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Mori A, Kato I, Kashiwagi H, Imai S, Narumi K, Sato Y, Furugen A, Yamada Y, Kobayashi M. [Development of an Online Role-play-based Medical Interview Training Method for Fourth-year Pharmacy Students]. YAKUGAKU ZASSHI 2022; 142:661-674. [PMID: 35650086 DOI: 10.1248/yakushi.21-00233] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With the coronavirus disease 2019 pandemic, businesses are rapidly expanding their online practices, and the online medical care system has been established and is growing. The field of pharmacy education is also looking for ways to conduct practical online training. Hence, we developed an online role-play-based medical interview training method for fourth-year pharmacy students. The purpose of this study was to describe in detail this method and to clarify the effect of online on medical interviewing practice. The training sessions were conducted using video teleconferencing software. Two settings were used for the role-play scenarios: the pharmacy and hospital. To evaluate the effectiveness of the sessions, a questionnaire was sent to the students, and the results were analyzed using text mining. The most important requirement for successfully conducting the interviews was a stable voice connection, and we reduced audio interruptions and delays by connecting the host personal computer to a wired local area network. We also solved the problem of howling when multiple terminals were installed in the same room by muting all devices in the room. Results of the analysis of the questionnaires suggested that students were more tense online. We also found that students perceived a difference between online and face-to-face interviews in terms of eye contact and the presentation of documents. In this way, we succeeded in conducting smooth online role-playing sessions while taking countermeasures against infection. In the future, it will be necessary to devise nonverbal communication methods and digital methods of presenting the training material.
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Affiliation(s)
- Ayako Mori
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Izumi Kato
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Hitoshi Kashiwagi
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Shungo Imai
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Katsuya Narumi
- Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Yuki Sato
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University.,Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Ayako Furugen
- Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Yuma Yamada
- Laboratory of Molecular Design of Pharmaceutics, Faculty of Pharmaceutical Sciences, Hokkaido University
| | - Masaki Kobayashi
- Education Research Center for Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University.,Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University
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Katsuki M, Matsuo M. Relationship Between Medical Questionnaire and Influenza Rapid Test Positivity: Subjective Pretest Probability, "I Think I Have Influenza," Contributes to the Positivity Rate. Cureus 2021; 13:e16679. [PMID: 34462700 PMCID: PMC8390973 DOI: 10.7759/cureus.16679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Rapid influenza diagnostic tests (RIDTs) are considered essential for determining when to start influenza treatment using anti-influenza drugs, but their accuracy is about 70%. Under the COVID-19 pandemic, we hope to refrain from performing unnecessary RIDTs considering droplet infection of COVID-19 and influenza. We re-examined the medical questionnaire’s importance and its relationship to the positivity of RIDTs. Then we built a positivity prediction model for RIDTs using automated artificial intelligence (AI). Methods We retrospectively investigated 96 patients who underwent RIDTs at the outpatient department from December 2019 to March 2020. We used a questionnaire sheet with 24 items before conducting RIDTs. The factors associated with the positivity of RIDTs were statistically analyzed. We then used an automated AI framework to produce the positivity prediction model using the 24 items, sex, and age, with five-fold cross-validation. Results Of the 47 women and 49 men (median age was 39 years), 56 patients were RIDT positive with influenza A. The AI-based model using 26 variables had an area under the curve (AUC) of 0.980. The stronger variables are subjective pretest probability, which is a numerically described score ranging from 0% to 100% of “I think I have influenza,” cough, past hours after the onset, muscle pain, and maximum body temperature in order. Conclusion We easily built the RIDT positivity prediction model using automated AI. Its AUC was satisfactory, and it suggested the importance of a detailed medical interview. Both the univariate analysis and AI-based model suggested that subjective pretest probability, “I think I have influenza,” might be useful.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Itoigawa General Hospital, Itoigawa, JPN
| | - Mitsuhiro Matsuo
- Department of Internal Medicine, Itoigawa General Hospital, Itoigawa, JPN.,Department of Anesthesiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, JPN
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Pihut M, Krasińska-Mazur M, Biegańska-Banaś J, Gala A. Psychoemotional disturbance in adult patients with temporomandibular disorders Research article. Folia Med Cracov 2021; 61:57-65. [PMID: 34185768] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Temporomandibular disorders (TMD) encompass a diverse group of abnormalities in the functioning of the masticatory muscles, temporomandibular joints, and surrounding structures within the facial skull. One of the important etiological factors, contributing to the development of TMD are psychoemotional disorders, which include: depression, dysthymia, personality disorders, panic attacks as well as states and anxiety neuroses.The aim of the study was to carry out a retrospective evaluation of the occurrence of psychoemotional disorders reported in the application form of medical interview of patients treated at the Consulting Room of Temporomandibular Disorders in Dental Institute (University Dental Clinic) for TMD. The research material consisted of a subjective survey according to the protocol of the RDC/TMD questionnaire, axis II, of the 360 patients (224 women, 136 men), aged 19 to 43 who came to the University Dental Clinic in Krakow due to TMD management. Result: The results of the conducted studies indicate the common occurrence of emotional disorders in the group of patients treated for TMD, both in the group of muscular and joint form of dysfunctions. The most often the patients selected: loss of sexual interest or pleasure, crying easily, feeling lonely, indifference to every- thing and feeling of worthlessness. These aspects show a significant influence of emotional factors on TMD. Conclusion: The results of the conducted research indicate a significant frequencies of psychological and emotional disturbances reported in a survey among patients with TMD.
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Affiliation(s)
- Małgorzata Pihut
- Consulting Room of Temporomandibular, Disorders, Dental Institute, Prosthodontics Department, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Krasińska-Mazur
- Consulting Room of Temporomandibular, Disorders, Dental Institute, Prosthodontics Department, Jagiellonian University Medical College, Kraków, Poland
| | - Joanna Biegańska-Banaś
- Institute of Nursing and Midwifery, Department of Health Psychology, Jagiellonian University Medical College Kraków, Poland
| | - Andrzej Gala
- Consulting Room of Temporomandibular, Disorders, Dental Institute, Prosthodontics Department, Jagiellonian University Medical College, Kraków, Poland.
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Harada Y, Hirayama Y, Wakuda K, Imura H, Otaki J. Assessing the empathy of medical students during medical interview training in Japan by using mixed-methods surveys of simulated patients. MedEdPublish (2016) 2019; 8:179. [PMID: 38089274 PMCID: PMC10712511 DOI: 10.15694/mep.2019.000179.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Medical interviews are performed during objective structured clinical examinations, to assess the communication skills of medical students. In particular, medical students are assessed regarding whether they demonstrate empathy during these staged interviews. However, no studies to date have analyzed the validity of the methods to evaluate empathy during objective structured clinical examinations. Aim: Here we sought to identify factors affecting whether simulated (standardized) patients (SPs) felt that the medical students had treated them empathetically during medical interview training. Methods: The training involved the participation of SPs during the bedside learning of fifth-year medical students in Japan. After the students completed medical interview training, we conducted a questionnaire-based survey. We developed the list of questionnaire items through semi-structured interviews asking SPs to describe when the student had been empathetic. Results: The item "I felt that the student was empathic throughout the interview" was significantly correlated with "I was given enough time to talk at the beginning of the interview," "The student made good eye contact," "The student's attitude was appropriate," "I was able to say enough of what I wanted to talk about," and "The student used phrases that expressed empathy." Multiple regression analysis revealed that "The student used phrases that expressed empathy" was the only independent predictor of "I felt that the student was empathic throughout the interview." Conclusions: The factor that correlated most strongly with the SP feeling that the student was empathic during a medical interview was "The student used phrases that expressed empathy." However, correlations also occurred with open-ended questions and the student's level of attention at the beginning of the interview and with the student's attitude. Together, these findings indicate that several types of both verbal and nonverbal communication determined whether SPs felt that medical students showed empathy during staged medical interviews.
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Affiliation(s)
| | | | - Kana Wakuda
- Department of General Medicine and Primary Care
| | | | - Junji Otaki
- Department of General Medicine and Primary Care
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Hayasaka Y, Fujikura T, Kashimura M. Expectations for the Next Generation of Simulated Patients Born from Thoughtful Anticipation of Artificial Intelligence-Equipped Robot. J NIPPON MED SCH 2019; 85:347-349. [PMID: 30568063 DOI: 10.1272/jnms.jnms.2018_85-57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is predicted that in the near future robot simulated patients (SPs) will come into use. Through the impressions of five SPs about robot SPs, we explored their vision of the future of medical education as an indicator of what ordinary citizens think. The opinions of SPs were collected using a semi-structured focus group interview, after which the perspectives provided were explored using a qualitative research method called Steps for Coding and Theorization (SCAT). Although SPs accepted the introduction of robot SPs, they regard them as potential substitutes. The use of robot SPs raised concerns about the level of response to human diversity and the level of emotional intelligence. The problem of how much diversity among patients and doctors is acceptable in the field of education was identified. On the part of citizens, there is not much expectation that artificial intelligence (AI) will lead to sophisticated machines capable of human conversation. However, looking ahead to the AI era, real SPs anticipate that, along with the evolution of AI, the next generation of SPs will have thought deeply about their role within a program employing both humans and robots.
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Nadir M, Hamza M, Mehmood N. Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country. Indian J Psychiatry 2018; 60:103-108. [PMID: 29736071 PMCID: PMC5914237 DOI: 10.4103/psychiatry.indianjpsychiatry_153_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor-patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor-patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan. MATERIALS AND METHODS The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data. RESULTS The study revealed four emerging themes: (1) Lack of doctor-patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients' concern with their improvement in health and doctor's demeanor. CONCLUSION The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.
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Affiliation(s)
- Maha Nadir
- Department of Surgery, Rawalpindi Medical College, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Muhammad Hamza
- Department of Surgery, Rawalpindi Medical College, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Nadir Mehmood
- Department of Surgery, Benazir Bhutto Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan
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Abstract
Objective To examine the characteristics of the communication skills of medical students, we observed their performance during introductory medical interview training with simulated patients (SPs). Methods The subjects of the present study included fifth-year medical students (male, n=180, female, n=99) who were undergoing clinical training in Japan from 2012 to 2014. Each student was assigned to one of four 10-minute clinical scenarios, which was conducted with an SP. Three or four teachers observed and assessed the performance of each of the students. The overall performance was rated on a 10-point scale, and nine basic communication skills that were common to each of the scenarios were rated using a four-point scale. The students also assessed their own performance on these items. The SPs assessed the students' performance from a patient's perspective on four items. Results There were significant correlations between the teacher and student scores. However, the students tended to score themselves significantly lower than the teachers. The female students were rated significantly higher by the teachers on the following four items; 'eye contact and appropriate attitude,' 'nodding and back-channeling,' 'giving empathic verbal responses,' and 'acquisition of patient's psychosocial information.' However, the self-assessments of the female students were only significantly higher than the male students in one item, 'acquisition of patient's psychosocial information.' In contrast, self-assessments of the male students were significantly higher in two items; none of their items was scored higher by the teachers. There was no significant gender difference in the assessments made by the SPs. Conclusion There were significant gender differences in the communication skills of the medical students during introductory training, suggesting the possibility that there were gender-specific traits and gender-based differences in the students' degrees of readiness.
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Affiliation(s)
- Akiko Sugawara
- Center for Medical Education and Career Development, Fukushima Medical University, Japan
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Japan
| | - Kazunobu Ishikawa
- Center for Medical Education and Career Development, Fukushima Medical University, Japan
| | - Ryo Motoya
- Center for Medical Education and Career Development, Fukushima Medical University, Japan
| | - Gen Kobayashi
- Center for Medical Education and Career Development, Fukushima Medical University, Japan
| | - Yoko Moroi
- Center for Medical Education and Career Development, Fukushima Medical University, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Japan
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Nazione S, Silk KJ, Robinson J. Verbal Social Support for Newly Diagnosed Breast Cancer Patients during Surgical Decision-Making Visits. J Commun Healthc 2016; 9:267-278. [PMID: 29081835 PMCID: PMC5659352 DOI: 10.1080/17538068.2016.1199174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study reports an analysis of verbal social support strategies directed by surgeons and patients' companions to breast cancer patients using the social support behavior code (SSBC). Additionally, the influence of companions on the provision of social support is examined. Forty-six videotapes of appointments where treatment regimens were being decided were analyzed. Results demonstrated that the majority of units spoken by surgeons were coded as verbal social support, primarily in the form of informational social support. Companions' social support was lower (relative to surgeons) in nearly every category of social support assessed. Patients who brought companions were found to receive more network social support from surgeons. Overall, these results point to low emotional support from surgeons and companions for patients during these appointments, which indicates a need for modifications in empathy training for medical providers.
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Affiliation(s)
- Samantha Nazione
- Communication Department, Berry College, Mount Berry, Georgia, United States
| | - Kami J Silk
- Communication Department, Michigan State University, East Lansing, Michigan, United States
| | - Jeffrey Robinson
- Department of Communication, Portland State University, Portland, Oregon, United States
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Keifenheim KE, Teufel M, Ip J, Speiser N, Leehr EJ, Zipfel S, Herrmann-Werner A. Teaching history taking to medical students: a systematic review. BMC Med Educ 2015; 15:159. [PMID: 26415941 PMCID: PMC4587833 DOI: 10.1186/s12909-015-0443-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/14/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students' interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program's efficacy. METHODS The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students' history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students' history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65). CONCLUSIONS These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping them to focus on interview skills and not being distracted by thinking about differential diagnoses or clinical management. The heterogeneity of outcome data and the varied ways of assessment strongly suggest the need for further research as many studies did not meet basic methodological criteria. Randomized controlled trials using external assessment methods, standardized measurement tools and reporting long-term data are recommended to evaluate the efficacy of courses on history taking.
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Affiliation(s)
- Katharina E Keifenheim
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Martin Teufel
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Julianne Ip
- Clinical Associate Professor of Family Medicine, Associate Dean of Medicine, Brown University, Providence, RI, USA.
| | - Natalie Speiser
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Elisabeth J Leehr
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Stephan Zipfel
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
- Dean of Medical Education, Medical Faculty, University of Tuebingen, Tuebingen, Germany.
| | - Anne Herrmann-Werner
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
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Hanley K, Zabar S, Charap J, Nicholson J, Disney L, Kalet A, Gillespie C. Self-assessment and goal-setting is associated with an improvement in interviewing skills. Med Educ Online 2014; 19:24407. [PMID: 25059835 PMCID: PMC4110382 DOI: 10.3402/meo.v19.24407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Describe the relationship between medical students' self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. METHOD 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. RESULTS SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills - those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1-10 and then increased significantly at week 17. For those whose SAGS remained 'poor' in weeks 1-10, interviewing skills declined in weeks 10-17. CONCLUSIONS In general, the quality of students' SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring.
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Affiliation(s)
- Kathleen Hanley
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA;
| | - Sondra Zabar
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
| | - Joseph Charap
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
| | - Joseph Nicholson
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
| | - Lindsey Disney
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
| | - Adina Kalet
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
| | - Colleen Gillespie
- Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA
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Agarwal AK, Murinson BB. New dimensions in patient-physician interaction: values, autonomy, and medical information in the patient-centered clinical encounter. Rambam Maimonides Med J 2012; 3:e0017. [PMID: 23908841 PMCID: PMC3678821 DOI: 10.5041/rmmj.10085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Patient-physician interactions are increasingly influenced by the extraordinary diversification of populations and rapid expansion of medical knowledge that characterize our modern era. By contrast, the patient-physician interaction models currently used to teach medical trainees have little capacity to address these twin challenges. We developed a new model of patient-physician interaction to explicitly address these problems. Historically, models of patient-physician interaction viewed patient autonomy and the manifestation of clearly defined health care-related values as tightly linked, and it was assumed that patients' medical knowledge was low. Unfortunately, this does not adequately represent patients such as 1) the highly educated non-medical specialist who possesses little familiarity with health-related values but is highly autonomous, and 2) the patient from a non-Western background who may have well-established health care-related values but a low sense of personal independence. In addition, it is evident to us that the assumption that all patients possess little medical knowledge can create alienation between patient and physician, e.g. the well-informed patient with a rare disease. We propose a paradigm that models autonomy, health care-related values formation, and medical knowledge as varying from patient to patient. Four examples of patient types are described within the context of the model based on clinical experience. We believe that adopting this model will have implications for optimizing patient-physician interactions and teaching about patient-centered care. Further research is needed to identify relevant patient types within this framework and to assess the impact on health care outcomes.
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Affiliation(s)
- Aakash Kumar Agarwal
- Department of Family Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Beth Brianna Murinson
- Department of Neurology, Rambam Healthcare Campus, Haifa, Israel; and
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Mortsiefer A, Rotthoff T, Schmelzer R, Immecke J, Ortmanns B, in der Schmitten J, Altiner A, Karger A. Implementation of the interdisciplinary curriculum Teaching and Assessing Communicative Competence in the fourth academic year of medical studies (CoMeD). GMS Z Med Ausbild 2012; 29:Doc06. [PMID: 22403591 PMCID: PMC3296104 DOI: 10.3205/zma000776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 10/04/2011] [Accepted: 11/07/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Implementation of a longitudinal curriculum for training in advanced communications skills represents an unmet need in most German medical faculties, especially in the 4rth and 5th years of medical studies. The CoMeD project (communication in medical education Düsseldorf) attempted to establish an interdisciplinary program to teach and to assess communicative competence in the 4th academic year. In this paper, we describe the development of the project and report results of its evaluation by medical students. METHODS Teaching objectives and lesson formats were developed in a multistage process. A teaching program for simulated patients (SP) was built up and continuous lecturer trainings were estabilshed. Several clinical disciplines co-operated for the purpose of integrating the communication training into the pre-existing clinical teaching curriculum. The CoMeD project was evaluated using feedback-forms after each course. RESULTS Until now, six training units for especially challenging communication tasks like "dealing with aggression" or "breaking bad news" were implemented, each unit connected with a preliminary tutorial or e-learning course. An OSCE (objective structured clinical examination) with 4 stations was introduced. The students' evaluation of the six CoMeD training units showed the top or second-best rating in more than 80% of the answers. DISCUSSION Introducing an interdisciplinary communication training and a corresponding OSCE into the 4th year medical curriculum is feasible. Embedding communication teaching in a clinical context and involvement of clinicians as lecturers seem to be important factors for ensuring practical relevance and achieving high acceptance by medical students.
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Affiliation(s)
- Achim Mortsiefer
- University Düsseldorf, Medical Faculty, Institute of General Practice, Düsseldorf, Germany.
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Hatem DS, Barrett SV, Hewson M, Steele D, Purwono U, Smith R. Teaching the medical interview: methods and key learning issues in a faculty development course. J Gen Intern Med 2007; 22:1718-24. [PMID: 17952511 PMCID: PMC2219821 DOI: 10.1007/s11606-007-0408-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 02/28/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the American Academy on Communication in Healthcare's (AACH) Faculty Development Course on Teaching the Medical Interview and report a single year's outcomes. DESIGN We delivered a Faculty Development course on Teaching the Medical Interview whose theme was relationship-centered care to a national and international audience in 1999. Participants completed a retrospective pre-post assessment of their perceived confidence in performing interview, clinical, teaching, and self-awareness skills. PARTICIPANTS AND SETTING A total of 79 participants in the 17th annual AACH national faculty development course at the University of Massachusetts Medical School in June 1999. INTERVENTION A 5-day course utilized the principles of learner-centered learning to teach a national and international cohort of medical school faculty about teaching the medical interview. MEASUREMENTS AND MAIN RESULTS The course fostered individualized, self-directed learning for participants, under the guidance of AACH faculty. Teaching methods included a plenary session, small groups, workshops, and project groups all designed to aid in the achievement of individual learning goals. Course outcomes of retrospective self-assessed confidence in interview, clinical, teaching, self-awareness, and control variables were measured using a 7-point Likert scale. Participants reported improved confidence in interview, clinical, teaching, and self-awareness variables. After controlling for desirability bias as measured by control variables, only teaching and self-awareness mean change scores were statistically significant (p < .001). CONCLUSIONS The AACH Faculty Development course on Teaching the Medical Interview utilized learner-centered teaching methods important to insure learning with experienced course participants. Perceived teaching and self-awareness skills changed the most when compared to other skills.
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Affiliation(s)
- David S Hatem
- American Academy on Communication in Healthcare, Chesterfield, MO, USA.
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Slingsby BT, Yamada S, Akabayashi A. Four physician communication styles in routine Japanese outpatient medical encounters. J Gen Intern Med 2006; 21:1057-62. [PMID: 16970555 PMCID: PMC1831641 DOI: 10.1111/j.1525-1497.2006.00520.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 12/28/2005] [Accepted: 04/11/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have explored how physicians approach medical encounters in Japan. OBJECTIVE This study examined how Japanese physicians conduct routine medical encounters in the context of outpatient care to patients with nonmalignant disorders. DESIGN Qualitative study using semi-structured interviews and direct observation. SETTING The outpatient department of a general hospital located in an urban area of Japan. PARTICIPANTS Physicians and nurses providing care and patients receiving care for nonmalignant disorders. RESULTS A 2-dimensional model was developed, with patient communication (how physician interacted with patients) along 1 axis, and nurse communication (how physicians collaborated with nursing staff) along the other axis. Four physician communication styles (individually adaptive, individually defined, collaboratively adaptive, and collaboratively defined) were identified as typical ways in which the Japanese physicians in the sample interacted with patients and nurses during routine medical encounters. CONCLUSIONS Results suggest the need for a multiprovider-patient model of medical communication among physician, nurse, and patient. Further research is needed to establish the applicability of this model to the communication styles of physicians in other countries.
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Lehmann F, Côté L, Bourque A, Fontaine D. Physician-Patient Interaction: A Reliable and Valid Check-list of Quality. Can Fam Physician 1990; 36:1711-1716. [PMID: 21233993 PMCID: PMC2280526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 21-item check-list is presented that evaluates the quality of the medical interview, focusing on politeness, respect, and communication. Twenty-eight interviews conducted by family medicine residents were videotaped. Using the check-list, four teachers as well as the resident evaluated each interview. Reliability and content validity were demonstrated. This list is easy to use and may enhance the learning of interviewing skills by giving objective feedback to the resident.
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