Notes for Observers
Notes for Observers
Remember to give feedback to the students only after the whole of the role-play has finished.
Why feedback?
Everyone needs feedback to develop and learn- to make sure we make the most of this opportunity it is important to emphasise how the doctor acts will have an impact on the patient- how much they tell the doctor and how much they listen to the doctors’ advice.
By giving positive feedback on what they did well you will give them confidence, but they need to understand WHAT they did well and WHY this was effective. For example:
“it was great how you used small talk to build rapport with Elaine after her mum left the room, by asking her what she studied at university, family and friends, ease as this would help Elaine to feel comfortable and make her more likely to open up”
Positive first
By starting your feedback with a positive statement about what they did well (and WHY it was good, the impact on the patient), they will be more receptive to constructive criticism.
You can back this up with examples you have of positive personal experiences with doctors and how this helped in your recovery. For example
“I thought it was very good that you asked Rhea what she thought might be causing her pain, this demonstrates to her respect for her opinions and will make Rhea feel listened to- and could help her feel more comfortable in opening up about other issues in her life- when I changed to a GP who asked me what I thought would help it really made me feel differently- by listening to me and understanding that this is something I have lived with for years- she really made me feel like this was something we could cope with together- I felt involved and empowered”
Everyone needs criticism
Everyone needs to hear constructive criticism in order to develop and learn. To make the most of our time with the medical students, it is vital that we think of how they can improve. This isn’t being mean- the students will be used to constructive criticism and want your feedback and it could make a real difference to their future patients. To make the most of this:
- Suggest ways of doing, or thinking about something differently in order to be more effective in the future
- Be specific and give them practical examples of things they can say or do in a different way
- Tell them about specific things your doctor has said or done which you found supportive to your recovery.
- Encourage them by explaining the difference this could have to patients- and how this will help them as a doctor
- Constructive criticism doesn’t just mean thinking about things they have done badly but generally how they can improve themselves as doctors- and how they can think about the patient’s point of view. Think about the key issues we have discussed in relation to the two role-plays- have they addressed these issues?
Avoid repeating what others have said
It can be annoying when feedback you were going to give to a student is bought up by someone else- but please resist the temptation of repeating what others have said- this can eats into the short time we have and can irritate the students, making them less likely to listen.
To make sure we make the most of our time with the students we need to offer feedback on as many things as possible. Think about the key issues we have discussed for each role-play- is there something you can say about one of these?
Remember the key issues
Before a role-play you need to go through the key messages which we have discussed and think about how you can include these into your feedback- reflect any personal experiences you have relating to this.
Feedback in Time outs
Time-outs may be used by the students to discuss tactics and you may be asked for opinions, feedback to the students and relevant personal experiences here. Be brief and keep it relevant to the discussion and key messages. The facilitator will ask you again at the end of role play if there are any points that have been missed, or for some final thoughts.
Things to Feedback on
- Content – what they actually say
For example:
“It was excellent that you asked about sleep because this can really affect how someone is feeling and could be causing psychosis in Elaine”
“It was great that you did ask about sleep and Elaine said she had trouble sleeping, and I think it would be helpful to find out more about that, how much sleep is she actually getting- if any at all as this could even be causing her psychosis”
- Body Language- if this is good or bad says WHAT makes it good and bad and WHY
For example:
“When Elaine’s mum left the room I noticed that you moved your chair slightly towards Elaine and turned your body towards her- this would have helped Elaine to feel listened to –that you were interested in what she had to say”
“Although I appreciate that you might need to make notes, it can be quite difficult as a patient if the doctor is looking down at their notes- If you try to make eye contact with the patients you might find that they feel more comfortable and are more likely to open up”
- Tone of Voice- explain the effect this can have on the patient
For example:
“You seemed very caring and understanding, and this came across in your tone of voice and body language- thisn would have really put me at ease as a patient which is so important when dealing with symptoms as distressing as these”
“It can be difficult sometimes to show empathy and for it to come across in the way that you intended- when I was in hospital I found that doctors would think they were being nice if they spoke to me like a child but it really irritated me- so I think tone of voice can be very important and it’s something everyone should bear in mind”
- Pace- if the interview feels rushed or slow- help them understand how this might effect how the patient feels
For example:
“The appointment felt relaxed and I felt the time you took at the beginning to ask Elaine about her university, friends and family really helped put her at ease and built up a rapport with her”
“Although sometimes you don’t have that much time with patients, it can be good to leave pauses- there may be things Elaine wants to say that your questioning won’t bring out”
- Listening- How do they do to show that they are listening? Explain WHAT they did and WHY it is good for the patient to feel listened to.
For example:
“It was great how you reflected things back to Elaine ‘you hear people talking about you’ this made sure you got what she was saying and gave her a chance to say more without feeling pressured”
“As well as asking the questions to Elaine you need to show her that you are listening to the answers- just small gestures like nods can really help someone feel that you care and make them more likely to tell you anything important”
- Language- how do they phrase questions, the words they use and how might this make the patient feel
For example:
“I thought it was great how you responded to Rhea’s husband, by saying things like ‘I can see you care very much for your wife” you bought out the positives in what he was saying which reassured Rhea and stopped them argueing”
“It’s obvious that this is hard for both Rhea and her husband and it is important you build a good relationship with her husband as he could be crucial to Rhea’s recovery- when doing this you need to be mindful of your patients feelings and very careful of how any language you use could be interpreted, and describing Rhea as a burden to her husband could really upset her and make her feel worse”
- Empathy – how do they show the patients that they understand things are difficult?
For example:
“It was great how you used small statements like ‘that must be really difficult’ and ‘I imagine that very frightening’ to show Elaine that you are trying to understand what if feels like for her- if she feels that you understand things from her perspective she is more likely to take your advice seriously”
I understand you have lots of questions you need to ask Elaine but disclosing about mental health issues is very difficult and very frightening, if you try and think of ways to show empathy with her, simply by saying things like “that must be very difficult” can help her to trust you and open up about her most distressing symptoms.