1. Dr. Ramesh Mehay Course Organiser (Bradford VTS)
Gask Video Analysis
Dr. Ramesh Mehay
Course Organiser (Bradford VTS)

2. This slide show has slide notes that you may wish to refer to
AIMS
To 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

3. OBJECTIVES 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)

4. You will soon come to see yourself in a better light.
Key Point 1
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.
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 tasks
Most VTS’s have a copy of the “Those things you Say” – go through it and do the tasks.

5. Why Do We Need Good Communication Skills?
Diagnosis
Giving Information
Giving Support
The 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.

6. Sources of Information in the Consultation
What the patient says (verbal cues)
What the patient does (non-verbal cues)
What the doctor perceives
How the doctor feels
Other parties (eg in 3 way consultations)
Note:
What the Patient Does :
behaviour in the consultation eg looking anxious still at the end of the consultation
behaviour outside the consultation eg non-compliance with medication, not attending hospital for review etc

7. After Linda Gask (Psychiatrist, Manchester) Session 1 (til 3.15pm)
The Gask Method
After Linda Gask (Psychiatrist, Manchester)
Session 1 (til 3.15pm)

8. The Gask Method
Problem Orientated Analysis for demonstrating cues or emotional content
Facilitator/Group members can stop the tape whenever they see a cue
Can also use it to demonstrate the structure as well as skills in the consultation
The 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 consultation
A good way to start new learners off with identifying and labelling skills

9. How the Gask Method Works
Learners select the consultation
Learners identify issues they want to focus on (agenda setting)
Focus on the tape
Anyone can stop the tape
Focus on specific skills, not generalities
Focus on consultation skills, not clinical content
Can stop the tape to draw attention to a skill which was demonstrated, or to something which could have been done differently
In the latter case, the person who stops the tape must have a specific suggestion for an alternative way of doing it

10. Consider role-playing certain issues
Additional Methods
Consider role-playing certain issues
Can use a variety of methods
One acts as dr, one acts as pt
Whole group acts as dr, one acts as pt
Where the whole group acts as a doctor, can ask each member of the group to work on one agenda item
Or alternatively get them to brainstorm doctor issues
Ask 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)

11. The 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

12. Giving Feedback Your aim is not to destroy the other person
A Balancing Act between
Being Too Critical Cosiness Zone
The Most Important Part of Feedback is Offering an Alternative to the Skill or Task Being Analysed
Need 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 analysed
Really 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.

13. Giving Feedback So, feedback requires: Courage Skill Understanding
Self Respect
RESPECT FOR OTHERS

14. Feedback – general principles revisited
Focus on
Behaviour which can be changed
Being accurate and clear
The behaviour, not the person
Observation, not inference
Description, not judgement
sharing ideas, not giving advice
Exploring alternatives, not providing answers

15. Feedback – general principles
Also think about:
How much to give
When to give it

16. Feedback – Pendleton’s Rules
Clarify matters of fact
Thing that went well
How they went well
Things that could have
been done differently
How they could have
The pair or group agree areas for development
Doctor first, then the group
Doctor first, then the group

17. What to look for in the Video
Look at (behaviour/skills)
Performance
Effects on Others
Be Aware of (tasks)
What (s)he does
How (s)he does it

18. FACILITATOR NOTES

19. Facilitator Notes – Gask 1
Facilitator’s roles
Monitor and facilitate discussion at each tape stop, summaries if appropriate. Make sure learner’s and group’s needs are both being attended to
Label/Identify the behaviour of the doctor on the tape and the alternative behaviours suggested by the group
Stop 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 suggestions
Ask for feedback at the end from the doctor who brought the tape
Give them some praise to go home with

20. Facilitator Notes – Gask 2
WHAT CAN YOU TEACH WITH GASK 1
Problem Detection Skills
Beginning the consultation
Picking up/responding to verbal cues
Picking up/responding to non verbal cues
Demonstrating empathy
Asking about Health Beliefs/Concerns
End the Consultation

21. Facilitator Notes – Gask 3
WHAT CAN YOU TEACH WITH GASK 2
Problem Management Skills
Ventilate Feelings
Information/Education
Making Links
Negotiating
Motivating Change
Problem Solving

22. Facilitator Notes – Gask 4
Possible Pitfalls
First time GPR’s may tend to go for content and clinical mistakes
Encouraging 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