MRCGP Examination

Answer Structures & Grids

Consultation Models

Pendleton

Neighbour

Byrne & Long

Stott & Davis

Pendleton “7 Tasks” 1

1) Define reason for attendance (patients ideas/concerns/expectations)

2) Consider other problems3) Choose appropriate action for each problem4) Achieve shared understanding5) Involve patient/accept responsibility6) Use time/resources appropriately7) Establish/maintain relationship with patient

1. Pendleton D, Schofield T, Tate D & Havelock P (1984) The Consultation: An Approach to Learning and Teaching (Oxford, OUP)

Neighbour: “5 Checkpoints”2

Connecting

Summarising

Handing Over

Safety Netting

Housekeeping

2. Neighbour R (1986) The Inner Consultation

Byrne & Long3

1) Doctor – Patient Relationship2) Discover reason for attendance3) Verbal/Physical Examination4) Doctor/Patient consider condition5) Doctor/Patient consider

Treatment/Investigation6) Terminate consultation

3. Byrne PS & Long BEL (1976) Doctors Talking to Patients (London HMSO)

Stott & Davis4

Management of presenting problems

Modification of help-seeking behaviour

Management of continuing problems

Opportunistic health promotion

4. Stott NCH & Davis RH (1979) The Exceptional Potential in each Primary Care Consultation JRCGP; 29: 201-205

Problem-Oriented Medical Records

SOAP Subjective Objective Assessment Plan

Pseudo-Latin Hx (History) Sx (Symptoms) Ix(Investigation

) Mx

(Management) Rx (Prescribe)

5 Areas of General Practice

1) Clinical Practice – Health & Disease

2) Clinical Practice – Human Development

3) Clinical Practice – Human Behaviour

4) Medicine & Society

5) The Practice

Health & Disease Normal Range Patterns of Illness Natural History Prevention Early Diagnosis Diagnostic skills/techniques Management/Treatment

Human Development Genetics Foetal Development Childhood Development

Physical Intellectual Emotional

Normal Range

Human Behaviour

Behaviour presenting to Doctor

Behaviour in Relationships

Behaviour in Family

Behaviour in Doctor-Patient

Relationship

Medicine & Society Sociological aspects Uses of Epidemiology Organisation of Healthcare in UK

comparison with abroad recent changes

Relationship between Healthcare services and other institutions of society

The Practice Practice Management The PHC Team Finance Premises & Equipment Medical Records Medico legal issues Research Lifelong Learning

Question Maker Problem Definition Management Prevention Communication Organisation Professional Values Personal Development

Situation Problems Advantages Disadvantages

Applied to: Doctor Patient Practice PHC Team Relatives Community

Healthcare General Public

Clinical Problems “HEIRS” History Examination Investigation Referral See again?

“RAPRIO(P)” Reassure Advice Prescribe Refer Investigate Observe (Preventative)

Illness Always answer in terms of:

Physical

Psychological

Social

Family/Community

Patient’s request

Agree

Disagree

Negotiate

Ethical problems Utilitarianism

examines moral dilemmas seeks to make decisions based on outcomes applies to large populations e.g. “the greatest good for the greatest

number” Deontological

applies to individuals based on the duties of the doctor and the rights

of the patient (and, of course, vice versa)

Ethical solutions ABCDE Autonomy (Patient) Beneficence

“above all, do no harm” “do good where possible”

Confidentiality Do not lie (Truthfulness) Everybody else (Society)

Doctor’s feelings Awareness Power Anger Guilt Stress Conflicts

Breaking Bad News “A KISS” Anxiety:

try to elicit anxieties Knowledge:

try to elicit knowledge Information:

give information simply re treatment, prognosis, follow up

Sympathy: give human contact (touch)

Support: give practical help

Dealing with Anger “AFVER” Avoid Confrontation Facilitate Discussion Ventilate Feelings Explore Reasons Refer/Investigate

Marking Schedules

Model answer

Areas of

Competence

Word Mapping

Areas of Competence Problem Definition Management Prevention Practice Organisation Communication Professional Values Personal/Professional Development