Consultation Review

Overview of Consultation Review
Direct Consultation Review
Direct consultation Review – In Practice Requirements
    - ACRRM requirements
Training for Consultation Review and Feedback
Direct Observation Versus Video Consultation Review
Video Equipment in Practices

Overview of Consultation Review

It is important that during training the GP supervisor reviews the doctor in training’s patient consultations – separate to that provided through the External Clinical Teaching Visits. This can be directly or indirectly.

1. Direct consultation review

  • Direct observation. GP supervisor sits in on consultations with the doctor in training.
  • Video observation. The doctor in training videos a number of consultations and reviews these with the supervisor.


2. Indirect consultation review

  • Random case review
  • Audit of patient cases
  • Patient survey and review of results
  • Practice doctor and staff feedback – nurses, receptionist etc

Direct Consultation Review

While both indirect and direct methods of consultation review are important it is essential that there is direct consultation review of the doctor in training. Both direct observation and video review are well recognised in the literature as ideal methods to provide feedback and assessment on an individual GP Registrar’s clinical consultation performance, for both content and process.

The advantages of direct consultation review include:

  • Excellent teaching/learning opportunity for the doctor in training
  • Allows the supervisor to feel confident about their patients’ safety
  • Acts as a learning needs “assessment” opportunity for the doctor in training
  • Is a direct measure of actual performance which can better inform the supervisor’s assessment of the doctor in training’s progress (including mid and end term assessments)

Direct Consultation Review – In Practice Requirements

WAGPET expects GP Supervisors to include both direct consultation review as part of normal in practice teaching.

For prevocational doctors direct observation by the GP Supervisor of the prevocational doctor is expected to occur on a number of occasions through the term (the frequency depends on the length of the term).

For GP registrars WAGPET encourages the use of direct observation and video consultation review. Following feedback from the majority of GP Supervisors across WA, video consultation review has been made compulsory for all GP Registrars in their first year of training. WAGPET provides video equipment to all Level 1 practices, and video equipment can also be borrowed from WAGPET.


Video consultation review requirement
Basic term  (GPT1/PPR1)
Total  ≥5 video consultation reviews each semester
Undertaken over at least 2 separate occasions in the semester
Advanced term  (GPT2/PPR2)
Total  ≥5 video consultation reviews each semester
Undertaken over at least 2 separate occasions in the semester
Subsequent term  (GPT3/PPR3)
Encouraged
GP extended skills or PPR4
No formal requirement


When planning to video patient consultations it is important to remember that a patient consent form should be completed by each patient prior to the consultation.

ACRRM requirements

ACRRM registrars are required have consultation review throughout their training, including during hospital terms. As an aid for feedback ACRRM encourages the use of the ACRRM MiniCEX . This is a structured tool for assessing consultation content and process and WAGPET encourages supervisors to use this tool when undertaking consultation review with ACRRM registrars.

There is an additional advantage in using the ACRRM MiniCEX as this is the tool used for one of the ACRRM summative assessments (exam).

For more information about the ACRRM assessment process.

Training for Consultation Review and Feedback

GP Supervisor training in consultation review and feedback is considered a core component of the Trainer Education Framework . This occurs through Perth based workshops, regional workshops, virtual classroom technology and online.

New supervisors should aim to attend this training within their first two years as a supervisor.

Direct Observation Versus Video Consultation Review


Direct observation
Video debriefing
Strengths
  • Synchronous – real time
  • Immediate feedback
  • Interpersonal recall (thoughts and feelings) vivid
  • Examination technique can be assessed at least in part
  • Asynchronous – viewed some time after the consultation
  • Multiple structured review possible – Self/peer/supervisor
  • Captures actual reality of the consultation – verbal/non-verbal
  • View a selection of consultations
  • Can have a larger bank of consultations available for review, not just those who attend on a specific day
  • Can drill down and review specific behaviours
  • Distance feedback possible
  • Multiple assessors of same consultation possible

Limitations
  • Effect of additional person in the consultation
  • Only review patients who attend on the day
  • Video can be like a third person in the room (more for Registrar than patient)
  • Negative cosmetic effects – impact of lighting, flattening effect on features and affect
  • Not immediate feedback
  • Interpersonal recall (thoughts and feelings) fade with time
  • Time consuming,
  • Examination technique not included
  • Remembering to turn the video on
  • Technical problems

Video Equipment in Practices

WAGPET provides video cameras to all accredited Level 1 Training as they join the WAGPET training program. Should a Level 2 practice wish to use the video, or a Level 1 practice requires more equipment because of registrar numbers, equipment can be borrowed from the WAGPET offices.

The equipment provided by WAGPET becomes the practice’s property for the specific purpose of teaching and learning.  As such the practice is responsible for the maintenance and insurance of the video camera equipment (replacement value).

WAGPET has additional sets of equipment and travel cases so that faulty equipment can be easily replaced while the practice’s equipment is being fixed.

GP Supervisor training in consultation review and feedback is considered a core component of the Trainer Education Framework . This occurs through Perth based workshops, regional workshops, virtual classroom technology and online.

New supervisors should aim to attend this training within their first two years as a supervisor.


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