ALOBA — Agenda-Led
Outcome-Based Analysis

Ask the learner what problems they experienced and what help they would like. This is the most important step. If you get this wrong, the rest of ALOBA unravels.

Thinking about goals — what the learner and patient were each trying to achieve — makes the feedback outcome-oriented rather than critical. It shifts the question from "what went wrong?" to "how could we get to a better result?"

Allow the learner to make their own suggestions before anyone else in the group contributes. Resist the urge to jump in with the "answer". When learners work it out themselves, they remember it far better — and they own the solution.

In group settings, others learn by helping to solve the presenting doctor's problem. They encounter the same consultation challenges. Encouraging group contributions means everyone benefits — not just the person on the tape.

Feedback should describe what was observed — not evaluate the person. "You looked away when she was speaking" is descriptive. "You seemed disinterested" is judgmental. Descriptive feedback is harder to dispute and easier to act on.

The SET-GO framework (described in detail below) provides a practical structure for delivering this kind of feedback consistently.

Cover both what worked well and what could be improved. Learning happens in both directions — we learn as much from analysing why something worked as from analysing what didn't. Do not finish a session without acknowledging strengths explicitly.

Suggest alternatives rather than telling the learner what they should have done. Frame feedback as possibilities — not commands. Reflect suggestions back to the learner for consideration. This preserves their autonomy and avoids the "teacher knows best" dynamic that shuts down learning.

Feedback without practice is just talk. When a good suggestion emerges, rehearse it immediately. One of the group plays the patient and the learner tries the new approach. This embeds the skill — it moves from concept to muscle memory.

The safety of the learning environment depends on trust. Every member of the group — and especially the facilitator — has a responsibility to be respectful and sensitive. Showing a consultation to a group takes courage. That courage should be honoured.

The video consultation is a learning resource for the whole group — not just an opportunity to analyse one person's performance. Every group member should be prepared to contribute, learn, and rehearse. The presenting doctor should not feel like the constant centre of critical attention.

When natural moments arise, use them to introduce broader teaching. Pull in a relevant Calgary-Cambridge concept, a piece of evidence about patient communication, or a teaching exercise. ALOBA is not just a review — it is a springboard for deeper learning.

By the end, the learner should leave with clarity — not confusion. Summarise what has been covered. Pull together the key learning points. Help the learner connect individual skills discussed back to the Calgary-Cambridge framework as a whole.

• Ask the presenting doctor to briefly set the scene — what they knew about the patient and any relevant context.
• Instruct the group to note down specific words, actions, and timestamps as they watch — this is essential for descriptive feedback.
• Nominate one group member to watch as if they were the patient, ready to role-play later.

• Give the group a few minutes to collect their thoughts before anyone speaks.
• Acknowledge the presenting doctor's feelings: "How are you feeling about watching that back?"
• Start with the presenting doctor: "What areas would you like to focus on? What is your agenda?"
• Write the agenda items up visibly for the group.

• Replay the relevant section. Get the presenting doctor to use descriptive feedback first — what worked well and what didn't.
• Elicit thoughts and feelings from the presenting doctor and, where appropriate, the patient-player.
• Invite the group to contribute using SET-GO language.
• Encourage offers and suggestions — then rehearse the best ones through role-play.
• Summarise progress back to the group using SET-GO prompts.

• Once the presenting doctor's agenda is covered, ask: "Does the group have any other areas they'd like to explore?"
• The facilitator can introduce their own teaching points, research evidence, or Calgary-Cambridge concepts at opportune moments.
• Make sure the balance of positive and developmental feedback is preserved throughout.

• Check with the presenting doctor that their agenda has been covered.
• Ask everyone: "What is the one thing you will take away from this session?"
• Summarise the key skills discussed, linking them back to the Calgary-Cambridge framework where possible.
• Ask whether the feedback felt useful and acceptable — this closes the safety loop.

The most common mistake is a trainer who says "What's your agenda?" — then promptly ignores it and teaches what they had already planned. This defeats the entire purpose of ALOBA. The learner's agenda must genuinely drive the session.

Discussion without practice is the single most common ALOBA failure. The conversation about what to do differently can feel like enough — but it rarely is. The brain learns motor skills through repetition, not discussion. Always try to rehearse.

In group settings, one harsh or evaluative comment early in the session can shut the presenting doctor down entirely. The facilitator must model and enforce SET-GO language from the start. If someone gives judgmental feedback, name it and correct it gently before moving on.

Saying "everything was fine" or "I'd just like general feedback" is not an agenda. It is an avoidance strategy (often unconscious). The facilitator's job is to gently but persistently help the trainee identify something specific and honest.

Watching yourself on video is uncomfortable. Receiving feedback is vulnerable. Defensiveness ("Yes, but the patient was difficult…") is a natural response — and it blocks learning. ALOBA is designed to minimise defensiveness, but trainees still need to consciously choose to stay open.

Sometimes a consultation clearly has issues and multiple group members raise the same concern one after another. This can feel overwhelming for the presenting doctor, even when each comment is intended kindly. The facilitator must manage flow — once an issue is identified and explored, move on.

• Not realising how often they interrupt patients — video makes this visible in a way that live observation cannot.
• Underestimating the importance of silence — a well-timed pause often gets more information than another question.
• Rushing through safety-netting — trainees often "tick the box" rather than genuinely individualise safety-netting for that patient.
• Assuming they explored ICE because they asked one question — ICE is a conversation, not a checkbox.
• Not noticing when they have already picked up a cue — they ask again because they did not register they heard it the first time.

The ALOBA Taster Session
For a group new to ALOBA: show a 5-minute demonstration video (trainer playing GP with a colleague playing patient), then model the full ALOBA process. This shows the method before trainees have to use it.

The Swap and Compare
Two trainees each play the same consultation scenario (different role-players). ALOBA is applied to both. The group compares approaches — invaluable for seeing that there is no single "right" way to consult.

The Silent Video
Play a consultation video with the sound off and ask the group to describe what they observe from non-verbal communication alone. Then play it again with sound. This trains precise descriptive observation — the core of SET-GO.

The Patient's Perspective
Ask one group member to stay in the role of the patient throughout the feedback session — they can only speak from the patient's perspective. This keeps the consultation's impact on the patient alive in the room.

• "If you had watched that consultation as the patient — what would you have wanted the doctor to do differently?"
• "What was the moment in the consultation when the relationship shifted — positively or negatively?"
• "Looking at the Calgary-Cambridge framework — which task do you think was done least well here?"
• "How did you feel when that part of the consultation happened? And how might the patient have felt?"
• "If you had 30 extra seconds at that point — what would you have done with them?"

ALOBA lends itself to formative, rather than summative, assessment. Signs that a trainee has genuinely internalised ALOBA include:

• They can identify their own agenda before being asked.
• They use SET-GO language naturally when watching others consult.
• They rehearse suggestions without being prompted.
• Their self-assessment is accurate — neither dismissive nor over-critical.
• They can distinguish descriptive from evaluative feedback.

These behaviours can be observed during any ALOBA session and documented as evidence of professional development on FourteenFish ePortfolio under reflective learning logs or supervisor reports.

New trainees may not have encountered ALOBA before. A brief introduction at the start helps enormously:

This brief framing removes the anxiety of the unknown and sets clear expectations for the session.

For a 1-to-1 tutorial: 20-35 minutes per consultation reviewed is typical. In a group (HDR) setting: 30-60 minutes for one consultation is reasonable, including rehearsal. Do not try to rush through multiple consultations — depth is more valuable than quantity.

No. ALOBA can be applied to any observed consultation — live, video-recorded, or role-played. Video is powerful because it provides an objective record that both trainer and trainee can refer back to. But swap and sits, simulated consultations, and role-play scenarios all work with the same ALOBA framework.

Yes — and increasingly this is the most relevant format for the SCA. The principles are identical. For telephone consultations, the analysis naturally focuses on vocal tone, pacing, language, and structure rather than non-verbal communication. Recording telephone consultations (with appropriate consent) is excellent SCA preparation.

ALOBA is the teaching and feedback method. The Calgary-Cambridge Guide provides the framework — the "what" of good consulting (structure, skills, tasks). ALOBA is the "how" of teaching and learning that framework. They were designed by the same authors (Silverman, Kurtz, Draper) to work together seamlessly.

Yes. The habit of asking "what was my agenda? what was I trying to achieve? what would I do differently?" is the core of ALOBA — and can be applied privately after every consultation. The RCGP encourages this kind of reflective practice explicitly. Logging these reflections on FourteenFish ePortfolio as learning log entries is excellent WPBA evidence.

In some medical traditions, the teacher tells the student what was wrong — and the student accepts it without question. ALOBA feels very different from this. It can feel uncomfortable to criticise your own performance in front of a trainer or group. This is completely understandable.

The key thing to know: in UK GP training, self-reflection is a valued clinical skill — not a sign of weakness. Identifying your own learning needs honestly is respected and encouraged. Start small — pick one specific moment you would have liked to handle differently. That is enough.

In a swap and sit, the trainer observes the trainee conducting a real clinic — or vice versa. After the consultation, ALOBA provides the feedback structure.

Recording and reviewing real video consultations with ALOBA is the most direct analogue of what the SCA requires. The trainee watches themselves back — which is always uncomfortable at first — and learns to analyse their own performance objectively.

• Record 2-3 real consultations per week during ST2-ST3.
• Review one at each tutorial using the full ALOBA process.
• Specifically map the feedback to the three SCA domains after each review.
• Ask: "Looking at the Relating to Others domain — where did you score yourself and why?"
• Replay the strongest moments as well as the difficult ones — knowing what good looks like is just as important.

Trainees preparing for the SCA increasingly form peer practice groups. ALOBA gives these groups a structured, safe, and productive feedback format.

The RCGP provides example SCA consultation videos and some deaneries offer video libraries. ALOBA can be applied to these — even self-directed, without a trainer present.

• Watch a practice or example SCA consultation.
• Ask yourself: "What was this doctor's apparent agenda? What were they trying to achieve?"
• Apply SET-GO to your observations — what did you see, specifically?
• Ask: "What would I have done differently and why?"
• Rehearse your alternative approach out loud or in writing.

This self-directed ALOBA approach develops exactly the metacognitive habits the SCA is designed to test.