2. >>0 >>1 >> 2 >> 3 >> 4 >> Good Morning! Please come forward to the flipchart & answer the following questions: 1. How do you evaluate communication skills?  direct observation  1:1 video review  group video review  simulate patients  role play  other _____________ 2. Do you have intentional teaching on giving peer to peer feedback?

3. >>0 >>1 >> 2 >> 3 >> 4 >> “ I get by with a little help from my friends” Benefits of Peer Video Review Amy Odom, DO Amy Romain, LMSW ACSW Sparrow/MSU Family Medicine Residency Program 2014 Forum for Behavioral Science in Family Medicine

4. >>0 >>1 >> 2 >> 3 >> 4 >> We have nothing to disclose!

5. >>0 >>1 >> 2 >> 3 >> 4 >> Objectives Understand the benefits of conducting peer review of provider encounters as a component of a curriculum on patient- centered communication Use and/or adapt a format for peer review of provider encounters in you own setting Link peer evaluation direct observation to behavioral medicine milestone achievements

6. >>0 >>1 >> 2 >> 3 >> 4 >> Agenda Benefits of peer video review Process of doing peer video review –Tools for giving feedback –Tool for evaluating video review Video examples Resident testimony Evaluation process linked to the milestones

7. >>0 >>1 >> 2 >> 3 >> 4 >> Methods for Assessing Communication Skills What are you doing (survey results) ? Direct Observation Video Review Role Playing Simulated patients Other Intentional teaching of peer to peer feedback?

8. >>0 >>1 >> 2 >> 3 >> 4 >> Benefits of Peer Video Review Slam Dunk! Added SkillsEfficient Low Intimidation

9. >>0 >>1 >> 2 >> 3 >> 4 >> Benefits of Peer Video Review Residents gain skills in the art of giving feedback to peers

10. >>0 >>1 >> 2 >> 3 >> 4 >> Benefits of Peer Video Review Feedback from peers is meaningful

11. >>0 >>1 >> 2 >> 3 >> 4 >> Benefits of Peer Video Review Learning opportunities are multiplied

12. >>0 >>1 >> 2 >> 3 >> 4 >> Benefits of Peer Video Review I am about to tell you something not positive but I have the same trouble you do –normalizes the negative, makes it less personal

13. >>0 >>1 >> 2 >> 3 >> 4 >> Video Review Tools Patient Centered Observation Form

14. >>0 >>1 >> 2 >> 3 >> 4 >> Video Review Tools Patient Centered Observation Form –division of expectations based on year –laminated copies –copies for review/self-evaluation prior to group session Makes reviews objectives Gives language for identifying specific positive behaviors

15. >>0 >>1 >> 2 >> 3 >> 4 >> Feedback Tools Plus - Delta Makes less personal, more behavioral focus Nurtures out self- criticism

16. >>0 >>1 >> 2 >> 3 >> 4 >> Feed Back Tools –Good - Better - Best –Acknowledging the positives with goal of advancing achievement

17. >>0 >>1 >> 2 >> 3 >> 4 >> How we do this: Interns Peer video review sessions –Small groups (4-5 residents) + 2 faculty –Intern year Behavioral Med Rotation (resources can be found on FMDRL) –2-3 sessions a week x 4 weeks Learn basics of patient centered communication Learn format for feedback Prompting and modeling by faculty

18. >>0 >>1 >> 2 >> 3 >> 4 >> Intern Video Review Faculty Active teaching role Demonstrate feedback skills (Plus/Delta) Prompting – “Can you be more specific” Balancing feedback with evidence/observation Residents More tentative Developing confidence and competence

19. >>0 >>1 >> 2 >> 3 >> 4 >> Interns: Modeling Positive Feedback “I can tell already that this patient felt really comfortable with you” “I liked how respectfully you handled…” Patient “rewarded” for coming in. Leads resident to say more about what he did well (“ask-tell-ask”).

20. >>0 >>1 >> 2 >> 3 >> 4 >> How we do this: Upper Levels Peer video review sessions- –Small groups (4-5 residents) + 2 faculty –Second and Third Years Longitudinal advanced communication curriculum 1x month Individual goal setting shared with group at beginning of year Video chosen by resident, previewed and PCOF scored prior to session Faculty present to guide peer review process but focus is on residents prompting each other

21. >>0 >>1 >> 2 >> 3 >> 4 >> Resident Goals Self-assessment of core skills Identify Deltas Set a self-management goal/action plan Share with group Revisit Hold accountable

22. >>0 >>1 >> 2 >> 3 >> 4 >> Upper Level #1 Plus/Delta Plus = Introduction “I like how you asked do you have any questions about your health?’’ Delta = Agenda setting with physical exam Residents identify with his challenge (verbally & non-verbally) and offer suggestion of how to handle differently

23. >>0 >>1 >> 2 >> 3 >> 4 >> Upper Level #2 Self-Disclosure Resident seeks feedback from peers “Let me hear your thoughts” PGY2’s (new) give supportive feedback PGY3 politely disagrees with peers yet still identifies with resident “I’ve struggled with that with a lot of patients because I can see my mom, myself. I tend to avoid it…” Opens door for faculty teaching

24. >>0 >>1 >> 2 >> 3 >> 4 >> Lights, Camera, Action Your turn to review your peer Dr. Possner. The video is from a patient encounter with Dr. Vivian Beiring an English professor who was just diagnosed with Stage 4 ovarian CA Think about “pluses” and “deltas”

25. >>0 >>1 >> 2 >> 3 >> 4 >>

26. Resident Response “Just the thought of it was intimidating at first…but everyone gives positive feedback, not just negative.” “The environment feels really safe. We’re less on the spot because everybody has to do it… people are careful about how they word things.” “We all want to be perfect… it helps to know that I am not alone. Others struggle with some of the same things.” “We really learn from the experience of the seniors.” “Video review really helps us grow. We want to see ourselves doing better on our next video, so it really pushes us to improve.” “This experience has helped me develop my skills in peer review, which I’ll have to do more of in the future. It teaches us how to give feedback that is constructive and respectful.”

27. >>0 >>1 >> 2 >> 3 >> 4 >> Evaluation / Milestones Semi-annual eval of performance in longitudinal communications course –Inspired by evaluation presented at last year’s Forum by Triana and Olson –Obvious connections to Communication milestones –Additional connections to Professionalism milestones

28. >>0 >>1 >> 2 >> 3 >> 4 >>

30. Resources on FMDRL Assembling a Behavioral Medicine Rotation ToolboxAssembling a Behavioral Medicine Rotation Toolbox Today’s powerpoint PCOF (2013) Resident Goal Setting Worksheet Advanced Communication Evaluation Should be available early next week.

31. >>0 >>1 >> 2 >> 3 >> 4 >> PCOF Training Link The videos of the physician who does and does not demonstrate relationship development, agenda setting and appropriate EHR use can be found at the link below on the “Improving Communication Assessment Project”. The full videos last about 10 minutes and 30 seconds and are for training to use the Patient Centered Observation Form (PCOF). Total training takes about 40 minutes. http://uwfamilymedicine.org/pcof

32. amy.odom@sparrow.org amy.romain@sparrow.org