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This page is based on a video produced by Prof Liz Farmer, Associate Professor of general practice, Flinders University, Adelaide, Australia.

The Five 'C's

 

1 Control
2 Context	1,2,3 = House keeping
3 Comment
4 Catalyst	4,5 = Feedback rules
5 Constructive

1. Control

• The trainee should always feel in control and must be informed of this.
• Emphasise the importance of self directed learning. This will help overcome the anxiety relating to videoing the consultation and also its review.
• It is entirely up to the trainee to decide what is reviewed. Initially only " good consultations " will be presented by the trainee for viewing but as his confidence grows they will bring tapes that they are less pleased with.

Two techniques that may increase trainees confidence in their control are:

a)"Fast forward"

Trainee can skip over whatever they want to.
Over use of this may be due to:
(i) trainee is unsure what is expected of them and how to comment
(ii) trainee feels threatened e.g. never been videoed or previous unpleasant experience.

The trainee can be helped by:
(i) the trainer not coercing the trainee, simply watch what is skipped over as this may give clues to concerns.
(ii) sit back and watch
(iii) don't comment or challenge

b) No sound De-Brief

Often less threatening
Allows for non verbal communication/body language to be viewed
May act as a trigger

2.Context

• The doctor must give the context of the consultation prior to it being viewed. i.e. what was it all about and how did he feel about it
• This allows the supervisor to approach the viewing of the consultation from the same perspective as the trainee

3. Comment

The consulting doctor always comments first thus allowing the trainee to learn from himself. The supervisor merely acts as a facilitator.

The "walk through" method may be used
a) The trainee can stop the tape at any time and comment
b) Later the supervisor may ask permission to stop the tape and comment

Always comment on the positive first as this increases trust to deal with "weaker" points later.

4. Catalyst

The supervisor should be a catalyst not a critic
i.e. be:

• open
• non critical
• positive

Remember that hospital training up until now has been often critical e.g. surgical ward rounds!!
If you recognise that a trainee has a particular problem one can often wait to see if the trainee recognises for himself.
The supervisor should always have been videoed himself and often sharing this tape with the trainee helps to show that we are all human.

5. Constructive feedback

There is no need to choose a complicated consultation. A request for a sick note may be a useful as and interesting medical condition
Concentrate on the PROCESS of the consultation rather than its content

Ask about:

1. What was going through the trainees mind
2. What were their diagnostic hypotheses
3. Achieving tasks in the consultation
4. What did the trainee want to achieve
5. What was the trainees task in the consultation
6. Why did the patient really come

How to give constructive feedback

1. How does the trainee feel, how does he react (? share your own)
2. Relate to exactly what is on the tape
3. Focus on behaviour rather than personality
4. Be specific about observations and ask how these might be changed

 

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