Some of the common problem patterns which occur in consultations are as follows
the learner does not discover all the issues or problems the patient wishes to discuss
the learner does not listen, often not asking open-ended questions initially or interrupting with closed questions
the learner does not elicit the patient’s ideas, concerns, expectations and feelings; or establish a collaborative relationship, and instead takes a doctor-centred position throughout the interview
the learner develops little rapport or is not responsive to the patient
the learner misses important cues from the patient
the learner obtains an inaccurate or incomplete clinical history because of failure to get the balance right between open and closed questions, summarising, checking, or sharing his thinking process
the learner forgets to find out what the patient already knows before giving an explanation
the learner gives too much information at once and uses jargon
the learner does not negotiate with the patient and check that the patient is agreeable to the plan
the learner makes inadequate follow up arrangements or none at all
A useful set of questions to ask yourself as the facilitator as you are watching any consultation are:
can you recognise any patterns here?
have you seen this problem before?
how might the learner who performed the consultation be feeling?
how might the “patient” be feeling?
what does the group already know?
how could you “generalise away”?
when would the best time be to do it?
what area or what research and theory would be relevant to teach on?
do you have the knowledge? do any of the learners have the knowledge?
is the overall balance of experiential work with didactic material from the literature right for the group?
‘have you got an aide-memoire/handout for the group?
