Teaching Tips - Parallel Consulting
The following is an account of parallel consulting which one of our senior GP supervisors has provided:
Parallel Consulting - How to have a 4th year medical student, and (maybe) even catch up on time. By Dr Ron Schweitzer, General Practitioner, Lecturer, Department of General Practice, Monash University
Many doctors are keen to teach medical students but feel constrained from doing so due to time concerns, specifically that they will end up running behind time. This explains how to have a medical student, not get behind, and maybe even catch up on time.
Parallel consulting is where patient A is booked in to see the doctor in one consulting room, and patient B is booked in to see the medical student at the same time in another consulting room. The doctor sees patient A and after finishing this consultation the GP then goes in to the consulting room where the medical student is seeing patient B. The medical student presents their findings to the GP (history, examination*, thoughts on management) and the GP then completes the consultation.
- Fully equipped spare room (we realize that it will not be feasible for all practices to offer this).
- Patients willing to be seen (initially) by a medical student.
- Medical student in whom you have confidence.
- Medical student who has some basic knowledge of your computer software.
Instructions for reception staff:
- Let’s assume you book patients every 15 minutes starting from 9.00a.m.
- Patient A is booked in to see you at 9.00 a.m.
- Patient B rings up to make an appointment. The receptionist says:
“Doctor “X” has a medical student with him/her today. Are you comfortable to see the medical student first and then to see Dr “X” afterwards? If you are happy to give permission, the medical student will chat to you first, examine you if appropriate and will think about what might be wrong with you and how to help you. Dr X will then come in, listen to the student’s findings and will then take over the consultation. (If the patient agrees): I can give you an appointment at 9.00. You would see the medical student first and then Dr “X” will come in at 9.15 to join the consultation. That means you will need to allow half an hour for the appointment. Is that OK?”
- The parallel bookings have the potential to continue throughout the day, with two patients booked in every half an hour, one for the doctor, one for the medical student.
Preparation / background:
- 4th year medical students are assigned to a General Practitioner for 9 weeks, 2 days a week, usually for 2 sessions per day.
- Generally, the medical student will be reasonably well skilled in taking a history, performing an examination and presenting their findings, but is likely to need assistance with their diagnostic and management skills.
- Initially, the medical student will need to earn your confidence that they are competent to perform a history and examination. This happens by the medical student sitting in with you and you inviting the student to take the history / examine the patient under supervision. This will initially take extra time and you are likely to run behind time unless catch up times are included. Hopefully the medical student will earn your confidence that they can perform a competent history and examination by the end of the first or second session.
- Once the medical student earns your confidence you can then commence parallel consulting.
How to do it:
- Patients are booked for parallel consulting as above.
- You take patient A into your consulting room and see the patient as per usual.
- The medical student takes patient B into their consulting room and takes the history and where appropriate, examines* the patient, adding notes to the patient’s file.
- When you finish the consultation with patient A, you then join patient B and the medical student. The medical student presents their findings to you including history and examination*, with the patient observing, adding, subtracting or correcting as appropriate.
- You then continue the consultation, with completion where necessary of the history, examination and management plan adding / subtracting to the notes that the medical student has made.
- If the student with patient B has any spare time, they can check that the medical file is up to date e.g. medications, alcohol / smoking history, past history, social history, family history, etc. –this is a great way of helping you to ensure that your medical files are up to date – great for accreditation!
- The 15 minutes that you spend in the consultation with patient A, the medical student spends taking the history and where appropriate, performing an examination* with patient B.
The medical student should be able to present this to you in 2 to 3 minutes. You then have 12 minutes to complete the consultation. This may even save you time because the student’s presentation generally takes less time than the time it takes you to take a full assessment de novo. You may use the time to do some teaching of the medical student relevant to the case. Or if your consultation with patient A is a quick consultation, you can leave the student with patient B for a few minutes whilst you catch up on other things, or maybe even have a cup of tea!
- Parallel consulting – please see section 4.3.4 by Associate Professor Lucie Walters
* Please note in relation to examinations – students are not to perform intimate examinations without their clinical supervisor acting as a chaperone. They should be reminded also that informed patient consent is obviously essential and in the case of children should be from the child’s parent or guardian.
Teaching Tips – Parallel Consulting
Instructions for the student Instructions for the student who sees a patient in a separate room
- Introduce yourself and ask permission
- Take a history of the presenting issue / complaint / symptom.
- Be careful to get ALL the issues that the patient wishes to discuss.
- Be careful to check the notes of the previous consultation
- Be careful to check if any pathology, imaging or specialist letters have arrived since the last consultation – and what information they convey
- Explore the patient’s expectations and ideas about the presenting issues
- Review the past history of the patient
- See if the record has up to date
- address, contact numbers,
- immunisation history ,
- Indigenous status,
- Present the information to the GP*
*Note – you should check with your GP supervisor to see if you may examine the patient by yourself. You should receive informed consent first from the patient before proceeding (in the case of children from their parent or guardian). You MUST NOT perform any intimate examinations without being chaperoned by your GP supervisor.
You could use the ISBAR format for the feedback:
Request / Referral
The following are some additional resources in relation to Parallel Consulting:
Parallel consulting – please see section 4.3.4 by Associate Professor Lucie Walters