Unearthing the Diamond within

GP SYNERGY- FRIDAY STUDY GROUP

SESSIONS
Dr Geetha Kunjit Dr Anne Eastwood
Dr Graham Lee

Mining - repeatedly looking for

minerals like a diamond . The diamond
exists but you need to find it using
extended resources.

Background
Several years of intensive study group sessions
for registrars who have failed the RACGP OSCE
exams.
Role-plays and case discussion.
A few registrars have repeatedly failed the
OSCE despite participating.
We looked extensively at the reasons why they
failed and how to help them.

Problems identified
Difficulty in communicating
Lack of insight about their clinical and
consultation techniques
Problems with clinical reasoning
Personality and attitude factors affecting
consultation skills
Learning patterns
Performance anxiety during exams

Difficulty Communicating
Kelapa-coconut

Kepala-head

Problems with clinical reasoning

Often influenced by previous learning patterns
Memorise the topic
Do not know how to apply the knowledge

Dr Challenge

Lack of eye contact

Inadequate history
Jumps to conclusions
Inappropriate
investigations
No differentials
Memorised
management

External resources
The two external resources we used to help this
registrar were:
Performance and language coaching with a
professional actor and language coach
Sessions with Dr Guy Gordon on managing
performance anxiety.

Performance anxiety
Sessions with Dr Guy Gordon
Two to three sessions on relaxation techniques
to use before exams

In particular breathing techniques were used

Friday Study Group sessions

6-8 sessions based on learning needs over a
period of 3 months
Held in the Mock consultation rooms in the
Liverpool GP Synergy Office
Video recording facilities in the rooms

Key Outcomes
1. Develop
Communication skills including performance and
accent.
Structured consultation; history and examination
techniques.
Clinical Reasoning-what they are doing and why it is
being done
Management- appropriate investigations, ability to
negotiate management with patients and their
families; involving other team members

Key Outcomes cont

Critical appraisal skills and using EBM in practice
Patient Education, safety net and follow up
Techniques to cope with performance anxiety

2. To provide feedback on performance and

encourage self-development based on this

Common topics for Role Plays

Mental Health
Womens health
Aged care
The Difficult
consultation-angry
patient/ breaking bad
news
Sexual Health
Critical Appraisal

Child Health/ DOCS

Aboriginal Health
Palliative care/ Grief
Chronic disease
management
Domestic Violence
Physical Examination
Emergency cases

Structure for sessions

Week 1
Identify problems and learning needs.
Week 2
Focus on how to do a structured consultation
and take an appropriate history.
Learn how to do a critical appraisal and use
evidence based medicine in daily practice

Structure for sessions cont

Week 3
Improve skills in clinical reasoning-SNAPPS
technique
Week 4
Develop correct examination techniques and
management skills

Structure for sessions cont

Week 5
Importance of patient education and safety
net and counselling
How to deal with clinical emergencies in an
exam situation
Week 6
Mock exam and feedback
Week 7
Self-development based on feedback

Mock Consultation Room

Activities
To complete a self-assessment grid to identify areas for
improvement
To develop a short case for the role play sessions and
role play this with colleagues
To actively participate in role plays and have a video
recording done of a consultation and receive feedback
To complete learning module on Evidence based
Medicine and do a Critical appraisal of a journal paper
with the group

Pre Study Group Questionnaire

What are your Learning Objectives for this
session?
How do you feel about the RACGP OSCE
exams?

What part of sitting for the exams did you

find difficult?

Pre Study Group Questionnaire cont

Do you feel you need assistance with

language and coaching in consultation
techniques ?
Do you feel extremely anxious before exams
and does this affect your performance?

Post Study Group Questionnaire

What were the three most valuable things
you learnt from this session?
Did you meet your learning objectives for the
session?
How would you rate your overall confidence
about the upcoming exam?
How has your confidence in preparing for the
exams changed?

Specific areas

Knowing how to prepare

Exam technique
Confidence in Consultation Skills
Confidence with Clinical Knowledge and reasoning
Confidence with clinical examination skills
Confidence with management, prevention and
safety net
Knowing how to do a Critical Appraisal
Time management

Evaluation
1.How the registrars found the
content
organisation
diversity of discussion

2. What other topics they still feel need to be

covered?
3. General Comments about the sessions and
facilitators.

Results-work in progress
Only 4 registrars have participated in
language/performance and performance anxiety
sessions to date
All felt they all improved in language and
performance and found the sessions on
performance anxiety beneficial

Only 1 registrar from this group passed the

OSCE

Improvements
Script Concordance testing questions developed
by Dr Canalese to assess clinical reasoning in
the first session
Encouraging the registrars to complete Direct
Observation Teaching forms while their
colleagues role play and provide feedback on
performance.

Thank You

Thank you
Thank you for your help and contribution:
Dr Anne Eastwood
Dr Graham Lee
Dr Rosa Canalese
Dr Guy Gordon