Using standardized video cases for assessment of medical communication skills: reliability of an objective structured video examination by computer

Examiner perceptions of the MRCGP recorded consultation assessment for general practice licensing during COVID-19: cross-sectional study

BACKGROUND

The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA.

METHODS

We employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses.

RESULTS

Overall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates' data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates' performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners' difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment.

CONCLUSION

The RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.

[Adaptation and validation of an instrument to evaluate the competence on a Brief Tobacco Intervention. BTI-Prof©]

OBJECTIVE

Adaptation and validation of the BTI-St© to assess the level of competence in brief tobacco intervention in general practitioners and nurses in Primary Health Care.

DESIGN

Cross-sectional study of adaptation and psychometric validation of a criterion-referenced test.

SETTING

Primary Health Care.

PARTICIPANTS

One hundred fifty-five general practitioners and nurses working at Primary Health Care.

INTERVENTIONS

Three clinical scenarios were designed. Using an online platform, participants first viewed each scenario in which brief tobacco intervention was given. Health professional had to assess whether or not the scenarios were carried out in accordance with the 5A+5R model.

MAIN MEASURES

Competence in brief tobacco intervention measured by the BTI-Prof©.

RESULTS

Results related to reliability were obtained through Kuder-Richardson coefficient, being for scenario 1, 0.880, for scenario 2, 0.829, and for scenario 3, 0.826. The test-retest shows adequate temporal stability: intraclass correlation coefficient for scenario 1 0.857 (95% CI 0.734-0.923), p<0.0001, for scenario 2 0.829 (95% CI 0.676-0.909), p<0.001, and for scenario 3 0.869 (95% CI 0.76-0.928), p<0.0001.

CONCLUSIONS

The BTI-Prof© is a robust tool with adequate psychometric properties to assess competence in brief tobacco intervention in Primary Health Care general practitioners and nurses.

A video-based situational judgement test of medical students' communication competence in patient encounters: Development and first evaluation

OBJECTIVE

We developed and evaluated the Video-Based Assessment of Medical Communication Competence (VA-MeCo), a construct-driven situational judgement test measuring medical students' communication competence in patient encounters.

METHODS

In the construction phase, we conducted two expert studies (n_panel1 = 6, n_panel2 = 13) to ensure curricular and content validity and sufficient expert agreement on the answer key. In the evaluation phase, we conducted a cognitive pre-test (n = 12) and a pilot study (n = 117) with medical students to evaluate test usability and acceptance, item statistics and test reliability depending on the applied scoring method (raw consensus vs. pairwise comparison scoring).

RESULTS

The results of the expert interviews indicated good curricular and content validity. Expert agreement on the answer key was high (ICCs> .86). The pilot study showed favourable usability and acceptance by students. Irrespective of the scoring method, reliability for the complete test (Cronbach's α >.93) and its subscales (α >.83) was high.

CONCLUSION

There is promising evidence that medical communication competence can be validly and reliably measured using a construct-driven and video-based situational judgement test.

PRACTICE IMPLICATIONS

Video-based SJTs allow efficient online assessment of medical communication competence and are well accepted by students and educators.

What do we know about written assessment of health professionals' communication skills? A scoping review

OBJECTIVE

The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals' education.

METHODS

Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995-7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics.

RESULTS

From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported.

CONCLUSION

There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used.

Development and testing of a summative video-based e-examination in relation to an OSCE for measuring communication-related factual and procedural knowledge of medical students

Objective: In the context of educating medical students, testing of competence in medical communication is carried out primarily with the Objective Structured Clinical Examination [1]. This makes it possible to assess practical performance, but it is resource-intensive and has a negative impact on test quality. The project "Digital test tool for measuring communication skills in medical studies" (digiRole) was funded by the BMBF (Federal Ministry of Education and Research) and its objective was to develop digital formats as electronic versions of an OSCE in order to test the communication competency of medical students. Such digital forms of examination should be cost-effective, be relevant to clinical practice and have high psychometric quality. In terms of content, the examination questions should incorporate factual and procedural knowledge as components of communication competency, although we assumed that procedural knowledge is more relevant than facutal knowledge to OSCE performance. This article describes the development and testing of a video-based, communication-related e-examination that is relevant to passing the test, which is the first milestone of the overall project. Methodology: We produced videos and related exam questions in the form of a situational judgement test [2] related to medical psychology and medical sociology, based on the educational content of a preclinical course on doctor-patient communication at the Mainz University Medical Center. In the summer semester of 2018, 226 students sat for this video-based single-choice e-examination (VSE). In the winter semester of 2018/2019, a different cohort of 192 students participated in the VSE as well as a tried-and-tested communication OSCE with five stations [3]. Results: The internal consistencies for the VSE in the summer semester of 2018 were α=.55, in the winter semester 2018/19 with α=.62 and for the OSCE with α=.60. There was a positive correlation between the performance of the students with the VSE and that with the OSCE (r=.21, p≤.01). Principal Axis Analyses did not reveal any dimensioning in terms of factual and procedural knowledge. In the evaluation, the majority of the students stated that the VSE was quite relevant to the practise of medical communication and were in favour of retaining this form of examination. Conclusion: The correlation between the VSE and the OSCE is relatively low, so that the VSE in this form is not a satisfactory predictor of an OSCE result. In terms of internal consistency, the VSE and the OSCE produced an almost identical result. It can also be assumed that the VSE can achieve a high degree of objectivity with the use of standardised video-based examinations as well as greater resource efficiency than OSCEs.

Design and Validation of an Instrument to Evaluate the Learning Acquired by Nursing Students from a Brief Tobacco Intervention (BTI-St©)

The aim of this study was to design and validate an instrument, based on the WHO 5As+5Rs model, to test the acquisition by nursing students of a brief tobacco intervention (BTI) learning. A validation design of an instrument following the criterion referenced tests model using videos of simulated BTIs in the primary care setting was carried out. The study included 11 experts in smoking prevention/care and 260 second-year nursing students. The study was in two stages: (1) selection and recording of clinical simulations (settings), and (2) test construction. Content was validated by applying the Delphi consensus technique and calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A pilot test was conducted for item analysis. Reliability was evaluated as internal consistency (Kuder-Richardson [KR-20]) and test-retest temporal stability (intraclass correlation coefficient [ICC]). Three simulation settings were recorded. An instrument (BTI-St^®) was developed with 23 items for dichotomous (yes/no) response. CVR was >70% for all items, KR-20 of 0.81-0.88, and ICC between 0.68 and0.73 (p < 0.0001). The BTI-St^® is a robust and reliable instrument that is easily and rapidly applied. It follows the WHO 5As+5Rs model and offers objective criterion-referenced evaluation of BTI learning in nursing students.

Learning communication from erroneous video-based examples: A double-blind randomised controlled trial

OBJECTIVE

Appropriate training strategies are required to equip undergraduate healthcare students to benefit from communication training with simulated patients. This study examines the learning effects of different formats of video-based worked examples on initial communication skills.

METHODS

First-year nursing students (N=36) were randomly assigned to one of two experimental groups (correct v. erroneous examples) or to the control group (no examples). All the groups were provided an identical introduction to learning materials on breaking bad news; the experimental groups also received a set of video-based worked examples. Each example was accompanied by a self-explanation prompt (considering the example's correctness) and elaborated feedback (the true explanation).

RESULTS

Participants presented with erroneous examples broke bad news to a simulated patient significantly more appropriately than students in the control group. Additionally, they tended to outperform participants who had correct examples, while participants presented with correct examples tended to outperform the control group.

CONCLUSION

The worked example effect was successfully adapted for learning in the provider-patient communication domain.

PRACTICE IMPLICATIONS

Implementing video-based worked examples with self-explanation prompts and feedback can be an effective strategy to prepare students for their training with simulated patients, especially when examples are erroneous.

Applying the Verona coding definitions of emotional sequences (VR-CoDES) to code medical students' written responses to written case scenarios: Some methodological and practical considerations

OBJECTIVE

To investigate whether the Verona Coding Definitions of Emotional Sequences to code health providers' responses (VR-CoDES-P) can be used for assessment of medical students' responses to patients' cues and concerns provided in written case vignettes.

METHODS

Student responses in direct speech to patient cues and concerns were analysed in 21 different case scenarios using VR-CoDES-P.

RESULTS

A total of 977 student responses were available for coding, and 857 responses were codable with the VR-CoDES-P. In 74.6% of responses, the students used either a "reducing space" statement only or a "providing space" statement immediately followed by a "reducing space" statement. Overall, the most frequent response was explicit information advice (ERIa) followed by content exploring (EPCEx) and content acknowledgement (EPCAc).

DISCUSSION

VR-CoDES-P were applicable to written responses of medical students when they were phrased in direct speech. The application of VR-CoDES-P is reliable and feasible when using the differentiation of "providing" and "reducing space" responses. Communication strategies described by students in non-direct speech were difficult to code and produced many missings.

PRACTICE IMPLICATIONS

VR-CoDES-P are useful for analysis of medical students' written responses when focusing on emotional issues. Students need precise instructions for their response in the given test format.

Breaking Bad News: Doctors' Feelings and Behaviors

The announcement about the handicap of a child is communicated to parents by gynecologists or ultrasonographists, in the prenatal period. Often, these professionals are not prepared to communicate this news to the parents, and they have some limitations that lead them to act inappropriately. Therefore, the aims of this research were to identify and to describe the feelings of professionals facing this situation, and to examine their behaviors when they have to inform a couple about the child's anomaly. Ten gynecologists and ultrasonographists were interviewed: five were consultants in Public Health Services and five were private clinicians. Interviews were carried out with a semi-structured script. The results showed that, according to the participants, there is no specific moment, nor a standard behavior, that is most appropriate for making such an announcement. Yet the data show that all the participants feel hurt or frustrated when they must announce this phenomenon, becoming involved with the case. In conclusion, no graduate course has prepared them to deal with this deficiency. Suggestions are made concerning the graduate curriculum in order to improve the preparation of future doctors. A mental health professional is even necessary among the multidisciplinary team formed to deal with the pain produced in the moment of the announcement.

Variations among primary care physicians in exercise advice, imaging, and analgesics for musculoskeletal pain: results from a factorial experiment

OBJECTIVE

To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider.

METHODS

We conducted a balanced factorial experiment among primary care physicians in the US. Physicians (n = 192) viewed 2 videos of different patients (actors) presenting with pain: undiagnosed sciatica symptoms or diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status, and race and physician gender and experience (<20 versus ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the American College of Rheumatology, American Pain Society, and clinical expert consensus.

RESULTS

Despite current recommendations, less than one-third of physicians would provide exercise advice (30.2% for osteoarthritis and 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P ≤ 0.01), and to prescribe nonsteroidal antiinflammatory drugs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment.

CONCLUSION

Physician education on disease management recommendations regarding exercise and analgesics and implementation of quality measures may be useful, particularly for physicians with more years in practice.

Education in patient-physician communication: how to improve effectiveness?

OBJECTIVE

Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication.

METHODS

We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature.

RESULTS

The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes.

CONCLUSION

The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training.

PRACTICE IMPLICATIONS

We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.

The Effectiveness of Medical Communication Skill of Medical Students, through an Emphasis on Role Play

Objectives Medical doctors require outstanding communication skills when meeting with their patients. Thus medical student need to education and training about medical communication skill. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. Methods In the year 2010 and 2011, first-year medical students at The Kosin University College of Medicine took 'Communication skills' course in total, 154 first-year medical students survey results was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet'. The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. Results All categories of communication skills showed an improvement. For year 2010, a statistically significant difference was shown into the 22 questions, whereas in 2011, improvements were shown in all questions. Conclusions From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

Using video-cases to assess student reflection: development and validation of an instrument

BACKGROUND

Reflection is a meta-cognitive process, characterized by: 1. Awareness of self and the situation; 2. Critical analysis and understanding of both self and the situation; 3. Development of new perspectives to inform future actions. Assessors can only access reflections indirectly through learners' verbal and/or written expressions. Being privy to the situation that triggered reflection could place reflective materials into context. Video-cases make that possible and, coupled with a scoring rubric, offer a reliable way of assessing reflection.

METHODS

Fourth and fifth year undergraduate medical students were shown two interactive video-cases and asked to reflect on this experience, guided by six standard questions. The quality of students' reflections were scored using a specially developed Student Assessment of Reflection Scoring rubric (StARS®). Reflection scores were analyzed concerning interrater reliability and ability to discriminate between students. Further, the intra-rater reliability and case specificity were estimated by means of a generalizability study with rating and case scenario as facets.

RESULTS

Reflection scores of 270 students ranged widely and interrater reliability was acceptable (Krippendorff's alpha = 0.88). The generalizability study suggested 3 or 4 cases were needed to obtain reliable ratings from 4th year students and ≥ 6 cases from 5th year students.

CONCLUSION

Use of StARS® to assess student reflections triggered by standardized video-cases had acceptable discriminative ability and reliability. We offer this practical method for assessing reflection summatively, and providing formative feedback in training situations.

Using an objective structured video exam to identify differential understanding of aspects of communication skills

BACKGROUND

Effective communication in health care is associated with patient satisfaction and improved clinical outcomes. Professional schools increasingly incorporate communication training into their curricula. The objective structured video exam (OSVE) is a video-based examination that provides an economical way of assessing students' knowledge of communication skills. This study presents a scoring strategy that enables blueprinting of an OSVE to consensus guidelines, to determine which aspects of communication skills create the most difficulty for students to understand and to what degree understanding improves through experiential communication skills training.

METHODS

Five interactions between a healthcare professional and client were scripted and filmed using standardized patients. The dialogues were mapped onto the Kalamazoo consensus statement by having five communication experts view each video and identify effective and ineffective use of communication skills. Undergraduate students enrolled in a communications course completed an OSVE on three occasions.

RESULTS

A total of 79 students completed at least one testing session. The scores assigned supported the validity of the scoring strategy as an indication of knowledge growth. Considerable variability was observed across Kalamazoo sub-domains.

CONCLUSION

With further refining, this scoring approach may prove useful for educators to tailor their education and assessment practices to specific consensus guidelines.

Pediatrics milestone project: next steps toward meaningful outcomes assessment

In the September 2010 issue of JGME, the Pediatric Milestones Working Group published "The Pediatrics Milestones: Conceptual Framework, Guiding Principles, and Approach to Development", a document that describes the construction of the first iteration of the Pediatric Milestones. These Milestones were developed by the Working Group as a group of practical behavioral expectations for each of the 52 sub-competencies. In constructing these Milestones, the authors were cognizant of the need to ground the Milestones themselves in evidence, theories or other conceptual frameworks that would provide the basis for the ontogeny of development for each sub-competency. During this next phase of the Milestones development, the process will continue with consultation with content experts and consideration of assessment of Milestones. We have described possible measurement tools, explored threats to validity, establishment of benchmarks, and possible approaches to reporting of performance. The vision of the Pediatrics Milestone Project is to understand the development of a pediatrician from entry into medical school through the twilight of a physician's career, and the work will require a collaborative effort of the undergraduate and graduate medical education communities, and the accrediting and certifying bodies.

Nurse responsiveness to cancer patient expressions of emotion

OBJECTIVE

This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.

METHODS

This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.

RESULTS

Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.

CONCLUSION

Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.

PRACTICE IMPLICATIONS

Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.

Reflective teaching of medical communication skills with DiViDU: assessing the level of student reflection on recorded consultations with simulated patients

OBJECTIVE

Acquisition of effective, goal-oriented communication skills requires both practicing skills and reflective thinking. Reflection is a cyclic process of perceiving and analysing communication behaviour in terms of goals and effects and designing improved actions. Based on Korthagen's ALACT reflection model, communication training on history taking was designed. Objectives were to develop rating criteria for assessment of the students' level of reflection and to collect student evaluations of the reflective cycle components in the communication training.

METHODS

All second year medical students recorded a consultation with a simulated patient. In DiViDU, a web-based ICT program, students reviewed the video, identified and marked three key events, attached written reflections and provided peer-feedback. Students' written reflections were rated on four reflection categories. A reflection-level score was based on a frequency count of the number of categories used over three reflections. Students filled out an evaluation questionnaire on components of the communication training.

RESULTS

Data were analyzed of 304 (90.6%) students. The four reflection categories Observations, Motives, Effects and Goals of behaviour were used in 7-38%. Most students phrased undirected questions for improvement (93%). The average reflection score was 2.1 (S.D. 2.0). All training components were considered instructive. Acting was preferred most. Reviewing video was considered instructive. Self-reflection was considered more difficult than providing written feedback to the reflections of peers.

CONCLUSION

Reflection on communication behaviour can be systematically implemented and measured in a structured way. Reflection levels were low, probably indicating a limited notion of goal-oriented attributes of communication skills.

PRACTICE IMPLICATIONS

Early introduction of critical self-reflection facilitates acceptance of an important ability for physicians for continued life-long learning and becoming mindful practitioners.

A personal computer-based undergraduate medical school curriculum using SOLE

BACKGROUND

We describe our experience with a personal computer and Web-based undergraduate curriculum for preclinical medical students using the Secure Online Environment (SOLE) education and information system.

DESCRIPTION

To test the potential effectiveness of SOLE as a learning tool, we analyzed the patterns of SOLE usage, usage intensity, and consistency among medical students in two preclinical courses (4th-year Human Function and 5th-year Pathology) and attempted to link these indicators to academic performance. Categories of SOLE usage included number of website log-ins and number of pages viewed per course.

EVALUATION

We found that A- and B-grade 4th-year students accessed course materials more frequently than did C- to failing-grade students, and both median and mean number of SOLE log-ins declined as student performance decreased. Higher-graded students were also more consistent in their usage of SOLE than were lower graded students. The range of log-in numbers (variability in frequency of usage) was greater for C- to failing-grade students than for A- and B-grade students. Compared to their 4th-year counterparts, 5th-year students increased their intensity of SOLE usage (indicated by the number of pages viewed) dramatically and numbers were comparable for A- and B-grade and for C- to failing-grade students. Consistency of usage, however, still remained higher for better performing students. Furthermore, students preferred SOLE to a traditional paper-based curriculum and felt it improved teaching effectiveness. Based on usage data and student preferences and perceptions we found Web-based SOLE to be an effective and well-accepted educational tool for preclinical medical students.

CONCLUSIONS

This integrative, online educational and information system offers numerous opportunities and advantages for self-assisted instruction that can serve as a foundation for clinical training and professional lifelong learning.

How are patient characteristics relevant for physicians' clinical decision making in diabetes? An analysis of qualitative results from a cross-national factorial experiment

Variations in medical practice have been widely documented and are a linchpin in explanations of health disparities. Evidence shows that clinical decision making varies according to patient, provider and health system characteristics. However, less is known about the processes underlying these aggregate associations and how physicians interpret various patient attributes. Verbal protocol analysis (otherwise known as 'think-aloud') techniques were used to analyze open-ended data from 244 physicians to examine which patient characteristics physicians identify as relevant for their decision making. Data are from a vignette-based factorial experiment measuring the effects of: (a) patient attributes (age, gender, race and socioeconomic status); (b) physician characteristics (gender and years of clinical experience); and (c) features of the healthcare system in two countries (USA, United Kingdom) on clinical decision making for diabetes. We find that physicians used patients' demographic characteristics only as a starting point in their assessments, and proceeded to make detailed assessments about cognitive ability, motivation, social support and other factors they consider predictive of adherence with medical recommendations and therefore relevant to treatment decisions. These non-medical characteristics of patients were mentioned with much greater consistency than traditional biophysiologic markers of risk such as race, gender, and age. Types of explanations identified varied somewhat according to patient characteristics and to the country in which the interview took place. Results show that basic demographic characteristics are inadequate to the task of capturing information physicians draw from doctor-patient encounters, and that in order to fully understand differential clinical decision making there is a need to move beyond documentation of aggregate associations and further explore the mental and social processes at work.

Integrating virtual patients into a self-care course

OBJECTIVE

To develop, implement, and evaluate the use of virtual patients as a teaching tool for third-professional year PharmD students within an advanced elective self-care course.

DESIGN

Practicing community pharmacists, faculty members, and pharmacy residents with alias e-mail accounts served as virtual patients and corresponded on a weekly basis via e-mail with pharmacy students regarding an assortment of fictional health concerns. Self-care inquiries were e-mailed to the students who replied and then forwarded their response to the course coordinator for evaluation and class discussion. At the end of the course, students were asked to assess the value of the learning activity.

ASSESSMENT

Students demonstrated significant improvement in knowledge, problem-solving, communication, and professional skills upon course completion. Student's assessments of the virtual patient activity have suggested positive feedback on developing self-care skills, patient interactions, and group dynamics.

CONCLUSION

This teaching tool was designed to enhance student's knowledge base, assessment, and counseling skills when interacting with patients in various situations. Instructor evaluation of responses, student feedback, and self-evaluation indicated the activity improved overall knowledge and communication skills.