Principles of agenda-led outcome-based analysis

Start with the doctor's agenda Ask what problems the doctor experienced and what help he would like from the rest of the group.
Always look at the outcome you are trying to achieve Thinking about where you are aiming and how you might get there encourages problem solving -effectiveness in communication is always dependent on what you are trying to achieve.
Encourage self-assessment and self problem-solving first Always allow the doctor space to make suggestions before the group shares its ideas.
Involve the whole group in problem solving The group should work together to generate solutions not only to help the doctor but also to help themselves in similar situations.
Use descriptive feedback to encourage a non-judgmental approach Descriptive feedback ensures that non-judgmental and specific comments are made and prevents vague generalisation.
Provide balanced feedback Each group member should ensure that they provide a balance in feedback of what worked well and what didn't work so well: this supports the learner and maximises learning -we learn as much by analysing why something works as why it doesn't.
Make offers and suggestions, provide alternatives Make suggestions rather than prescriptive comments and reflect them back to the doctor for consideration.
Rehearse suggestions Rehearse and practise suggestions by role play -when learning any skill, observation, feedback and rehearsal are required to effect change
Be well intentioned, valuing and supportive It is the group's responsibility to be respectful and sensitive to each other.
Value the tape as a gift of raw material for the group The tape provides the raw material around which the whole group can explore communication issues: group members can learn as much as the doctor on the tape and should be prepared to make and rehearse suggestions -the doctor should not be the constant centre of attention.
Opportunistically introduce teaching exercises and research evidence The facilitators should opportunistically offer to introduce teaching exercises and research evidence to help to draw out principles of communication and to illuminate learning for the group as a whole.
Structure and summarise learning so that a constructive endpoint is reached The facilitators should summarise the session to ensure that learners piece together the individual skills that have arisen into an overall conceptual framework.

Agenda-led outcome-based analysis in practice

Prior to showing the tape

After showing the tape

Start with the doctor on the tape

To the group as a whole

Ending

Descriptive feedback

The SET-GO method

Group members to base feedback on...

  1. What I Saw
    Descriptive, specific, non-judgemental. Facilitator to prompt if necessary with either or both of...
  2. What Else did you see?
    What happened next in descriptive terms?
  3. What do you Think, John?
    Reflecting back to the doctor on he video, who is then given the opportunity to acknowledge and problem solve.

Facilitator then to get the whole group to problem solve

  1. Can we clarify what Goal we would like to achieve?
    An outcome-based approach
  2. Any Offers of how we should get there?
    Suggestions and alternatives to be rehearsed if possible.

Source: Silverman, Draper and Kurtz: Education for General Practice vol 7 no 4 and vol 8 no 1.