As a formal or informal educational method, this is indispensable. Rooted in real life and in the personal experience of the learners involved, posing real questions for practical solutions yet flexible enough to range beyond the immediate, it has many characteristics of an ideal problem-based learning tool. It can employ features of role-play, micro-teaching, group work and critical incident.
It may focus on issues of clinical content, process, communication, decision-making and consultation technique, especially when based on a video-recording of a real or simulated case.
The principal difficulties include lack of focus, ineffective use of time and avoidance of confrontation.
Reality based, versatile, relevant and economical.
To explore attitudes, decision-making, problem solving and clinical skills – spontaneously or after planning – and to feed group work.
Random case analysis
Random case analysis is probably the most valuable and under- used teaching method. It provides an opportunity to focus on a trainee’s attitude or blind spot to check awareness and encourage use of the full potential of the consultation. The cases selected should be truly random (e.g. the fourth case seen that morning, as chosen by the trainer).
While the trainee outlines what happened during the consultation, the trainer should be listening and listing all the subjects which can be used as teaching areas. The trainer should, however, only choose the one or two most appropriate topics and save the others for another time.
It is particularly helpful to concentrate on behavioural aspects of the consultation-examples are the patient who arrives late, giveaway remarks about ‘trivia’ from the trainee, patterns of the patient’s health-seeking behaviour, how you feel when listening to the trainee.
It is important to work on the assumption that nothing happens by accident and that the trainee will try to rationalize his actions. Note should also be made of how the trainee uses opportunistic preventive medicine. Areas of factual ignorance may best be rectified by directing the trainee to articles or books prior to discussing the topic at a subsequent tutorial.
Problem case analysis
In problem case analysis the trainee brings something that he or she perceives as a problem.
Again it is important to list teaching areas whilst listening to the trainee. Remember that, although the case is expressed as a problem of patient care, the reason it is being presented is because the doctor has a problem.
As with the patient the doctor’s problem may not be one which he immediately presents-for example, a young female doctor presenting a problem of chronic back pain in a male may have underlying feelings of being patronized or threatened by middle-aged males, or a male doctor presenting a female patient with dysmenorrhoea may feel inhibited and embarrassed when examining female patients. Feelings as well as facts should be looked at.
Although the tutorial can be wide-ranging, the problem originally identified by the trainee should always be dealt with.