Calgary- Cambridge

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Calgary-Cambridge Video Analysis

 

Principles

Start with the doctor’s agenda

ask what problems the doctor experienced and what help he or she would like.

Always look at the outcome you are trying to achieve

thinking about where you are aiming and how you might get there encourages problem solving
effectiveness in communication is always dependent on what you are trying to achieve

Encourage self assessment and self problem solving first

always allow the doctor space to make suggestions before sharing ideas

In group situations, involve everyone in problem solving

everyone should work together to generate solutions not only to help the doctor but also to help themselves in similar situations
use descriptive feedback to encourage a non-judgemental approach
descriptive feedback ensures that non-judgmental and specific comments are made and prevents vague generalisation

Provide balanced feedback

everyone should ensure that they provide a balance in feedback of what worked well and what didn’t work so well – this supports the learner and maximises learning
we learn as much by analysing why something works as why it doesn’t

Make offers and suggestions, provide alternatives

make suggestions rather than prescriptive comments and reflect them back to the doctor for consideration

Rehearse suggestions

rehearse and practise suggestions by role play
when learning any skill, observation, feedback and rehearsal are required to effect change

Be well intentioned, valuing and supportive

it is everyone’s responsibility to be respectful and sensitive to each other

Value the tape as a gift of raw material

the tape provides the raw material around which everyone can explore communication issues
everyone can learn as much as the doctor on the tape and should be prepared to make and rehearse suggestions – the doctor should not be the constant centre of attention

Opportunistically introduce teaching exercises and research evidence

the trainer should opportunistically offer to introduce teaching exercises and research evidence to help to draw out principles of communication and to illuminate learning for all

Structure and summarise learning so that a constructive endpoint is reached

the trainer should summarise the session to ensure that learners piece together the individual skills that have arisen into an overall conceptual framework

Practice

Prior to showing the tape

ask the doctor showing the tape to set the scene, describing prior knowledge of the patient and listing the extenuating circumstances! You should know exactly what the doctor knew and was feeling when the patient entered the room and no more

During the tape

  • note down very specific words and actions plus their times as an aid to descriptive feedback
  • watch as if the patient and be prepared to role-play the patient afterwards to enable rehearsal

After showing the tape

  • allow several minutes to collect thoughts and identify the one or two most important points you would like to bring up in feedback, making sure to provide a balance
  • trainer to consider where to place feedback on what worked well
  • acknowledge any feelings of the doctor showing the tape if necessary

Start with the doctor on the tape

What areas do you want to highlight as being problems for you? Tell me your agenda: has it changed on reviewing? – Write up agenda items
What help would you like from me?
What outcome would you like to achieve?
trainer to consider whether to add in own agenda here
negotiate with the doctor the best way of looking at the tape – choose which area to replay
get the doctor to start off looking at own agenda by showing again the relevant part of the tape and asking to use descriptive feedback to say what worked well and what didn’t work so well
elicit thoughts and feelings of doctor and possibly patient if appropriate
rehearse with role-playing the patient
add in facilitator’s ideas and thoughts
appropriately introduce generalising away into other teaching areas and exercises

Ending

  • clarify with doctor on tape that own agenda has been covered
  • be very careful to balance what worked well and what didn’t work so well by the end
  • ask what everyone has learned (one thing to take away) and whether the feedback was useful and felt acceptable

Feedback using SET-GO

Feedback should be: 

  • Non-judgmental 
  • Specific 
  • Directed towards behaviour rather than personally 
  • Checked with the recipient 
  • Outcome based 
  • Problem solving 
  • Suggestions rather than prescriptive 

Using the SET-GO method

What I Saw Descriptive, specific, non-judgmental
What Else did you see? What happened next – descriptive
What does learner Think? reflect back to learner,
acknowledge and problem-solve
group problem-solves
What Goal are we trying to achieve? Outcome-based approach
Any Offers of how we should get there?

 

Source: Silverman et al. The Calgary-Cambridge approach to communication skills teaching – Agenda-led outcome-based analysis. (See Education for General Practice Vol. 8 No1)