Interviewing Techniques as Tools for Diagnosis and Treatment, part 2: Developing More Advanced Skills The Practice of Medicine -1 Christine M. Peterson, M.D.

Techniques Are Not Results u The true endpoint of your use of techniques is the patient’s performance in the interview. l Complete (facts, concerns & requests, context) l Truthful (facts and emotions)

Skills that Convey Empathic Understanding

(REALLY PREPARE for understanding) u Re flection u Le gitimation u Per sonal support u Pa rtnership u R espect

Convey Empathic Understanding by: u Re u Le u Per u Pa u Re

Techniques Are Not Results u You need good tools (and a good plan!) in order to achieve good results….

© Tim Stewart Design

Techniques Are Not Results u However, the use of good tools does not always produce good results…..

“BEFITS”, “FOCUS”, “PREP”, “REALLY PREPARE” u Have you witnessed effective use of any of these skills in medical school so far?

“BEFITS”, “FOCUS”, “PREP”, “REALLY PREPARE” u Which skills seem easiest and most natural to you? u Which skills seem most challenging?

Feedback vs. Evaluation

Evaluation - by supervisor u Evaluation: “To examine and judge” (Random House Dictionary, emphasis added)

Interviewer’s actionPatient’s response Evaluation Observer evaluatesReport

Feedback u Feedback: “Knowledge of the results of any behavior, considered as influencing or modifying further performance” (Random House Dictionary, emphasis added)

Interviewer’s actionPatient’s response Feedback Loop

Interviewer’s action Patient’s response Observer’s impression and comment to interviewer Feedback Loop

Interviewer’s action Patient’s response Observation; Comment to interviewer Interviewer’s reflection Feedback Loop

Interviewer’s new action Patient’s new response Interviewer’s reflection Feedback Loop

Interviewer’s action Patient’s response Observer’s next comment Interviewer’s reflection Feedback Loop

Evaluation vs. Feedback

Ende, J. Feedback in clinical medical education. JAMA 1983; 250(6): Feedback Characteristics, part 1 u Based on first-hand observation u Limited to remediable behaviors (decisions and actions, not presumed intentions or interpretations) u Descriptive, non-evaluative terms

Ende J., Feedback in clinical medical education. JAMA 1983; 250(6): Feedback Characteristics, part 2 u Specific performance u Can offer overtly subjective data u Avoid the “perils of praise” - a steady diet of praise can be addicting

Examples:Examples: u Evaluation: “Your interviewing technique is really good - better than most interns.” u Feedback: “When you let the patient talk without interrupting her, she gave you a couple of details that will be really helpful in figuring out her diagnosis.”

Examples:Examples: u Evaluation: “You did a great job eliciting the patient’s concerns.” u Feedback: “When you asked the patient to tell you more about his job situation, he was able to let you know how worried he is about losing his job because of his injury.”

Examples:Examples: u Evaluation: “Your use of touch was appropriate and effective.” u Feedback: “When you touched the patient’s hand after she told you her mother had recently died, she seemed more comfortable with you and immediately gave you more details about her concerns.”

Examples:Examples: u Evaluation: “You shouldn’t interrupt when the patient is talking.” u Feedback: “When you asked a question before the patient had finished answering the previous one, his responses became shorter and less informative.”

Examples:Examples: u Evaluation: “That wasn’t very good. I don’t think the patient trusts you at all.” u Feedback: “When you skirted the patient’s question about side effects, she stopped asking questions and seemed to lose interest.”

Delivering feedback, part 1 u Understand learner’s goals u Choose appropriate (expected) timing u Start by eliciting self-observations

Delivering feedback, part 2 u Feedback “sandwich”: positive / negative / positive u “When … / then …” statements

u A good teacher can evaluate anyone…

u But a great teacher can provide feedback to anyone.

Videos and Role Play u Practice observing others u Practice giving feedback u Practice skills u (Practice being in the patient’s position)

u Video #