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© 2012 NBOME INSTRUCTION AND ASSESSMENT OF DOCTOR-PATIENT COMMUNICATION SKILLS: A NOVEL WEB-BASED APPROACH Erik Langenau, DO; Luciana Goldstein, MLIS, MSEd; Dot Horber, PhD Continuous Professional Development & Innovations
© 2012 NBOME Disclosures None to report
© 2012 NBOME Web-based communication module Competency-based assessment for physicians – Patient care – Medical knowledge – Interpersonal and communication skills – Professionalism – Systems-based practice – Practice-based learning and improvement – Osteopathic principles and practice Assessment needs – Resident level assessment (ACGME and AOA competencies) – Maintenance of Licensure (MOL) – Maintenance of Certification (MOC) – Osteopathic Continuous Certification (OCC) Description of Learning Need
© 2012 NBOME Web-based communication module 58,000 Osteopathic Physicians in U.S. (7% of all physicians) All physicians – Wish to learn to improve the care of patients – Are busy – Participate in Continuing Medical Education (CME) – Need to comply with new state medical board and specialty board requirements – Want educational activities which are relevant, practical, and easy to use. Description of Learners
© 2012 NBOME Web-based communication module Increasing emphasis on competency-based assessment for physicians – Medical students – Residents – Practicing physicians Increasing emphasis on doctor-patient communication skills (Teutsch, 2003; Duffy et al, 2004) Increasing use of Objective Structured Clinical Examinations (OSCEs) (Boulet et al, 2009) Emergence of Web-OSCEs (Daetwyer et al, 2010; Novack et al, 2002) Background: web-based communication
© 2012 NBOME Web-based communication module Web-based communication assessment of doctor-patient communication skills Remote Standardized Patients (RSPs) – Commonly used for education and assessment – Have been used by schools, residency and licensure Many content areas could be considered: – Communication with child – Communication with colleague – Communication with teenager – Cultural diversity – Delivering bad news – Empathy – End of life/health care proxy – Limited English proficiency – Medical mistake E-Learning Solution
© 2012 NBOME Web-based communication module
© 2012 NBOME Web-based communication modules Communication-focused Skype Physicians receive – Verbal feedback – Global communication assessment – Communication skills checklist – Self-assessment – Teaching Points Implications for – CME – MOL – OCC – Resident Education
© 2012 NBOME Web-based communication module Research Purpose: To evaluate the effectiveness and user acceptance of a web-based educational module for doctor-patient communication skills Short-term goal
© 2012 NBOME Research Study: Web-based communication module – Scheduling, troubleshooting, updating PowerPoint – Training Listserv: – Providing opportunity for RSPs to reach out to one another Doodle: – Obtaining RSP availability Skype: – Training, technical support and live encounters SuperTinTin: – Recording encounters (screen capture) NBOME website: – Uploading videos HP Webcam HD-2200: – Standardize video and audio quality Survey Monkey – Surveying (demographics, post-exercise experience) Technologies used in the project
© 2012 NBOME Web-based communication module Recruitment Training documents – Skype Trouble Shooting – Encounter Instructions Scheduling Pre-encounter – Skype Username – Technology check – Case Introduction Physician Experience
© 2012 NBOME Web-based communication module Encounter – Doctor-patient communication (15 min) – Self-assessment (5 min) – Verbal Feedback (10 min) – Support: 24-hour staff support (phone) Post-encounter – Self-assessment – Receive from NBOME staff Completed Global Assessment Completed Case-specific Checklist (Key Action) Completed Self-Assessment Teaching Points – Survey of Experience – Focus Group Discussion NBOME Staff support throughout experience (phone, and Skype) Physician Experience (continued)
© 2012 NBOME Web-based communication module Four assessments – Verbal feedback from remote SPs Emphasis on teaching points for each case – Written Feedback Communication key action assessment (key action checklist) Global communication skills assessment – Likert-type scale Self-assessment of global communication skills Formative Assessment
© 2012 NBOME Web-based communication module Informed by Essential Communication Elements, Kalamazoo Consensus Statement. – Duffy FD, Gordon GH, Whelan G, Cole-Kelly K, Frankel R. Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Academic Medicine. 2004;79(6): Case Development Committee Global Assessment
© 2012 NBOME Web-based communication module Case Development Committee Case-Specific Checklist
© 2012 NBOME Web-based communication module Global Assessment Modified for self assessment Self-Assessment
© 2012 NBOME Web-based communication module Summary of Case Medical History Pain History Case-specific Information References Teaching Points
© 2012 NBOME Web-based communication module Introduction to Osteopathic Medicine: 20 min – Review prerecorded PowerPoint Presentation Case Training: 4-6 hours – Portrayal – Scoring (checklist and global assessment) – Technology – Delivering verbal feedback Technology Check: 1 hour Dress Rehearsal: 1 hour Remote Standardized Patient (RSP) Training
© 2012 NBOME Web-based communication module Training documents – Technology Set Up Procedures – Skype Trouble Shooting – Encounter Instructions Scheduling Pre-encounter – Skype Username – Skype Account – SuperTinTin Encounter – Doctor-patient communication (15 min) – Complete evaluation forms (5 min) – Verbal Feedback (10 min) – Support: 24-hour staff support (phone) Post-encounter – Complete evaluations: checklist, global assessment, technology report – Upload video to NBOME research website – Survey of experience NBOME Staff support throughout experience (phone, and Skype) Remote Standardized Patient (RSP) Experience
© 2012 NBOME Research Study: Web-based communication module Web-based communication formative assessment using RSPs Authentic Practice-relevant Allows physicians to participate in a meaningful exercise, while potentially satisfying – Licensure requirements – Specialty board requirements for continuous professional development – Residency program requirements Summary
© 2012 NBOME Research Study: Web-based communication module Analyze data – Scoring – Survey of Residents – Survey of RSPs – Focus Group of Residents – Focus Group of RSPs Dissemination of findings Next Steps
© 2012 NBOME Web-based communication module Accreditation Council on Graduate Medical Education. (2007). Common program requirements: general competencies. Retrieved from (Archived on 8 June 2011 at American Association of Colleges of Osteopathic Medicine. (April 6, 2012). Osteopathic Core Competencies for Medical Students: Addressing the AOA Seven Core Competencies and the Healthy People Curriculum Task Forces Clinical Prevention and Population Health Curriculum Framework. Retrieved from inal%20draft.pdf. (Archived on 28 May 2012 at ) American Osteopathic Association. (2004). Core Competency Compliance Program (CCCP) Part III. Retrieved from (Archived on 16 May 2012 at Chaudhry, H.J., Rhyne J., Cain, F.E., Young, A., Crane, M., & Bush, F. (2010). Maintenance of Licensure: Protecting the Public, Promoting Quality Health Care. Journal of Medical Regulation, 96, 1-8. Daetwyer, C.F., Cohen, D.G., Gracely, D., & Novak, D.N. (2010). eLearning to enhance physician patient communication: a pilot test of doc.com and WebEncounter in teaching bad news delivery. Medical Teacher, 32, e374-e383. doi: / x Duffy, F.D., Gordon, G.H., Whelan, G., Cole-Kelly, K., & Frankel, R. (2004). Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Academic Medicine, 79(6), References
© 2012 NBOME Web-based communication module Harasim, L. (2012). Learning theory and online technologies. New York, NY: Routledge. National Board of Osteopathic Medical Examiners. (June 2011). Fundamental Osteopathic Medical Competency Domains Document. Retrieved from encies.pdf (Archived on 16 May 2012 at Novack, D.H., Cohen, D., Peitzman, S.J., Beadenkopf, S., Gracely, E., & Morris, J. (2002). A pilot test of WebOSCE: a system for assessing trainees' clinical skills via teleconference. Medical Teacher, 24(5), doi: Spagnoletti, C.L., Bui, T., Fisher, G.S., Gonzaga, A.M.R., Rubio, D.M., & Arnold, R.M. (2009). Implementation and evaluation of a web-based communication skills learning tool for training internal medicine interns in patient-doctor communication. Journal of Communication in Healthcare, 2(2), Turner, M.K., Simon, S.R., Facemyer, K.C., Newhall, L.M., Veach, T.L. (2006). Web-based Learning Versus Standardized Patients for Teaching Clinical Diagnosis: A Randomized, Controlled, Crossover Trial. Teaching and Learning in Medicine, 18(3), References (cont)
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