The perception of video-recorded consultations as an educational tool in aiding self-reflection in a general practice setting

Background

General Practitioners (GPs) are the first point of contact for patients seeking medical care. The level of communication between patients and their GPs needs to be of a high quality to yield a satisfactory patient-doctor relationship and a successful clinical outcome. Self-reflection is generally considered a significant element in this process for doctors in general practice. GPs are encouraged to utilise a variety of strategies to aid self-reflection as a means of identifying learning needs and improving their overall clinical practice. One such strategy is the use of video to record clinical consultations which can be subsequently watched and utilised to facilitate a purposeful reflective process. The incorporation of video recordings into clinical practice is highly recommended by the Royal College of General Practitioners (RCGP) and it is important to explore GPs’ perception of their use as an educational tool and its impact on self-reflection. This study looks at the perception of video-recorded consultations as an aid to self-reflection in a general practice setting. It has been conducted among general practice registrars who are in their final year of training and who regularly use video for feedback and reflection.

Methods

A descriptive cross-sectional qualitative study method has been used which employed a purposeful sampling method among all 30 general practice registrars within a Southern general practice community who regularly use videos. Ten GP registrars offered to take part in the study. Data collection methods, guided by an inductive research approach aimed at generating new and diverse opinions without a pre-existing hypothesis, included one focus group session comprising six participants and four semi-structured individual interviews carried out face to face and by telephone. Data obtained was audio-recorded digitally and transcribed. It was analysed thematically informed by the grounded theory to yield themes that aimed to answer the research question.

Results

All the participating GP registrars found the process of self-reflection very useful for learning and identifying areas for improvement. They also considered it as a means to identify their knowledge level, knowledge gaps and ways to further improve communication skills. As well as aiming to improve self-development in general, self reflection was also recognised as a potential fault-finding process, which could lower self-confidence in certain situations. The use of video was rated as a powerful educational tool as it is an objective method of observing one’s own consultation that can be re-watched in the future. It was recognised as offering the potential to improve communication skills in GP consultations. However, the challenges were unanimously highlighted as the registrars reported that they found video-recorded consultations very unnatural and awkward to watch. They also suggested that video recording within an allocated time causes increased performance anxiety. For these reasons, there were heterogeneous views of the use of video in aiding self-reflection. Some mentioned that video-recorded consultations can be useful as an aid to self reflection due to its objectivity; however, others did not consider these to be helpful for reflection as other strategies may be equally employed to yield similar outcomes.

Discussion

These results may indicate the general view that reflection is crucial for self development and that it also offers autonomous learning opportunities. In this case, self-reflection among GPs is deemed essential to identify what went well in a consultation, as well as unexpected outcomes, knowledge gaps, learning needs, useful non-verbal communication styles and areas for improvement. In that context, trainees believed that the use of video as an aid towards the reflective process can offer objectivity, an opportunity for feedback and added insight into their consultation. These can then be utilised to promote change in consultation style and improved clinical practice, with better patient satisfaction and outcome. The disadvantages of video-recording of consultations as an aid to reflection, especially in the time-pressured environment of general practice, makes its perception quite disparate. The discomfort felt in watching oneself, coupled with the challenges of set-up and patient consent, including the unnatural environment of consultation, do not encourage the regular and frequent use of videos for reflection.