1. Paired Observation and Video Editing Blending Continuous Feedback and Self-Directed Learning to Assess Communication Competency Larry Mauksch, M.Ed, University of Washington

2. Challenges in Teaching and Assessing Communication in Medicine Many people lack specific language to describe communication and relationship components such as skills, cues, and interview phases. This limitation of language impedes one’s capacity to learn, to teach and to assess competency, promoting the feeling of ineffable inadequacy. Many people lack specific language to describe communication and relationship components such as skills, cues, and interview phases. This limitation of language impedes one’s capacity to learn, to teach and to assess competency, promoting the feeling of ineffable inadequacy.

3. Challenges in Teaching and Assessing Communication in Medicine Without relegated time, its difficult for learners to intentionally practice, reflect, refine and integrate important communication habits. Without relegated time, its difficult for learners to intentionally practice, reflect, refine and integrate important communication habits.

4. Goals: Paired Observation and Video Editing To develop conscious control of specific skills. To develop conscious control of specific skills. To demonstrate “growing competence” in using core interviewing skills. To demonstrate “growing competence” in using core interviewing skills. To develop an an articulate “observer self”. To develop an an articulate “observer self”. To promote the learner’s ability to reflect on and refine communication skill use. To promote the learner’s ability to reflect on and refine communication skill use. To create a feasible educational model. To create a feasible educational model.

5. Course Philosophy Clinicians have a strong, but often undisclosed desire to become more effective communicators. Clinicians have a strong, but often undisclosed desire to become more effective communicators. If given the language, time, and responsibility, trainees will help one another increase competence. If given the language, time, and responsibility, trainees will help one another increase competence. Assessment and learning should be part of one integrated, ongoing process. Assessment and learning should be part of one integrated, ongoing process.

6. Differentiation Before Integration When the trainee is given the task of observing behavior (of oneself or a partner) and categorizing behavior, his/her understanding becomes more precise. When the trainee is given the task of observing behavior (of oneself or a partner) and categorizing behavior, his/her understanding becomes more precise. As one’s ability to describe skills becomes more precise, so can the practice of these (micro)skills. As one’s ability to describe skills becomes more precise, so can the practice of these (micro)skills. The degree of one’s language specificity (differentiation) for describing interview components is proportional to one’s versatility as a maturing clinician(integration). The degree of one’s language specificity (differentiation) for describing interview components is proportional to one’s versatility as a maturing clinician(integration).

7. Course Design 4 weeks Instructor(s) meets with students regularly for: Instructor(s) meets with students regularly for: Mini talks: sequenced in the order of interview phases, plus counseling topics ( 8 hours) Mini talks: sequenced in the order of interview phases, plus counseling topics ( 8 hours) Reflection and video review (6-8 hours) Reflection and video review (6-8 hours) Students always see patients together alternating roles as observer and interviewer. Students always see patients together alternating roles as observer and interviewer. Interviews are videotaped with patient consent Interviews are videotaped with patient consent Students view videotapes of prior students Students view videotapes of prior students Students create and present video of learning Students create and present video of learning

8. Mini Talk Topics 4 week course (8 hours of presentation) Orientation to course (30 min) Orientation to course (30 min) Giving and receiving feedback (15 min) Giving and receiving feedback (15 min) Video recording, editing and patient consent (60 min-2 talks) Video recording, editing and patient consent (60 min-2 talks) Agenda Setting(45 min) Agenda Setting(45 min) Eliciting the patient perspective(45 min) Reaching common ground(30 min) Family assessment and relational questions (1 hour, 2 talks) M I / primary care counseling (2-3 hours 2-4 talks)

9. Paired Observation Check lists (PCOF) are used to structure feedback Check lists (PCOF) are used to structure feedback Students develop an an articulate “observer self” from: Students develop an an articulate “observer self” from: *Tracking skill use of their partner and *Tracking skill use of their partner and Receiving feedback Receiving feedback *Students learn teamwork skills *Students learn teamwork skills *unexpected outcome

10. Video Editing: Instructions for Students Show me your growth by including: Show me your growth by including: Baseline skills Baseline skills Struggles with learning Struggles with learning Competency Competency Don’t address everything you learned Don’t address everything you learned Protect time in advance for review and editing Protect time in advance for review and editing A secondary goal is to create a teaching tape A secondary goal is to create a teaching tape Be creative and have fun! Be creative and have fun!

11. Video Editing Tips Orientation takes < 40 minutes (iMovie) Orientation takes < 40 minutes (iMovie) Introduce students to editing by using three, one minute clips of themselves in role play Introduce students to editing by using three, one minute clips of themselves in role play Use software tutorial programs Use software tutorial programs Video should be no longer than 30 minutes Video should be no longer than 30 minutes Use short clips, 15 seconds to 3 minutes Use short clips, 15 seconds to 3 minutes Clips should include enough lead to create context for the viewer-- 3-10 seconds Clips should include enough lead to create context for the viewer-- 3-10 seconds

12. Video Editing- Costs and Equipment Current prices of PCs and Macs between $1400 and $3000 and beyond Current prices of PCs and Macs between $1400 and $3000 and beyond Get lots of RAM - at least 256, > 640 better $100-300 Get lots of RAM - at least 256, > 640 better $100-300 Consider buying extra hard drive for storage and faster editing $500-1000 Consider buying extra hard drive for storage and faster editing $500-1000 Use a digital video camera. The newer flip style cameras work well (we like the Kodak Zi8) Use a digital video camera. The newer flip style cameras work well (we like the Kodak Zi8)

13. Course Reading If the Spirit Catches You Fall Down, by Anne Fadiman (understanding the value of patient, family, community and cultural perspectives) If the Spirit Catches You Fall Down, by Anne Fadiman (understanding the value of patient, family, community and cultural perspectives) Patient Centered Medicine by Stewart et al Patient Centered Medicine by Stewart et al Many selected articles on: Many selected articles on: Overview of health communication Overview of health communication Elements and phases of interviewing Elements and phases of interviewing e.g., Kalamazoo Statement, Establishing Focus, Clues to Patient Explanations…, family assessment, etc. e.g., Kalamazoo Statement, Establishing Focus, Clues to Patient Explanations…, family assessment, etc. Primary care counseling/Motivational Interviewing Primary care counseling/Motivational Interviewing

14. Faculty Logistics Faculty Logistics Preceptors must be oriented, hopefully trained Preceptors must be oriented, hopefully trained Nursing staff need to be included to make sure patient flow is not adversely affected Nursing staff need to be included to make sure patient flow is not adversely affected Protect time in the preceptors’ schedule for teaching Protect time in the preceptors’ schedule for teaching Distribute schedules ahead of time to all involved Distribute schedules ahead of time to all involved Protect student time for video review Protect student time for video review

15. Logistical Instructions for Students Orient nursing staff and preceptors in advance of each clinic Orient nursing staff and preceptors in advance of each clinic Protect time for video review and logging Protect time for video review and logging Never see two patients at the same time, especially with the same preceptor Never see two patients at the same time, especially with the same preceptor Protect time in advance for student video presentation Protect time in advance for student video presentation

16. Summary of a 4 Week Course Student pairs see 40-50 patients and fill out feedback forms on all patients. Student pairs see 40-50 patients and fill out feedback forms on all patients. 75% of patients consent to be videotaped 75% of patients consent to be videotaped Edited videotapes use 10-20 patients, some patients up to 6 times to tell a story. Edited videotapes use 10-20 patients, some patients up to 6 times to tell a story. Final video is no longer than 30 minutes. Final video is no longer than 30 minutes. Student video presentations easily take 90 minutes because discussion is lively. Student video presentations easily take 90 minutes because discussion is lively.

17. Limitations Not all rotations would work Not all rotations would work Decreased patient volume (absolute) Decreased patient volume (absolute) AV equipment has start-up cost AV equipment has start-up cost Some people may have difficulty working in pairs, learning to accept and give feedback Some people may have difficulty working in pairs, learning to accept and give feedback Paired observation may feel burdensome to preceptors Paired observation may feel burdensome to preceptors Design deserves more research Design deserves more research

18. Other Applications Paired Observation, alone, useful for: Paired Observation, alone, useful for: Medical student and Residency training Medical student and Residency training Faculty development Faculty development CME CME Students can create tapes to teach others Students can create tapes to teach others Senior students/residents become role models Senior students/residents become role models Videotapes(or CDs or DVDs) become portfolios Videotapes(or CDs or DVDs) become portfolios