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Facilitating learning of the clinical interview
- 1. Facilitating Learning the Clinical Interview Glori Hinck, RD, MS, DC Assistant Professor, Methods Department & Clinical Nutrition Program Northwestern Health Sciences University Bloomington, MN USA
- 4. Patient Interviewing Lab University Health Service (UHS)
- 7. ???? Can technology be used to facilitate learning the clinical interview?
- 8. Using Technology to Enhance Learning the Clinical Interview LITERATURE REVIEW Simulations
- 12. hologram
- 18. Virtual Worlds in Medical & Health Education
- 19. http://www.nmc.org/pdf/2007_Horizon_Report.pdf “… virtual learning spaces will impact higher education and be adopted on a wide scale basis within the next two to three years….
- 22. Virtual world: Nursing students- University of Auckland
- 23. Second Life Patient Interview
- 33. Thank You…. See you in Second Life! Dr. Glori Hinck Glorious Guisse
Hinweis der Redaktion
- A number of important skills are part of the process of learning how to perform a clinical interview. How does the student introduce themselves and establish rapport. Learn how to ask open-ended questions and use appropriate questioning techniques. Elicit the full history, demonstrate empathy and learn how to use verbal transitions from one part of the interview to another. 1. to conducting an interview. 2. introducing self to patient in an appropriate and respectful manner. 3. using open-ended questions, listening and facilitating responses which encourage and clarify the patient’s story. 4. using appropriate questioning techniques, moving from open- to closed-ended. 5. eliciting a systematic history of the onset and course of a chief complaint. 6. using empathy to encourage, support, and accurately understand the patient’s feelings. 7. perceiving and correctly interpreting the patient’s verbal and nonverbal cues. 8. summarizing and soliciting the patient’s feedback regarding completeness and accuracy of information. 9. using alternative approaches for data gathering when an interview is difficult. 10. using verbal transitions to move from one area of inquiry to another.
- A number of changes have been made at Northwestern to facilitate how students learn how to perform a patient interview. The course has been moved from term 5 to term 3 to give the students more time to perfect this process. More labs have been added and the labs now take palce int eh University Health Service rather than around a table in the cafeteria. Students view videotaped interviews performed by clinicians that are posted on Moodle and greater emphasis is placed on the development of DDX’s. With a change in instructor, a number of positive changes have been made to improve how clinical interviewing skills are taught at NWHSU. The course has recently been moved from the 4 th trimester to the 3 rd trimester to give students more practice with this important aspect of clinical education. Our course involves a combination of lecture, lab, Moodle Move from T5 to T3 Created labs to allow for supervised practice sessions with direct feedback from the instructor or TA Videotaped NWHSU clinicians performing histories on patients (student, infant, 50+ female) students access these videos and intake forms on Moodle. Once they watch the video they take a quiz Altered the notes to include spaces that the students could elaborate on DDX/Red flags... In class power point activities which outlines the flow/line of questioning required to ask in order to DDX a specific condition Mid-term and finals based on lab, lecture and power point presentations
- The labs are now more closely replicate the interview experience and take place in the University Health Servivce patient rooms. TA’s and faculty rotate between rooms observing, evaluating and answering questions Previously the students sat around a table in the cafeteria. This situation more closely replicates an actual patient interview.
- The 5 general make-up of the labs are described on this slide. Students are first introduced to the HPI via a group exercise moderated by a faculty or upper level student acting as a simulated patient using a script that is provided. Each person in the group will be responsible for taking a part of a history. When the group history is completed, student critique each other’s performance and come to a consensus for differential diagnosis under the guidance of the supervisor. The instructor will also complete an assessment rubric for each student. Lab 2 involves groups of 2 students who take turns acting as patient and doctor again with a mock history for the patient. An important part of the exercise is critical evaluation of self and peers. Labs 3 and 4 are similar to Labs 1 and 2 except this time a CHH is addressed. Lab 5 is the culiminating activity. You will be given age, sex and general complaint of the individual All students should introduce themselves in a professional manner All students will record information on HPI recording forms which will are provided for you on the following page of your lab notes. This is MEMORIZED and no notes are to be used. Your score will be determined by the proctor utilizing a rubric format The final course assessment involves performance of a comprehensive health history on a simulated patient. These simulated patients are upper level students or faculty. This takes place in the University Health Service Clinic and is recorded on a DVD for review by the instructor. Following completion of the interview, students write a narrative report that addresses the history they completed. They are also required to critique view their DVD and critique their performance note areas of strength and weakness.
- While these changes have certainly improved the patient interviewing course, there are still issues. Not feasible for lower level student to interview real patients- both in terms of time and in terms of patient satisfaction/safety. Student Focus group comments: Patient was fellow student Patient didn’t have a real problem
- The question then is, can technology be used to facilitate learning the clinical interview?
- A review of the literature shows a number of ways in which technology is bbeing used in this process. I concentrated on one specific aspect of technology enhanced learning- simulations.
- The literature if full of examples of simulation based teaching and learning in medicine and other health related professions. Simulations have been shown to improve performance- students have an opportunity to practice their skills repetitively. Patient safety is enhanced as they are not initially practicing on real patients. And they have an opportunity to learn from their mistakes without negatively impacting patient oucomes. The literature contains numerous examples of various types of simulations as they are used in surgical and nursing procedure training, disaster training, and clinical patient encounters in medicine, psychiatry, and nursing. Little or no mention is made of simulations in chiropractic education. In the next several slides I will touch on several examples of technology enhanced simulations
- When I reviewed the literature I focused specifically on simulations that involved teaching the clinical interview and those simulations that were technology related. This is a relatively new direction for health care education and many of the simulations discussed are in initial or beta testing phase. I will talk about 4 types of simulations….
- This is described as an initial effort to create an interactive virtual clinical scenario. I think our institution is probably some time away from being able to do a scenario such as this. Abstract: Background: At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills . Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills . Methods: In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user’s head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students’ performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment). Results: All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student’s questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 ± 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 ± 1.76 for version 2.0 (4 ... [Copyright 2006 Elsevier]
- Abstract: Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking , clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history . [ABSTRACT FROM AUTHOR]
- Abstract: Simulations are important educational tools in the development of health care competence. This study describes a virtual learning environment (VLE) for diagnosis and treatment planning in oral health care. The VLE is a web-based, database application where the learner uses free text communication on the screen to interact with patient data. The VLE contains forms for history taking , clinical images, clinical data and X-rays. After reviewing the patient information, the student proposes therapy and makes prognostic evaluations of the case in free text. A usability test of the application was performed with seven dental students. The usability test showed that the software responded with correct answers to the majority of the free text questions. The application is generic in its basic functions and can be adapted to other dental or medical subject areas. A randomised controlled trial was carried out with 39 students who attended instruction in history taking with problem-based learning cases, lectures and seminars. In addition, 16 of the 39 students were randomly chosen to practise history taking using the virtual patient prior to their first patient encounter. The performance of each student was recorded on video during the patient sessions. The type and order of the questions asked by the student and the degree of empathy displayed towards the patient were analysed systematically on the videos. The data indicate that students who also undertook history taking with a virtual patient asked more relevant questions, spent more time on patient issues, and performed a more complete history interview compared with students who had only undergone standard teaching. The students who had worked with the virtual patient also seemed to have more empathy for the patients than the students who had not. The practising of history taking with a virtual patient appears to improve the capability of dental students to take a relevant oral health history . [ABSTRACT FROM AUTHOR]
- I’m going to focus on simulaions in virtual worlds
- What can you do in a virtual world? There are many options that can be used to enhance teaching and learning. Access streaming audio/video Browse 3-D virtual libraries Multi-player health related educational games Attend live lectures, conferences and events Build communities of learners Develop clinical skills
- Why virtual worlds? The 2007 HorizonReport from New Media Consortium and Educause predicted that virtual learning spaces would impact higher education and be adopted on a wide scale basis within the next two to three years…
- Pharmacy case histories in a virtual world Using their Second Life avatars, UNC-Chapel Hill Pharmacy students visit a virtual representation of Greensboro’s Moses Cone Family Practice Center. There, they learn the location of the exam room and waiting room and the layout of the building. They view video clips demonstrating a successful and effective patient interview. Another pharmacy student, whose avatar has the role of patient, is given all the information they need to effectively play their role. The patient is invited into the exam room for a consultation with the pharmacy student who takes the case history. The interview is conducted with the voice chat feature of Second Life, allowing the students to talk to each other in real-time as if they were conducting a real interview at the Family Practice Center. At the conclusion of the interview, the “patient” leaves the Exam Room, and the pharmacy student proceeds to a quiz station where he or she takes a quiz to assess the effectiveness of the information obtained during the case history interview. Once the review is completed, the results are e-mailed to the pharmacy instructor to assure him or her that the student has completed the module successfully.
- This paper presents the virtual world pilot environment developed by the Academic and Collaborative Technologies Group and Faculty of Medical and Health Sciences at the University of Auckland within Second Life to explore the potential of bringing the same actors into a very low-cost virtual world. The Medical faculty at the University currently utilises trained actors, called standardised patients, to give participants a realistic clinical encounter, including taking a history, discussing the likely differential diagnoses and making management decisions. A ward round can be simulated, taking in a sequence of patients. A wide range of problems can be presented to the students in this manner, although there is significant cost associated with the development of these simulations. The ICU project is a pilot environment to explore the potential of bringing the same actors into a very low-cost virtual world.
- Postpartum simulation scenario The entire floor of the central building has been dedicated to the simulation, and includes a lecture area complete with whiteboard, a round-table discussion area for debriefing, and the medical simulation itself. The simulation comprises a single hospital room, but it is surrounded by a one-way curtain (see in, but not out) that prevents participants from seeing people in the observation seating area. The simulation requires student nurses to interview a patient in the bed (played by the instructor) and to make appropriate clinical decisions following the discovery of profuse bleeding (fig. 11).
- Not ready to commit to this with the limited information received.
- Upper level students trained as simulated avatar patients Learn conditions while simulating them Build avatar to represent health related condition Lower level students interview these avatar patients in small groups Self , peer, and instructor critique and feedback Opportunity to interview patients w/real problems Students interview injured athletes in Second Life Combine with videos of mechanism of injury Combine with hands-on sideline care
- Implications for Practice • Educators and their institutions need to ‘ think out of the box’. 3-D virtual worlds should enable educators and learners to be more creative and to develop new effective ways of teaching and learning, rather than to purely replicate real life and classrooms in Second Life! • We need to especially identify and focus/ capitalise on what 3-D virtual worlds are best at; those useful things and scenarios that can only be effectively carried out in virtual worlds and not via any other electronic medium (as effectively), and also determine and disseminate the optimal formulae for blended approaches that combine 2-D and 3-D media. • Research is still needed to make 3-D virtual worlds more accessible and user friendly. Learners, educators, and developers in these virtual environments also need to acquire and master new sets of competencies and skills in order for them to make the most efficient and effective use of 3-D virtual worlds in learning and teaching.