Paired Paired Observation and Observation and

Video EditingVideo Editing(POVE)(POVE)Blending Continuous Peer Feedback Blending Continuous Peer Feedback and Reflection to and Reflection to

Strengthen Communication TrainingStrengthen Communication Training

Larry Mauksch, M.Ed, University of WashingtonLarry Mauksch, M.Ed, University of Washington

AcknowledgmentsAcknowledgments

Angel Platus, MDAngel Platus, MD

Kim O’Conner, MDKim O’Conner, MD

Stu Farber, MDStu Farber, MD

Tom Greer, MD, MPHTom Greer, MD, MPH

Many in this roomMany in this room

A challenge in teaching and A challenge in teaching and assessingassessing

communication in medicine…communication in medicine…

Without protected time, it is difficult Without protected time, it is difficult

for learners to intentionallyfor learners to intentionally….….

Practice Practice

Define Define

ReflectReflect upon upon

Refine the use ofRefine the use of

AssessAssess

IntegrateIntegrate

……communication skillscommunication skills

Goals: Goals: Paired Paired Observation Observation

and Video Editingand Video Editing To help students develop a lasting, To help students develop a lasting,

articulate “observer self”--the ability to articulate “observer self”--the ability to

reflect on and refine (communication) skill reflect on and refine (communication) skill

use to optimize interactions with patients.use to optimize interactions with patients.

To demonstrate “growing competence” in To demonstrate “growing competence” in

using core communication skills.using core communication skills.

To create a learning laboratory for facultyTo create a learning laboratory for faculty

Course PhilosophyCourse Philosophy Clinicians have a strong, but often Clinicians have a strong, but often

undisclosed desire to become more undisclosed desire to become more effective communicators.effective communicators. They experience They experience ineffable inadequacyineffable inadequacy

If given the language, time, and If given the language, time, and responsibility, trainees will help one responsibility, trainees will help one another increase competence.another increase competence.

Assessment and learning should be part of Assessment and learning should be part of one integrated, ongoing process.one integrated, ongoing process.

Differentiation Precedes Differentiation Precedes IntegrationIntegration

Observing and categorizing Observing and categorizing behavior enhances articulation behavior enhances articulation

One’s precision (differentiation) in One’s precision (differentiation) in describing skills is proportional to describing skills is proportional to one’s ability to be creative in skill one’s ability to be creative in skill application (integration).application (integration).

With a distant reference to Michael Polyani’s book, Personal Knowledge

Course Design: 4 weeksCourse Design: 4 weeks

Paired Observation PhasePaired Observation Phase 3 weeks3 weeks

Video Editing and Presentation Video Editing and Presentation PhasePhase 1 week1 week

Paired Observation: Paired Observation: First 3 weeksFirst 3 weeks

Students see patients on preceptors’ scheduleStudents see patients on preceptors’ schedule They They alwaysalways see patients together alternating see patients together alternating

roles as observer and “physician” roles as observer and “physician” Tracking forms are used to:Tracking forms are used to:

structure observation and feedbackstructure observation and feedback catalog interviews for video editingcatalog interviews for video editing

Instructor(s) give mini didactics, review videos Instructor(s) give mini didactics, review videos and discuss encounters with studentsand discuss encounters with students

Interviews are videotaped, with patient consentInterviews are videotaped, with patient consent

Mini Talk TopicsMini Talk Topics4 week course (12-14 hours of 4 week course (12-14 hours of

presentation)presentation) Orientation to courseOrientation to course

Giving and receiving Giving and receiving

feedbackfeedback

Video recording, editing Video recording, editing

and patient consentand patient consent

Overview: relationship, Overview: relationship,

communication and communication and

efficiencyefficiency

Mindful practiceMindful practice

Upfront, collaborative Upfront, collaborative

agenda settingagenda setting Eliciting the patient Eliciting the patient

perspectiveperspective Reaching common Reaching common

groundground Family assessmentFamily assessment Behavior change / Behavior change /

primary care counselingprimary care counseling Requested topicsRequested topics

Schedule: Paired Schedule: Paired Observation Observation

MonMon TuesTues WedWed ThursThurs FriFriOrient, Orient, Giving Giving FeedbacFeedbackk

ClinicClinic

Agenda Agenda settingsetting

ClinicClinic

ClinicClinic ClinicClinic

DebriefDebrief

ClinicClinic

Shared Shared DecisioDecisionn

ClinicClinic

OverviewOverview

ClinicClinic

DebriefDebrief

Cues Cues and PPIand PPI

ClinicClinic

ClinicClinic

Video Video reviewreview

ClinicClinic

Tape Tape catalogcatalog

Video Editing-4th weekVideo Editing-4th week Students create a Students create a video essayvideo essay examining examining

their growththeir growth

Students design, film and edit a role-Students design, film and edit a role-

played played teaching tapeteaching tape

Students present their work in one or Students present their work in one or

more interactive seminars to fellow more interactive seminars to fellow

students, residents and facultystudents, residents and faculty

Videotape Editing:Videotape Editing: Instructions for Students Instructions for Students

For video essay, “study your growth by For video essay, “study your growth by

including..”:including..”: Baseline skillsBaseline skills

StrugglesStruggles

Best performancesBest performances

Use protected time to review, catalog and Use protected time to review, catalog and

editedit Create a teaching tapeCreate a teaching tape Be creative and have fun!Be creative and have fun!

Schedule: Video Editing Schedule: Video Editing MonMon TuesTues WedWed ThursThurs FriFri

Video Video review review and and editingediting

ClinicClinic Video Video review review and and editingediting

TeachinTeaching tape g tape creatiocreationn

EvalEval

TeachinTeaching tape g tape creatiocreationn

Video Video review review and and editingediting

Video Video review review and and editingediting

PresentPresent TeachinTeaching tape g tape creatiocreationn

PresentPresent

Summary of a 4 Week Summary of a 4 Week CourseCourse

Student pairs see 50-60 patients in 3 Student pairs see 50-60 patients in 3 weeks weeks

75% of patients consent to be videotaped75% of patients consent to be videotaped

Video essay is 25- 30 minutes.Video essay is 25- 30 minutes.

Video essay presentations easily take 90 Video essay presentations easily take 90 minutes because discussion is expansive.minutes because discussion is expansive.

Teaching tapes have been used to train Teaching tapes have been used to train hundreds of students and facultyhundreds of students and faculty

All students demonstrate All students demonstrate growth in:growth in:

Upfront collaborative agenda settingUpfront collaborative agenda setting

Picking up on patient cues and Picking up on patient cues and

exploring patient, family and cultural exploring patient, family and cultural

perspectiveperspective

Expression of empathyExpression of empathy

Reaching mutual agreement on a planReaching mutual agreement on a plan

EfficiencyEfficiency

Student EvaluationsStudent Evaluations( 11 pairs of 4th year students)( 11 pairs of 4th year students) ““Peak experience”Peak experience” ““Best course in medical school”Best course in medical school” Students feel:Students feel:

More organizedMore organized More able attend to the patientsMore able attend to the patients More able to learn about disease, More able to learn about disease,

because they are…because they are… Less anxious about time managementLess anxious about time management Interviewing is less mysteriousInterviewing is less mysterious

POVE - secondary POVE - secondary outcomesoutcomes

Faculty learningFaculty learning

Students learn teamwork skillsStudents learn teamwork skills

Student pairs are efficientStudent pairs are efficient

Contribution to the educational Contribution to the educational

communitycommunity

Other ApplicationsOther Applications Use only Paired Observation (no video): Use only Paired Observation (no video):

Medical student / Residency training on a larger scale Medical student / Residency training on a larger scale

Faculty developmentFaculty development

CMECME

Conceptual preparation can be done without Conceptual preparation can be done without

faculty time: videos, reading, Powerpointfaculty time: videos, reading, Powerpoint

Videotapes(or CDs or DVDs) become portfoliosVideotapes(or CDs or DVDs) become portfolios

LimitationsLimitations

Not all rotations would workNot all rotations would work Decreased patient volume?Decreased patient volume? Start-up cost for AV and computer Start-up cost for AV and computer

equipment equipment Some people may have difficulty learning to Some people may have difficulty learning to

accept and give feedbackaccept and give feedback Paired observation may feel burdensome to Paired observation may feel burdensome to

preceptors (…but it takes no more time)preceptors (…but it takes no more time) POVE design deserves research…POVE design deserves research…

Video Editing TipsVideo Editing Tips

Orientation takes < 40 minutes (iMovie 2)Orientation takes < 40 minutes (iMovie 2)

Introduce students to editing by using three, Introduce students to editing by using three,

one minute clips of themselves in role playsone minute clips of themselves in role plays

Use software tutorial programsUse software tutorial programs

Tapes should be no longer than 30 minutesTapes should be no longer than 30 minutes

Use short clips, 15 seconds to 3 minutesUse short clips, 15 seconds to 3 minutes

Clips should include enough lead to create Clips should include enough lead to create

context for the viewer-- 3-10 secondscontext for the viewer-- 3-10 seconds

Video Editing- Video Editing- Costs and EquipmentCosts and Equipment

Current prices of PCs and Macs between Current prices of PCs and Macs between

$1100 and $2500 and beyond$1100 and $2500 and beyond Get lots of RAM - at least 512; 1gig betterGet lots of RAM - at least 512; 1gig better

Consider buying extra hard drive for storage Consider buying extra hard drive for storage

and faster editing and faster editing

Using analog cameras requires purchase Using analog cameras requires purchase

of analog to digital converter, about $300of analog to digital converter, about $300

Cost of VCR, monitor and tapesCost of VCR, monitor and tapes

Logistical ConsiderationsLogistical Considerations Preceptors must be oriented, trained if Preceptors must be oriented, trained if

possiblepossible Great way to reinforce resident learning and Great way to reinforce resident learning and

educate facultyeducate faculty Distribute precepting across several senior Distribute precepting across several senior

residents and facultyresidents and faculty Nursing staff need to be included to make Nursing staff need to be included to make

sure patient flow is not adversely affectedsure patient flow is not adversely affected Protect time in the preceptor’s schedule Protect time in the preceptor’s schedule Distribute schedules ahead of time to all Distribute schedules ahead of time to all

involvedinvolved

Logistical Instructions for Logistical Instructions for StudentsStudents

Meet nursing staff and preceptors in Meet nursing staff and preceptors in

advance of each clinicadvance of each clinic Protect time for video review and loggingProtect time for video review and logging Never see two patients at the same time, Never see two patients at the same time,

especially with the same preceptorespecially with the same preceptor Protect time in advance for student video Protect time in advance for student video

presentationpresentation

POVE DISSEMINATION POVE DISSEMINATION PROJECTPROJECT

Funded by Arthur Vining Davis Funded by Arthur Vining Davis FoundationsFoundations

Three year program to create a Three year program to create a learning community with 9 medical learning community with 9 medical schoolsschools

GoalsGoals

To disseminate the POVE modelTo disseminate the POVE model To stimulate faculty exploration of To stimulate faculty exploration of

how to teach and how students learnhow to teach and how students learn To provide an in-house resource for To provide an in-house resource for

the creation of training tapesthe creation of training tapes To study the learning process of To study the learning process of

medical students and their teachersmedical students and their teachers

Participants ReceiveParticipants Receive

Three day training in Seattle (winter, 07’)Three day training in Seattle (winter, 07’)

Computer with video editing softwareComputer with video editing software

Curriculum and site visitCurriculum and site visit

Three day learning & evaluation conference in Three day learning & evaluation conference in

Seattle for one faculty and two students (fall, Seattle for one faculty and two students (fall,

08’)08’)

POVE Research POVE Research

Web surveys of faculty and studentsWeb surveys of faculty and students Qualitative and QuantitativeQualitative and Quantitative

Learning and Evaluation conference Learning and Evaluation conference Focus groupsFocus groups

FacultyFaculty StudentsStudents

Video essay reviewsVideo essay reviews Teaching tape reviewsTeaching tape reviews

Pre-post tape comparisonPre-post tape comparison

www.fammed.washington.edu/pove