Using Spark MediaMarkup in the Rheumatology Outpatient Setting: Teaching Clinical Skills and Compassionate Care Together Robert A Kalish, MD Malgorzata Inez Dawiskiba, Medical Student Maria Alejandra Blanco, EdD Tufts University School of Medicine

Goals of this Talk 1.Demonstrate the application of Sparks MediaMarkups to a videotaped clinical exercise to provide feedback and promote self assessment and reflective learning. 2.Discuss lessons learned.

Goal of Exercise To raise medical student awareness of compassionate care opportunities in the setting of a videotaped rheumatologic patient-partner experience

Curriculum Participants & Setting Third-Year Tufts Medical Students rotating through the ambulatory block of their Internal Medicine Clerkship. Setting: Tufts Medical Center. Real patients with real diagnoses volunteer to present their stories as unknowns to the students (classic differential diagnosis exercise).

Protocol: Videotaped Patient–Partner Exercise Day of Patient-Partner Exercise: A patient with a known rheumatologic diagnosis is presented to the student as an unknown diagnosis. The student is to “pretend” they are the patient’s rheumatologist and have to determine the patient’s work-up and diagnosis Students complete a full history and physical exam. The exercise is videotaped.

Protocol: Videotaped Patient–Partner Exercise After the Patient-Partner Exercise: Students and preceptor independently observe the videotaped patient-partner exercise utilizing Spark MediaMarkup software to tag video segments with identified and missed opportunities for 1.compassion 2.rheumatologic history taking skills. Students and preceptor independently complete the compassionate care interactions global rating form to assess student’s compassionate care skills after viewing the videotape.

Elements of Interviewing Quality of Student Interviewing History Taking – Rheumatology Specific Excellent Very Good Good Fair Poor CA* Symptom details – elicits location, nature of pain, radiation, timing within the day (e.g..AM stiffness, constant or not?), exacerbating features CA Temporal sequence (over days, weeks, years) - elicits onset, order of symptoms, modulation CA Rheum “history cassettes”- asks relevant cassettes CA Symptom effects- inquires about effectson function, mood, relationships/social life CA Compassionate Care InteractionsExcellent Very Good Good Fair Poor CA* Respect- treats the patient non-judgmentally and respects his/her perspective CA Attentive Listening- attentively listens to the patient by paying attention to the details of the patient’s problems and complaints; maintains eye contact CA Validation of the Patient’s Emotions & Perspectives- enables the patient to express his/her point of view and emotions about his/her illness and medical care; communicates the legitimacy of these expressions CA Compassionate Empathy- communicates understanding of the patient’s concern/suffering/pain/feelings, and shows a desire to comfort the patient and offer help CA Forbearance-attempts to understand the patient’s manner of communication without showing annoyance, and refrains from expressing frustration if the patient does not understand CA

Spark MediaMarkUp A website for interactive viewing and commentary (Dave Grogan, Tufts University Information Technology). Allows videos to be viewed by multiple individuals on their own at a time of their convenience and choosing. Allows the viewer to stop the video at any time and write in or tag a comment about what they are seeing at any specific time. Limits viewers to those selected by an administrator or teacher.

Sample Video: Rheumatology Patient-Partner Experience

Student: “I think this is a missed opportunity for a compassionate interaction. I continue to ask about about symptoms, but neglect to ask how those symptoms affect her activities of daily living, and how she copes and how she feels about her condition.” Preceptor: “Good observation and would often apply. In this case so much about how this disease has affected her life and the difficulties it has caused has already come out it is OK to be pressing on with the more purely medical information you need.”

Students highlighted the following pros of videotaping the experience: “I remember at the time thinking that one part was [very] compassionate and then I watched the video and thought that [it was] so contrived, there is nothing compassionate about that! I think the video was helpful in that way…” “It was important to see sometimes we are so concentrated on ourselves and what we need to get done that we ignore the patient.” “I think the added benefit to [the video] was that you can actually go back and see what [the preceptor’s] feedback pertains to.”

Students highlighted the following cons of videotaping the experience: “Even with videotape, you know someone else is watching, and it’s going to affect the interaction, it’s going to take away from it, so it’s hard.” “I thought the setup was awkward… you’d never interview a patient sitting side by side, the way the chairs were setup.”

Conclusions 1)The teaching and learning of compassionate care in the setting of an outpatient clinical skills exercise is a feasible and valuable component of a medical school curriculum. 2)The utilization of MediaMarkup videotaped feedback proved to be an effective format for promoting student self-reflection and self- assessment.

Other potential uses of MediaMarkup Teaching –Physical examination demonstration –Skit or trigger tape with patient and/or actors –Student role playing –Peer feedback Assessment –Demonstrate specific skills Patient testimony –Record classic history –Patient reflection –Patient feedback to student

Thank You! Special Thanks To: David Grogan, Manager, Curricular Technology Group TMS 4’s: Jacob Berman, Ryan Sullivan, David Tsai,