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| Caught on camera |
30-May-2007 |
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Recording patient encounters can be a practical and useful teaching tool.
By Bianca Nogrady
THE camera can reveal some unconscious habits. When Dr Rachel Sutherland was filmed during a consultation with a patient, she discovered to her surprise that she talked far more than she thought.
“I think there’s certainly verbal things that you might say in certain circumstances ... where you might be buying yourself thinking time, might be processing thoughts in your head,”says Dr Sutherland, chairwoman of General Practice Registrars Australia.
But far from being an embarrassment, having your bad habits captured on video can be a valuable learning opportunity.
“The registrar can actually watch themselves and get reflection on how they sit, the language they use and the interactions that are occurring on a more subtle level between them and the patient,” she says.
It’s one example of how videoing a registrar during a patient consultation can give the registrar a unique perspective of their consultation style.
Videoing has become a popular teaching tool in general practice, and in some clinics has replaced the more traditional teaching method of a supervisor sitting in with the registrar during the consultation.
Supervisor Dr Ron Roth believes video is the way of the future.
“I see very few downsides and lots of upsides,” says Dr Roth, from the Southern Cross Medical Centre at Hampton, Victoria. “It allows somebody to observe themselves in consultation rather than being told what’s happening.”
In his experience, registrars are often their own best critics. He says when registrars watch their consultations they come to their own conclusions, which are more powerful than when given that information by an observer.
However, having a technological eye over your shoulder is not for everyone, says supervisor Dr Tim Ross, from Olinda, Victoria.
“There are two groups —those who hate it with a passion and there are those who accept it reluctantly but once they do it, they find the positives,” Dr Ross says.
Many registrars are self-conscious about seeing themselves on screen and take a long time to get used to the camera’s presence in the room. One way around that is to leave the camera running for several sessions, so the registrar forgets its presence in the room and is able to relax into their typical consultation style.
Dr Sutherland says it’s also important that the technology is easy to manage and unobtrusive. “I think the ease with which you can undertake the process also has a big part to play,” she says. “If the technology is fiddly or interrupts you then I think that raises additional problems.”
Registrars are also often nervous about watching themselves on video with another observer, such as the supervisor.
Dr Edmund Poliness, GP educator at the Victorian Aboriginal Health Service in Melbourne, says one technique he had come across was to get registrars to video their entire session, then in their own time choose 20 minutes that they were most happy with from the consultations to show the supervisor.
Dr Roth gives control of the video to the registrar and lets them guide him through the consultation. In his experience, registrars are often highly critical of their performance and “what I tend to be doing is pulling out the positives”.
If the registrar feels they have had a bad consultation that they would rather not see the light of day, Dr Roth gives them the choice to fast-forward through that consultation altogether.
But it’s not just registrars who can be uneasy about having the consultation recorded and examined. Patients also take some time to get used to the technique and some are apprehensive about being recorded.
Associate Professor Simon Willcock, GP supervisor and chairman of General Practice Education and Training, says patient consent is essential and patients have to be informed that the video will be erased after the registrar assessment is completed.
Dr Poliness says patients’fears can also be eased by making sure the video camera is not angled towards the examination couch or by having the camera behind the patient, pointing towards the registrar.
Patients rarely object outright to videotaping, particularly in teaching practices where patients are used to the consultations being observed.
While videoing hasn’t entirely done away with the more traditional practice of supervisors sitting in with the registrar, it does overcome some of the problems associated with having a third party in the room.
When the supervisor is known to the patient, registrars can sometimes find themselves left out of the equation altogether, Professor Willcock says.
“The beauty of videotaping is that it takes away the falseness of having an observer in the room,” he says. “Particularly if the observer is well known to the patient, the patient can direct their response and communication back to the supervisor, who they know better.”
Directly supervised consultations can still offer some advantages. Professor Willcock says registrars will sometimes specifically request a supervisor sit in on a consultation if they are concerned about their interaction with a patient or for a difficult case.
“It can be useful to have a supervisor there as an observer, but the supervisor can also be asked to comment if required,” he says.
Some clinics, such the Aboriginal health clinic where Dr Poliness works, do not allow videotaping of consults, so supervisors must sit in to observe their registrars in action.
However, most supervisors and registrars prefer video, even if some do find it a little confronting, because it gives them such a unique perspective on someone’s consulting style.
Dr Sutherland even believes videoing consultations can be useful not just at the beginning of a medical career, but throughout.
“If people see this as a tool that encourages them throughout their professional lives to reflect on how they practise and how they might improve their practice, it might be a wise thing.”
VIDEO FAN
HAVING a patient lean past her to tell the attending supervisor "she's really good, this doc" is one reason why Dr Rachel Lee prefers to have her consultations videotaped.
"Sometimes patients explain things to the supervisor and I get a little bit awkward in terms of 'No, actually I'm the doctor'," says Dr Lee, an advanced term registrar at the North Yarra Community Health Centre in
Melbourne
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Dr Lee says having a supervisor sit in can be useful for basic-term registrars, to help them with their confidence, and patients generally are also more willing to have a third party sit in than be videotaped. But she is firmly in favour of videotaping
as a learning technique.
"I think you get better learning out of doing the video," she says. "It's helpful to be able to see yourself and look at your body language and see where things went wrong and right."
Videotaping the consultation makes it easy for Dr Lee to analyse the flow and structure of the consultation, and learn how she might handle problem patients better.
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