One to One - teaching the consultation

to individual instead of groups

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Handling mismatch with learners agenda

The main difficulties are that there are only two opinions rather than a whole group, and it is easy for the session to become a teach-in by the trainer. The success of the session is more dependant on the relationship between teacher and learner. The trainer has a more complex and multi-faceted role with the individual learner, (confidant, support, giver of reference, assessor, advocate etc.) which may be advantageous and give the learner a less threatening exposure to direct observation of practice, but not necessarily so. The use of roleplay may be difficult as there are only two people rather than the whole group who would contribute more suggestions and thereby extend the repertoire of skills and strategies. In one-to-one training there is no observer to contribute objectivity.

What  helps is the trainer being prepared to put herself in the shoes of the learner by contributing directly by offering own suggestions of skills/strategies,  and showing her own video first.

We would suggest that watching a video every other week during the registrar year is mandatory.

Main methods

·      video/audio of real consultations

agenda-led, problem based analysis using roleplay and reverse roleplay and discussion

            Linda Gask’s method/ problem based analysis

            RCA

labelling structure and skills

            using the tape for exploring clinical problems

focusing on specific issues, eg BBN, interviewing depressed patients/telephone consultations

focusing on specific skills eg body language, open/closed cone

            looking at a whole tape to see the patterns emerging (useful for SA/MRCGP)

·      problem case discussion

            roleplay/reverse roleplay

·      trigger tapes

            labelling structure and skills

·      direct observation of surgeries/visits/coop

Strategies for teaching communication skills in the medical interview, when your agenda does not match the learner’s

If, after watching a consultation, roleplay or a video your agenda as the trainer does not match the learner’s, you have the following options:

1.  Once trust has been established in the one-to-one/group relationship, agree a contract that allows both the learner’s and trainer’s agenda to be on the table and to be subsequently addressed.

 2.  If the trainer’s agenda does not come up in the initial exploration of the learner’s agenda and preferred outcome :

·       Wait for the appropriate point to raise your concerns

·       Go into feelings during the initial exploration – “how did you feel that went”, rather than “how did that go”?

·       Raise your agenda in a straightforward manner, using descriptive feedback and asking permission

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