Teaching Consultation Skills
path: THE GASK METHOD
About Linda Gask
Linda Gask is a Professor of Psychiatry at the University of Manchester and has done a lot of work with the University of Leeds too. She’s written a wonderful book; having spent her life trying to patch up the souls of others, psychiatrist Linda Gask came to realize that being an expert in depression didn’t confer any immunity from it—she had to learn take care of herself, too. Artfully crafted and told with warmth and honesty, this is the story of Linda’s journey, interwoven with insights into her patients’ diverse experiences of depression -inextricably linked with problems in the past and the present such as vulnerability, fear, loss, loneliness, dependence and grief.
Throughout her career she has contributed significantly to psychiatry in primary care. For example, the art of reattrubition in helping patients who somatise. And in so doing, has develop a method for helping doctors review their consultation and communication skills in order to get the best out of patients.
The Gask Method for teaching consultation skills
- Ask learner to select consultation
- Ask learner to identify issues they want to concentrate on (agenda setting) . You might need to really tease the specifics out of them.
- Focus on the tape
- Anyone can stop the tape
- Focus on specific skills, not generalities
- Focus (of course) on consultation skills, not clinical content
- Can stop the tape to draw attention to a skill which was demonstrated, or to something which could have been done differently
- In the latter case, the person who stops the tape must have a specific suggestion for an alternative way of doing it
What sorts of issues can you teach on?
Problem detection skills
- beginning the consultation
- picking up/responding to verbal cues (open ended q’s, clarification, example)
- picking up/responding to non verbal cues
- demonstrating empathy
- asking about health beliefs/concerns
- ending the consultation
Problem management skills
- ventilating feelings
- making links
- motivating change
- problem solving
- Monitor and facilitate discussion at each tape stop, summarise if appropriate. Make sure learner’s and group’s needs are both being attended to
- Label/identify the behaviour of the doctor on the tape and the alternative behaviours suggested by the group
- Stop the tape when the patient clearly exhibits verbal or non verbal cues, if necessary prompt group to develop own skills in identifying these by asking a hierarchy of questions like ‘Why do you think I stopped the tape?’ ‘Did you notice anything happening at that point?’ ‘Did you notice anything about the patient’s voice?’ ‘Did you notice her voice changed when she talked about her husband?’
- Make sure the group gives constructive criticism: balance between positive comments and alternative suggestions
- Ask for feedback at the end from the doctor who brought the tape
- Give them some praise to go home with!