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Facilitating Learning the Clinical Interview Glori Hinck, RD, MS, DC Assistant Professor, Methods Department & Clinical Nu...
Skills related to clinical interviewing <ul><li>Introductions </li></ul><ul><li>Rapport  </li></ul><ul><li>Open ended ques...
Facilitating learning clinical interviewing skills at NWHSU <ul><li>Previously </li></ul><ul><ul><li>Lecture based with li...
Patient Interviewing Lab  University Health Service (UHS)
NWHSU Patient Interviewing Course  (Trimester 3) <ul><li>Lab 1- History of present illness/injury  (HPI) </li></ul><ul><li...
Issues with Current Methodology <ul><li>Not feasible to interview real patients </li></ul><ul><li>Mock histories & fake pa...
????  Can technology be used to facilitate learning the clinical interview?
Using Technology to Enhance Learning the Clinical Interview LITERATURE REVIEW Simulations
Simulation-based teaching & learning in health care <ul><li>Benefits </li></ul><ul><ul><li>Improve performance </li></ul><...
Simulation-based teaching & learning in health care <ul><li>Clinical interview </li></ul><ul><li>Technology-related </li><...
Virtual Patient: Medical Students <ul><li>Initial effort to create an interactive virtual clinical scenario  </li></ul><ul...
hologram
Computer-based:  Dental Students <ul><li>Web-based virtual learning environment in which student uses free text communicat...
Computer-based:  Dental Students <ul><li>Students who undertook history taking w/ VLE  prior to first patient encounter: <...
Moodle case studies
Virtual Worlds in Medical & Health Education <ul><li>Second Life ( http://secondlife.com/ </li></ul><ul><ul><li>Most popul...
Virtual Worlds in Medical & Health Education <ul><li>Access streaming audio/video </li></ul><ul><li>Browse 3-D virtual lib...
Virtual Worlds in Medical & Health Education
http://www.nmc.org/pdf/2007_Horizon_Report.pdf “…  virtual learning spaces will impact higher education and be adopted on ...
Virtual World: Pharmacy Students (UNC-Chapel Hill) <ul><li>http://its.unc.edu/InsideITS/insideitsnews/CCM1_010995   5-30-0...
Virtual world: Medical students- University of Auckland <ul><li>Actors trained as simulated patients </li></ul><ul><li>Com...
Virtual world: Nursing students- University of Auckland
Second Life Patient Interview
Student Viewpoint
Second Life Student Focus Group  <ul><li>June 16, 2009 </li></ul><ul><li>Demographics </li></ul><ul><ul><li>9 students (5 ...
Second Life Student Focus Group Survey Results  <ul><li>“ Based on the information presented in this focus group, the use ...
Second Life Student Focus Group Survey Results  <ul><li>“ I would take an elective NWHSU course involving participating in...
Second Life Student Focus Group Survey Results  <ul><li>“ Which of the following (mark all that apply) do you perceive as ...
Second Life Student Focus Group Additional comments: <ul><li>Benefits </li></ul><ul><ul><li>Exposure to a variety of diffe...
Second Life Student Focus Group Additional comments: <ul><li>General comments </li></ul><ul><ul><li>Elective or independen...
My future vision…. <ul><li>Not so future! </li></ul><ul><li>Clinical education department </li></ul><ul><ul><li>Beta test ...
Implications for Practice <ul><li>Use virtual worlds selectively for teaching & learning </li></ul><ul><li>Think outside t...
Thank You…. See you in Second Life! Dr. Glori Hinck Glorious Guisse
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Facilitating learning of the clinical interview

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Facilitating learning of the clinical interview

  1. 1. Facilitating Learning the Clinical Interview Glori Hinck, RD, MS, DC Assistant Professor, Methods Department & Clinical Nutrition Program Northwestern Health Sciences University Bloomington, MN USA
  2. 2. Skills related to clinical interviewing <ul><li>Introductions </li></ul><ul><li>Rapport </li></ul><ul><li>Open ended questions </li></ul><ul><li>Appropriate questioning techniques </li></ul><ul><li>Elicit systematic history of onset/course </li></ul><ul><li>Empathy </li></ul><ul><li>Verbal transitions </li></ul>
  3. 3. Facilitating learning clinical interviewing skills at NWHSU <ul><li>Previously </li></ul><ul><ul><li>Lecture based with limited small group sessions </li></ul></ul><ul><li>Currently </li></ul><ul><ul><li>Move from T5 to T3 </li></ul></ul><ul><ul><li>Added labs </li></ul></ul><ul><ul><li>View videotaped NWHSU interviews performed by clinicians </li></ul></ul><ul><ul><ul><li>Moodle </li></ul></ul></ul><ul><ul><li>Emphasize development of DDX’s </li></ul></ul>
  4. 4. Patient Interviewing Lab University Health Service (UHS)
  5. 5. NWHSU Patient Interviewing Course (Trimester 3) <ul><li>Lab 1- History of present illness/injury (HPI) </li></ul><ul><li>Lab 2- Individual HPI </li></ul><ul><li>Lab 3- Comprehensive health history (CHH) </li></ul><ul><li>Lab 4- Individual CHH </li></ul><ul><ul><li>Standardized patient from community </li></ul></ul><ul><ul><li>3 students split interview/patient </li></ul></ul><ul><ul><li>Grant funded </li></ul></ul><ul><li>Lab 5- CHH recorded on DVD for grading </li></ul><ul><ul><li>Upper trimester student trained as simulated patient </li></ul></ul><ul><ul><li>1:1 ratio </li></ul></ul>
  6. 6. Issues with Current Methodology <ul><li>Not feasible to interview real patients </li></ul><ul><li>Mock histories & fake patients </li></ul><ul><li>High cost of simulated patients </li></ul><ul><li>Time-intensive to organize </li></ul>
  7. 7. ???? Can technology be used to facilitate learning the clinical interview?
  8. 8. Using Technology to Enhance Learning the Clinical Interview LITERATURE REVIEW Simulations
  9. 9. Simulation-based teaching & learning in health care <ul><li>Benefits </li></ul><ul><ul><li>Improve performance </li></ul></ul><ul><ul><li>Enhance patient safety </li></ul></ul><ul><ul><li>Learn from mistakes </li></ul></ul><ul><li>Examples </li></ul><ul><ul><li>Surgical procedures </li></ul></ul><ul><ul><li>Disaster Training </li></ul></ul><ul><ul><li>Clinical- history and exam, procedures </li></ul></ul><ul><li>Health Professions </li></ul><ul><ul><li>Medicine, Nursing, Pharmacy, Psychology, Dentistry </li></ul></ul><ul><ul><li>NO mention of chiropractic </li></ul></ul>
  10. 10. Simulation-based teaching & learning in health care <ul><li>Clinical interview </li></ul><ul><li>Technology-related </li></ul><ul><ul><li>Beta testing </li></ul></ul><ul><li>Types of simulations </li></ul><ul><ul><li>Real world simulated patients </li></ul></ul><ul><ul><li>Computer-based </li></ul></ul><ul><ul><li>Virtual patients </li></ul></ul><ul><ul><li>Virtual worlds </li></ul></ul>
  11. 11. Virtual Patient: Medical Students <ul><li>Initial effort to create an interactive virtual clinical scenario </li></ul><ul><li>Life size virtual patient projected on wall of exam room </li></ul><ul><li>The VP is programmed with specific answers and gestures in response to questions asked by students- voice recognitition software </li></ul><ul><li>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. </li></ul>
  12. 12. hologram
  13. 13. Computer-based: Dental Students <ul><li>Web-based virtual learning environment in which student uses free text communication to interact with patient data </li></ul><ul><ul><li>History taking forms </li></ul></ul><ul><ul><li>Clinical Images and data </li></ul></ul><ul><ul><li>X-rays </li></ul></ul><ul><li>Randomised clinical trial using this system prior to first patient encounter. Results find…. </li></ul><ul><li>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. </li></ul>
  14. 14. Computer-based: Dental Students <ul><li>Students who undertook history taking w/ VLE prior to first patient encounter: </li></ul><ul><ul><li>Asked more relevant questions </li></ul></ul><ul><ul><li>Spent more time on patient issues </li></ul></ul><ul><ul><li>Performed a more complete history interview </li></ul></ul><ul><ul><li>Seemed to have more empathy for the patients. </li></ul></ul><ul><li>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. </li></ul>
  15. 15. Moodle case studies
  16. 16. Virtual Worlds in Medical & Health Education <ul><li>Second Life ( http://secondlife.com/ </li></ul><ul><ul><li>Most popular virtual world platform for education </li></ul></ul><ul><li>Computer/web- based simulated multi-media environment </li></ul><ul><li>3-D social network </li></ul><ul><ul><li>Users interact via avatars </li></ul></ul><ul><ul><li>Voice chat/text chat/instant messaging </li></ul></ul><ul><li>Integrate with Moodle via SLOODLE </li></ul><ul><li>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. </li></ul>
  17. 17. Virtual Worlds in Medical & Health Education <ul><li>Access streaming audio/video </li></ul><ul><li>Browse 3-D virtual libraries </li></ul><ul><li>Multi-player health related educational games </li></ul><ul><li>Attend live lectures, conferences and events </li></ul><ul><li>Build communities of learners </li></ul><ul><li>Develop clinical skills </li></ul><ul><li>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. </li></ul>
  18. 18. Virtual Worlds in Medical & Health Education
  19. 19. 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….
  20. 20. Virtual World: Pharmacy Students (UNC-Chapel Hill) <ul><li>http://its.unc.edu/InsideITS/insideitsnews/CCM1_010995 5-30-09 </li></ul>
  21. 21. Virtual world: Medical students- University of Auckland <ul><li>Actors trained as simulated patients </li></ul><ul><li>Comprehensive patient records database </li></ul><ul><ul><li>Patient history & sx </li></ul></ul><ul><ul><li>Clinical test results </li></ul></ul><ul><ul><li>Interview notes </li></ul></ul><ul><li>Clinical Scenarios </li></ul><ul><li>http://www.caudit.edu.au/educauseaustralasia09/assets/papers/monday/Scott-Diener.pdf </li></ul>
  22. 22. Virtual world: Nursing students- University of Auckland
  23. 23. Second Life Patient Interview
  24. 24. Student Viewpoint
  25. 25. Second Life Student Focus Group <ul><li>June 16, 2009 </li></ul><ul><li>Demographics </li></ul><ul><ul><li>9 students (5 women and 4 men) </li></ul></ul><ul><ul><ul><li>8 completed survey </li></ul></ul></ul><ul><ul><li>Terms 5 thru 8 </li></ul></ul><ul><ul><li>Average computer skill rated as 6/10 </li></ul></ul><ul><ul><li>None with previous experience in Second Life </li></ul></ul><ul><ul><li>Minimal experience with other virtual worlds </li></ul></ul><ul><li>Videos- Article- Discussion </li></ul><ul><li>Survey questions </li></ul>
  26. 26. Second Life Student Focus Group Survey Results <ul><li>“ Based on the information presented in this focus group, the use of virtual worlds could facilitate learning of clinical interviewing skills.” </li></ul><ul><ul><li>Yes- 5 </li></ul></ul><ul><ul><li>No- 3 </li></ul></ul><ul><ul><li>Maybe </li></ul></ul><ul><ul><li>Not enough information </li></ul></ul>
  27. 27. Second Life Student Focus Group Survey Results <ul><li>“ I would take an elective NWHSU course involving participating in a virtual world.” </li></ul><ul><ul><li>Yes </li></ul></ul><ul><ul><li>No- 2 </li></ul></ul><ul><ul><li>Maybe- 4 </li></ul></ul><ul><ul><li>Not enough information- 2 </li></ul></ul><ul><ul><li>CONCERNS: </li></ul></ul><ul><ul><li>Want electives that are hands on </li></ul></ul><ul><ul><li>Tough to add any more courses to program </li></ul></ul><ul><ul><li>Time! </li></ul></ul>
  28. 28. Second Life Student Focus Group Survey Results <ul><li>“ 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?” </li></ul><ul><ul><li>Require too much time commitment from the student- 6 </li></ul></ul><ul><ul><li>Require too much technological savvy from the student- 1 </li></ul></ul><ul><ul><li>Inadequate technological support available on campus- 6 </li></ul></ul><ul><ul><li>Not enough information- 6 </li></ul></ul><ul><ul><li>Faculty do not have the necessary knowledge- 3 </li></ul></ul>
  29. 29. Second Life Student Focus Group Additional comments: <ul><li>Benefits </li></ul><ul><ul><li>Exposure to a variety of different cases </li></ul></ul><ul><ul><ul><li>Conditions not usually seen </li></ul></ul></ul><ul><ul><li>Good for developing diagnostic skills </li></ul></ul><ul><li>Barriers/Concerns </li></ul><ul><ul><li>Time! </li></ul></ul><ul><ul><li>Interaction with professor/loss of personal touch </li></ul></ul><ul><ul><li>Concerned about electives that aren’t hands-on </li></ul></ul><ul><ul><li>Technology </li></ul></ul>
  30. 30. Second Life Student Focus Group Additional comments: <ul><li>General comments </li></ul><ul><ul><li>Elective or independent study only </li></ul></ul><ul><ul><li>Liked heart murmur simulation </li></ul></ul><ul><ul><li>Would like spinal simulations </li></ul></ul><ul><ul><li>Tie into hands-on class </li></ul></ul><ul><ul><ul><li>Have Second Life as a component of a class </li></ul></ul></ul><ul><ul><li>Credit clinic hours </li></ul></ul>
  31. 31. My future vision…. <ul><li>Not so future! </li></ul><ul><li>Clinical education department </li></ul><ul><ul><li>Beta test </li></ul></ul><ul><li>Modules </li></ul><ul><ul><li>Elective patient interviewing experience </li></ul></ul><ul><ul><li>Disability/diversity </li></ul></ul><ul><ul><ul><li>Collaborate with SL support groups </li></ul></ul></ul><ul><ul><li>International collaboration </li></ul></ul><ul><ul><li>Sports medicine module </li></ul></ul><ul><ul><ul><li>Integrate with SLOODLE </li></ul></ul></ul>
  32. 32. Implications for Practice <ul><li>Use virtual worlds selectively for teaching & learning </li></ul><ul><li>Think outside the box </li></ul><ul><ul><li>Don’t simply replicate real life and classrooms </li></ul></ul><ul><li>Research needed to make virtual worlds more accessible and user friendly </li></ul>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.
  33. 33. Thank You…. See you in Second Life! Dr. Glori Hinck Glorious Guisse

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