Facilitating learning of the clinical interview

Facilitating Learning the Clinical Interview

Glori Hinck, RD, MS, DCAssistant Professor, Methods Department & Clinical Nutrition ProgramNorthwestern Health Sciences UniversityBloomington, MN USA

Skills related to clinical interviewing

•Introductions•Rapport •Open ended questions•Appropriate questioning techniques•Elicit systematic history of onset/course•Empathy•Verbal transitions

Facilitating learning clinical interviewing skills at NWHSU

•Previously• Lecture based with limited small group

sessions•Currently

• Move from T5 to T3• Added labs• View videotaped NWHSU interviews

performed by clinicians• Moodle

• Emphasize development of DDX’s

Patient Interviewing Lab University Health Service (UHS)

NWHSU Patient Interviewing Course (Trimester 3)• Lab 1- History of present illness/injury (HPI)• Lab 2- Individual HPI • Lab 3- Comprehensive health history (CHH)• Lab 4- Individual CHH

▫Standardized patient from community▫3 students split interview/patient▫Grant funded

• Lab 5- CHH recorded on DVD for grading ▫Upper trimester student trained as simulated

patient ▫1:1 ratio

Issues with Current Methodology

•Not feasible to interview real patients

•Mock histories & fake patients

•High cost of simulated patients

•Time-intensive to organize

???? Can technology be used to

facilitate learning the clinical interview?

Using Technology to Enhance Learning the Clinical Interview

LITERATURE REVIEWSimulations

Simulation-based teaching & learning in health care• Benefits

▫Improve performance▫Enhance patient safety▫Learn from mistakes

• Examples▫Surgical procedures▫Disaster Training▫Clinical- history and exam, procedures

• Health Professions▫Medicine, Nursing, Pharmacy, Psychology, Dentistry▫NO mention of chiropractic

Simulation-based teaching & learning in health care

•Clinical interview•Technology-related

▫Beta testing•Types of simulations

▫Real world simulated patients▫Computer-based ▫Virtual patients▫Virtual worlds

Virtual Patient:Medical Students

• Initial effort to create an interactive virtual clinical scenario

•Life size virtual patient projected on wall of exam room

•The VP is programmed with specific answers and gestures in response to questions asked by students- voice recognitition software

Stevens, A., et. al. The use of virtual patients to teach medical students history taking and communication skills. 2006. American Journal of Surgery. 191(6) 806-811.

hologram

Computer-based: Dental Students

• Web-based virtual learning environment in which student uses free text communication to interact with patient data▫ History taking forms▫ Clinical Images and data▫ X-rays

• Randomised clinical trial using this system prior to first patient encounter. Results find….

Schittek, J.M. et. al. Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills. European Journal of Dental Education. 2004. 8(11) 111-119.

Computer-based: Dental Students

• Students who undertook history taking w/ VLE prior to first patient encounter:▫ Asked more relevant questions▫ Spent more time on patient issues▫ Performed a more complete history interview ▫Seemed to have more empathy for the patients.

Schittek, J.M. et. al. Simulation of patient encounters using a virtual patient in periodontology instruction of dental students: design, usability, and learning effect in history-taking skills. European Journal of Dental Education. 2004. 8(11) 111-119.

Moodle case studies

Virtual Worlds in Medical & Health Education

• Second Life (http://secondlife.com/▫ Most popular virtual world platform for education

• Computer/web- based simulated multi-media environment

• 3-D social network▫ Users interact via avatars▫ Voice chat/text chat/instant messaging

• Integrate with Moodle via SLOODLE

Boulos, M.N., Hetherington, L., & Wheeler, S. 2007. Second Life: an overview of the potential of 3-D virtual worlds in medical & health education. Health Information and Libraries Journal. 24. 233-245.


• Access streaming audio/video• Browse 3-D virtual libraries• Multi-player health related educational games• Attend live lectures, conferences and events• Build communities of learners• Develop clinical skills


http://www.nmc.org/pdf/2007_Horizon_Report.pdf

“… virtual learning spaces will impact higher education and be adopted on a wide scale basis

within the next two to three years….

Virtual World:Pharmacy Students (UNC-Chapel Hill)

http://its.unc.edu/InsideITS/insideitsnews/CCM1_010995 5-30-09

Virtual world:Medical students- University of Auckland

• Actors trained as simulated patients

• Comprehensive patient records database▫ Patient history & sx▫Clinical test results▫ Interview notes

• Clinical Scenarios

http://www.caudit.edu.au/educauseaustralasia09/assets/papers/monday/Scott-Diener.pdf

Virtual world:Nursing students- University of Auckland

Second Life Patient Interview

Student Viewpoint

Second Life Student Focus Group •June 16, 2009•Demographics

▫9 students (5 women and 4 men) 8 completed survey

▫Terms 5 thru 8▫Average computer skill rated as 6/10▫None with previous experience in Second Life▫Minimal experience with other virtual worlds

•Videos- Article- Discussion•Survey questions

Second Life Student Focus GroupSurvey Results

“Based on the information presented in this focus group, the use of virtual worlds could facilitate learning of clinical interviewing skills.”

a. Yes- 5b. No- 3c. Maybed. Not enough information

Second Life Student Focus GroupSurvey Results “I would take an elective NWHSU course

involving participating in a virtual world.”a. Yesb. No- 2c. Maybe- 4d. Not enough information- 2

CONCERNS: ▫ Want electives that are hands on▫ Tough to add any more courses to program▫ Time!

Second Life Student Focus GroupSurvey Results

“Which of the following (mark all that apply) do you perceive as a barrier to the use of virtual worlds such as Second Life at NWHSU?”

a. Require too much time commitment from the student- 6

b. Require too much technological savvy from the student- 1

c. Inadequate technological support available on campus- 6

d. Not enough information- 6e. Faculty do not have the necessary knowledge- 3

Second Life Student Focus GroupAdditional comments:

•Benefits▫Exposure to a variety of different cases

Conditions not usually seen▫Good for developing diagnostic skills

•Barriers/Concerns▫Time!▫ Interaction with professor/loss of personal touch▫Concerned about electives that aren’t hands-on▫Technology

Second Life Student Focus GroupAdditional comments:

•General comments▫Elective or independent study only▫Liked heart murmur simulation▫Would like spinal simulations▫Tie into hands-on class

Have Second Life as a component of a class▫Credit clinic hours

My future vision….

•Not so future!•Clinical education department

▫Beta test•Modules

▫Elective patient interviewing experience▫Disability/diversity

Collaborate with SL support groups▫International collaboration▫Sports medicine module

Integrate with SLOODLE

Implications for Practice

•Use virtual worlds selectively for teaching & learning

•Think outside the box▫Don’t simply replicate real life and

classrooms•Research needed to make virtual worlds

more accessible and user friendly


Thank You….See you in Second Life!

Dr. Glori HinckGlorious Guisse

Facilitating learning of the clinical interview

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