Video Consultations in General Practice – why do we do them? 

There have been times over the past two years of registrar training when I have questioned and contemplated, why am I undertaking so many work-based assessments. Will it help me with my exams, is it useful for improving my clinical skills or will it make me a better GP? In the first 12 – 18 months of community training much of the focus seems to be on study and how one is to pass the three RACGP exams. I wonder if we, as registrars, are losing sight of why work-based assessments exist.

Let’s consider the video consultations. It is a mandatory training requirement for GPEx registrars to record six video consults and then review three of these consults with your supervisor. At least an hour is then spent with the supervisor reviewing and evaluating these consults. These recorded consults, which some may see as a nuisance or awkward, are in fact GOLD, pure gold! Why? Because it is these videos which may make the difference between someone passing or failing practical exams, such as the RACGP OSCE or ACRRM StAMPS and miniCEX. Another benefit is that they enable us to develop ourselves as doctors through self-reflection of our communication skills. As an example, it may highlight how many times you say “ummmm…” – which we all know is unlikely to instil confidence in our patient’s mind, especially when we repeat it three to four times per minute!

I know of a registrar who always typed while the patient spoke so that she lost rapport with her patients, and it never occurred to her until watching the video that she maintained very little eye contact. Another registrar realised that he cut the patient off too quickly at the beginning and was too quick to provide advice and management. His intentions were good because he thought he was efficient, but in fact, the patient felt unheard. This same registrar also tended to lean back in his chair, legs spread out as if lounging back watching a YouTube video of the NBA in his lunch break. These habits would probably continue if it weren’t for the video consult, subsequent reflection and becoming aware of their own idiosyncrasies.

In my first video consultation reviews back in 2016, I just recorded the patient, thinking that this was an assessment in my history and physical examination skills. It hadn’t occurred to me that the iPad should be directed at me and not the patient so that my supervisor and I could reflect on my body language, my eye contact, my note taking/typing skills and my interactions with the patient. I’ve since learnt that sometimes I maintain too much eye contact!
A small study in the UK reported that trainees noticed a 90% improvement in their communication skills post video recording consults. [1] If we can reflect on our habits, our communication skills and ensure that our consults are patient-centred, surely this will improve overall care. So next time your Video Review Direct Observation is due, use it as an opportunity to reflect and see how YOU can change your consults or communication style to improve patient care. And if that’s not enough, see this as one of the best ways to prepare for exams!

Reference:
[1]
Eeckhout T, Gerits M, Bouquillon D, Schoenmakers B. Video training with peer feedback in real-time consultation: acceptability and feasibility in a general-practice setting. Postgraduate Medical Journal. 2016 Feb 3. Available from: https://pmj.bmj.com/content/92/1090/431

 

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