1
|
Mazouri-Karker S, Braillard O, Lüchinger R, Bajwa N, Achab S, Hudelson P, Dao MD, Junod-Perron N. Patients preferences for communication during video consultations. Patient Educ Couns 2023; 115:107894. [PMID: 37480793 DOI: 10.1016/j.pec.2023.107894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
Objective The aim of our simulation-based study was to explore patient preferences for physician behaviours in video consultations METHODS: We conducted an exploratory study in outpatient setting in Geneva, Switzerland.Patients were invited to watch two variations videos of six simulated physician communication behaviours (camera framing, gaze orientation, initial talk at the opening phase, privacy reminder, pauses, empathy)and to indicate which one they preferred RESULTS: 417 patients watched three different video-recorded encounters. Most patients preferred framing with both face and bust (50.7 %) versus face alone (21.8 %). They valued eye gazing towards the camera (42.9 %) versus eye gazing shifting between screen and camera (13 %). The social talk related to the connection quality was appreciated (43.1 % vs 17.1 %) as well as the privacy reminder (80.8 % vs 6.5 %). Patients preferred short rather than long pauses after physician's statements (63.9 vs 14.9 %) as well as expressive rather than neutral nonverbal behaviour (46.7 % vs 17.6 %). CONCLUSION: Our results confirm that patients prefer the use of video specific communication behaviours recommended by experts except for shifting eye gaze and long pauses after physician's statements. PRACTICE IMPLICATIONS: Given the increasing use of video consultations, video communication "best practices"should be systematically addressed in physician training.
Collapse
Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland.
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Bajwa
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sophia Achab
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; ReConnecte Unit, Addiction Division, University Hospitals, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Mélissa Dominicé Dao
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod-Perron
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
2
|
Coen M, Sader J, Junod-Perron N, Audétat MC, Nendaz M. Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic. Intern Emerg Med 2022; 17:979-988. [PMID: 34997906 PMCID: PMC8742156 DOI: 10.1007/s11739-021-02884-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022]
Abstract
Cognitive biases are systematic cognitive distortions, which can affect clinical reasoning. The aim of this study was to unravel the most common cognitive biases encountered in in the peculiar context of the COVID-19 pandemic. Case study research design. Primary care. Single centre (Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland). A short survey was sent to all primary care providers (N = 169) taking care of hospitalised adult patients with COVID-19. Participants were asked to describe cases in which they felt that their clinical reasoning was "disrupted" because of the pandemic context. Seven case were sufficiently complete to be analysed. A qualitative analysis of the clinical cases was performed and a bias grid encompassing 17 well-known biases created. The clinical cases were analyzed to assess for the likelihood (highly likely, plausible, not likely) of the different biases for each case. The most common biases were: "anchoring bias", "confirmation bias", "availability bias", and "cognitive dissonance". The pandemic context is a breeding ground for the emergence of cognitive biases, which can influence clinical reasoning and lead to errors. Awareness of these cognitive mechanisms could potentially reduce biases and improve clinical reasoning. Moreover, the analysis of cognitive biases can offer an insight on the functioning of the clinical reasoning process in the midst of the pandemic crisis.
Collapse
Affiliation(s)
- Matteo Coen
- grid.8591.50000 0001 2322 4988Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- grid.150338.c0000 0001 0721 9812Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julia Sader
- grid.8591.50000 0001 2322 4988Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- grid.8591.50000 0001 2322 4988iEh2-Institute for Ethics, History, and the Humanities-Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod-Perron
- grid.8591.50000 0001 2322 4988Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- grid.8591.50000 0001 2322 4988Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- grid.8591.50000 0001 2322 4988Institute of Primary Care (IuMFE), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | |
Collapse
|
3
|
Monti M, Klöckner-Cronauer C, Hautz SC, Schnabel KP, Breckwoldt J, Junod-Perron N, Feller S, Bonvin R, Huwendiek S. Improving the assessment of communication competencies in a national licensing OSCE: lessons learned from an experts' symposium. BMC Med Educ 2020; 20:171. [PMID: 32456675 PMCID: PMC7249637 DOI: 10.1186/s12909-020-02079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND As the communication competencies of physicians are crucial for providing optimal patient care, their assessment in the context of the high-stakes Objective Structured Clinical Examination (OSCE) is of paramount importance. Despite abundant literature on the topic, evidence-based recommendations for the assessment of communication competencies in high stakes OSCEs are scarce. As part of a national project to improve communication-competencies assessments in the Swiss licensing exam, we held a symposium with national and international experts to derive corresponding guidelines. METHODS Experts were invited on account of their recognized expertise either in teaching or assessing communication competencies, or in conducting national high-stakes OSCEs. They were asked to propose concrete solutions related to four potential areas for improvement: the station design, the rating tool, the raters' training, and the role of standardized patients. Data gene.rated in the symposium was available for analysis and consisted of video recordings of plenary sessions, of the written summaries of group work, and the cards with participants' personal take-home messages. Data were analyzed using a thematic analysis approach. RESULTS Nine major suggestions for improving communication-competencies assessments emerged from the analysis and were classified into four categories, namely, the roles of the OSCE scenarios, rating tool, raters' training, and simulated patients. CONCLUSION In the absence of established evidence-based guidelines, an experts' symposium facilitated the identification of nine practical suggestions for improving the assessment of communication competencies in the context of high-stakes OSCEs. Further research is needed to test effectiveness of the suggestions and how they contribute to improvements in the quality of high-stakes communication-competencies assessment.
Collapse
Affiliation(s)
- Matteo Monti
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Christina Klöckner-Cronauer
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011, Lausanne, Switzerland
| | - Stephanie C Hautz
- Institute of Medical Education, Department of Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Kai P Schnabel
- Institute of Medical Education, Department of Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Jan Breckwoldt
- Student's Deanery, Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Noëlle Junod-Perron
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, Geneva, Switzerland
| | - Sabine Feller
- Institute of Medical Education, Department of Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Raphael Bonvin
- Medical Education Unit, Faculty of Sciences and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Sören Huwendiek
- Institute of Medical Education, Department of Assessment and Evaluation, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Luthy C, Cedraschi C, Pasquina P, Uldry C, Junod-Perron N, Janssens JP. Perception of chronic respiratory impairment in patients' drawings. J Rehabil Med 2013; 45:694-700. [PMID: 23828136 DOI: 10.2340/16501977-1179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore the perception of dyspnoea in patients with severe chronic obstructive pulmonary disease. DESIGN Cross-sectional study using mixed methods. METHODS Thirty-two patients with severe chronic obstructive pulmonary disease were included. Data collected included 3 health-related quality of life questionnaires (SF-36, St George and Maugeri respiratory questionnaires) and the Hospital Anxiety and Depression scale (HADS) to assess the impact of chronic obstructive pulmonary disease on quality of life and psychological functioning. Patients were then asked to draw their body and represent difficulties related to breathing. Drawings were coded and categorized. Patients' comments were transcribed. RESULTS HADS showed scores of depression and anxiety as high as 12.3 ± 2.6 and 9.3 ± 2.2, respectively; SF-36 subscales were severely affected, and the St Georges and Maugeri questionnaires indicated a high impact of chronic obstructive pulmonary disease (79 ± 13 and 60 ± 18, respectively). Drawings illustrated the pervasiveness of dyspnoea; patients' comments stressed breathlessness. Obstruction and tightening were salient, with a prominent representation of the head and internal structures, e.g. the lungs and the airways. CONCLUSION Patients' drawings capture a global expression of illness experience. They provide insight into the heterogeneity of patients' perceptions, and allow acknowledgement of patients' representations and experiences. This may, in turn, help in gaining patients' participation in rehabilitation programmes or adherence to new medications.
Collapse
Affiliation(s)
- Christophe Luthy
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
| | | | | | | | | | | |
Collapse
|
5
|
Lanier C, Camp-Wachsmuth M, Delémont C, Dominicé-Dao M, Favrod-Coune T, Guessous I, Huber T, Humair JP, Junod-Perron N, Keta A, Gaspoz JM. [What is new in ambulatory internal medicine in 2012?]. Rev Med Suisse 2013; 9:182-185. [PMID: 23413647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ten articles published in 2012 and of interest for the practice of ambulatory general internal medicine are reviewed in this paper. Topics of public health issues, such as the association between sleep disorders and prediabetes, the association between prediabetes and stroke, and the harmful effects of prolonged sitting are tackled. Other focuses include hepatitis C screening, abdominal aortic aneurysm screening and prostatic cancer screening. Therapeutic aspects are reviewed, such as the management of nongonococcal urethritis, the treatment of iron deficiency without anemia and the substitution of subclinical hypothyroidism. Finally a new study about aspirin and cancer prevention is discussed.
Collapse
Affiliation(s)
- C Lanier
- Service de médecine de premier recours, Département de médecine communautaire, de premier recours et des urgences, HUG, Genève.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|