenda, health beliefs and preferences. Elicits psychological and social information to place the patient’s problem in context. Works in partnership with the patient, negotiating a mutually acceptable plan that respects the patient’s agenda and preference for involvement. Explores the patient’s understanding of what has taken place. Flexibly and efficiently achieves consultation tasks, responding to the consultation preferences of the patient. Excellent Incorporates the patient’s perspective and context when negotiating the management plan. Whenever possible, adopts plans that respect the patient’s autonomy. Uses a variety of communication techniques and materials to adapt explanations to the needs of the patient. Appropriately uses advanced consultation skills such as confrontation or catharsis to achieve better patient outcomes. Practising Holistically - Impact of problem on work, family etc Data-gathering & Interpretation - Targeted history & examination Making Diagnosis/ Decisions - Disease patterns, generating functional solutions Clinical Management - Treatment choices, follow-up arrangements Primary Care Admin/ IM&T - Use of the computer during consultations

Where are the Opportunities? How & where do our trainees learn? –Working with videos –Working in joint surgeries –Case discussions (rehearsal) –VTS : Communication skills –VTS : Working with simulators –Working with peers (CSA practice) (Video work is just one part...)

Why Video? (Apart from having a larff) Summative Approach: –COT framework –CSA model Formative Approach: Spectrum of tools - Watch me Pendleton Novice Advanced Disease Illness ModelCalgary-Cambridge

Phase 3 Patient presents problem Gathering information Parallel search of two frameworks Illness Framework Patient’s agenda : Ideas Concerns Expectations Feelings Thoughts Effects Disease Framework Doctor’s agenda : History - symptoms Examination - signs Investigations Understanding the patient’s unique experience of the illness Underlying pathology Differential diagnosis Integration of the two frameworks Explanation and planning : Shared understanding and decision making Phase 1 Phase 2 Disease – Illness Model

When Watching the Videos... Summative Approach: COT framework – calibration exercise (CSA model) Formative Approach: Pendleton (Trianee1st, good bits, bad bits) Disease Illness Calgary Cambridge