Title: Communication Skills: Opening the Interview
Date: 10/7 (Groups E-H), 10/10 (Groups A-D)
Time: 2:15-5:05
Location: F-Labs
Responsible Faculty: Small Group Preceptors
Erika Schillinger, MD
Clarence H. Braddock III, MD, MPH
Stanford University
Session Goal(s):
1.
2.
Understand the importance of establishing rapport during the very opening part of the medical
interview
Develop skills that foster rapport
Learning Objectives:
At the end of the session the students will be able to:
1. Describe the three functions of the medical interview
2. Discuss the importance of the medical interview and effective communication in clinical medicine
3. Identify specific behaviors within the three functions of the medical interview
4. Describe the performance expectations in the medical interview (Stanford Interview Checklist [SIC])
Session Summary:
Introduction
Overview LGO
Review reading and discuss learner assessment questions
Discuss strategies for giving feedback
Role play demo with standardized patient volunteer
Triad Debrief SP role play demo
Practice patient interview opening with standardized patient volunteers
Triads debrief patient interview opening
Group debrief: What did you learn?
Learner reflection and establishment of personal learning goals
30 min
5 min
20 min
10 min
10 min
5 min
10 min each
5 min each
10 min
15 min
Teaching Preparation
Reading Assignment
Cole & Bird, Chapter 3 (14-22), Chapter 7(63-67)
Coulehan, Chapter 2 (18-37)
Stanford Interview Checklist [SIC]
Video Assignment
Doc.com video, module #6
Student Assignment review
Students will complete the doc.com assessment questions and one learner
reflection question prior to session (by midnight the day before session).
Preceptors will have access to these responses on the day of class. Preceptors
should review their students’ responses, highlighting salient issues, questions, and
topics for discussion at the beginning of class.
Comments:
Students are expected to do the reading for each small group IN ADVANCE of the
session. Small group preceptors should therefore not spend time reviewing basic
concepts covered in the reading. The time should be used for reflection and amplification
of the preparatory material, as well as for hands on practice. In order to conduct this
discussion and review, it is strongly suggested that each preceptor review the reading
and the doc.com assignment as well.
For this first small group session, you may need to emphasize the importance of coming
to class prepared to put concepts that they have read about into practice. They should
also know that you will assume that they have done the reading and video assignments,
and as such you will feel at liberty to call on them in class.
This is the second week of POM. In their first week, in the large group, students
observed a Model Patient Interview, attempting to identify specific behaviors that fit into
the “3 function” framework. After a brief discussion, the interview was repeated, with the
students observing and attempting to identify specific behaviors from the Stanford
Interview Checklist. A panel discussion following the interviews allowed faculty from
the other elements of the POM course (Ethics, Psychiatry, Epidemiology, Health and
Society) to comment on the interview and to highlight themes that will come up in their
parts of the course.
Students have had one prior experience with Standardized Patients in POM. All students
conducted a medical interview before the official beginning of the POM course. The
principal goals and objectives for this early experience were to establish a baseline for
students’ interviewing skills, to heighten their awareness of areas of the medical
interview in which they need help, and to allow them an immediate hands on experience
at the outset. Apart from that one Standardized Patient interview, many students in your
group may not have had any other patient interviewing experience.
Preceptor Guide to Small Group Activities
Introduction (10-15 minutes)
Please start by having all group members introduce themselves, and give a little of their
backgrounds. Some students will have already had some experience with patients.
Please say a bit about your own background and experiences that you will bring to
facilitating these sessions. Make some comments about how you will be sharing (if that
is the case) teaching with other faculty and the TAs. Go over the general format of each
session. Emphasize the importance of the background readings for each session. Most of
the readings are from the texts but there are also assigned articles and videos that will be
on the course website. Invite questions about the course format.
Please tell your students that there will be a mid-quarter review at which point students
will receive feedback about their small group performance. They will be evaluated on
their attendance, doc.com assignments, level of engagement and participation, and
interviewing skills (later on in the year they will also be evaluated on their physical
examination skills).
Discuss the learning goals and objectives (LGO) of this session (5 minutes)
An example of an overview of learning goals and objectives might go something like:
“Today we are going to practice opening the interview. You have done the reading,
and have had a little experience with Standardized Patients. You will now have
another opportunity to work with Standardized Patients. Our specific goals for
today are that you 1. understand the importance of the first minutes of the interview,
a time when you are establishing initial rapport, attending to patient comfort and
setting the stage for the interview that will follow, and 2. that you develop specific
skills that foster rapport. We do not expect, or want, you to delve into the medical
aspects of the patient’s story.
By the end of this session, you will be able to
1. Describe the 3 functions of the medical interview (Building the Relationship,
Assessing the Patient’s Problems, and Managing the Patient’s Problems)
2. Discuss the importance of the medical interview and effective communication in
clinical medicine
3. Identify specific behaviors within the 3 functions of the medical interview
4. Describe the performance expectations in the medical interview (Stanford
Interview Checklist [SIC]
5. Understand the process of giving feedback and how it will be used in this course
Review reading and discuss learner assessment questions from Doc.com (20
minutes)
Students will have done the Doc.com assignment on the CWP. This includes a narrated
series of slides and video clips addressing the topic of the day’s session. In addition, they
are asked to complete a set of both closed and open-ended questions. We ask them to
type in the answers to the questions and submit them by midnight the night before their
small group session. We will provide you with their responses on the day of class.
Please spend a few minutes prior to class looking through your students’ responses in
order to pick out salient themes and questions. The group facilitator’s role is to:
1. Make sure students have done the reading and doc.com assignment
2. Help students synthesize major issues
3. Address concerns, questions about the reading and doc.com
assignment.
Doc.com learner reflection questions from module 6:
• In thinking about your own skills in connecting with friends and others:
which of these could you apply to building relationships with patients?
• Which of these skills do you consider most important for building
relationships with patients?
• What attitudes do you have about yourself that might get in the way of
building relationships with patients?
• How do people see you as a person? What are your hopes for how patients
will think of you?
Understanding feedback and its use in this course (10 minutes)
Please go over the nature and purpose of feedback in clinical skills (see “Providing
Feedback” in your Facilitator Guide). Discuss the usual format of feedback (goals
agreed to before the exercise, after the exercise, students who interview do selfevaluation, first saying what they did well, followed by peer and then faculty comments.
When appropriate, ask SPs for their feedback.) Explain the characteristics of effective
feedback, to help evaluate peers more consistently based on learning objectives rather
than personal guidelines.
Also be sure to invite student feedback to facilitators on how the sessions are going in the
interest of constantly improving the learning experience.
Role Play Demo and debrief (15 minutes)
For this initial demonstration of “Opening the interview” we suggest that a student
volunteer perform the interview. The primary reason for a student to do the interview is
that we want students to jump right into active participation, as distinct from the
relatively passive experience of watching their group facilitator perform the interview.
You will have just discussed giving feedback, and as such we expect the environment to
be supportive, “safe,” and helpful.
For each mini “interview” students will be divided into triads, with one student playing
the “doctor,” one the “consultant” and the third the timekeeper. The role play
demonstration should model this structure.
The role of the “doctor” is to establish rapport, open the interview, engage the
patient in discussion. The “doctor” is NOT supposed to come up with a diagnosis and/or
plan.
The standardized patients for today’s session have been instructed to come up
with their own chief complaint. This could be that they are healthy and simply need a
check up.
The consultant should be available to help the “doctor” if he/she gets stuck or
just wants some suggestions of how to proceed. The consultant will use the Stanford
Interview Checklist (SIC) to aid in giving feedback at the end of the mini interview.
The timekeeper should ensure that the interview is over within 10 minutes, and
that feedback lasts no longer than 5 minutes per interview. The timekeeper is responsible
for orchestrating the feedback/ debrief of the interview, starting with the “doctor’s”
impressions of what went well and then what could use improvement, then the patient’s
impressions, followed by the consultant and finally the timekeeper. The timekeeper also
uses the SIC to aid in giving feedback.
Practice patient interview opening with Standardized Patients—Round Robin (15
minutes per interview plus debrief)
Following the demonstration, students should break into triads. Each small group should
have either 9 or 12 students, and should therefore be easily divisible by 3. Extra students
can either pair up or form a group of 4. Each triad (diad or quartet) should then team up
with a Standardized Patient. There will be 3 or 4 SPs per small group. The triad will then
go through the exercise as described above, with each of the students taking one off the 3
roles (doctor, consultant, timekeeper). After the 10 minutes (approximately) of
interviewing, the debrief commences for each triad with the “doctor” starting his/her
impressions, and so on. This debrief is only conducted within the triad and with the SP
for that station, not with the whole group. After the 5 minute debrief, the triad then
rotates to the next Standardized Patient.
For this new patient, with a different presentation, the person who was the doctor in the
previous encounter takes on a different role. This allows each of the three in the triad to
play the role of the doctor as they rotate in round robin fashion from SP to SP.
Group Debrief: What did you learn? (10 minutes)
Ask students to discuss the functions of medical interviewing, and the core skills needed
to elicit a history, as delineated in the reading. Go over the SIC in more detail, and
emphasize the skills used in eliciting a history. Ask students to describe their
understanding of these skills.
Wrap-up (15 minutes)
Allow 15 minutes to wrap up, review relevant lessons from the day, and plan for next
time. This time for learner reflection should include establishment of personal learning
goals for each student.
Looking ahead
In addition to opening the interview and setting the agenda, the focus of next session will
be on assessing the patient’s problem. Each student should prepare in advance to role
play a patient with a specific PULMONARY chief complaint.
Students should start by studying a particular pulmonary problem. Please encourage
students to choose a presentation that is simple and straightforward, such as shortness
of breath, cough, or pleuritic chest pain. Once they have decided on a chief complaint or
problem, they should memorize the symptoms associated with it, and be prepared to
answer the "what, where, when, how, why and who" questions as a real patient would.
(See page 47 of Coulehan and Block.)
Please impress upon students that they must prepare for next session, as they will be
divided into triads for interviewing. In a rotating fashion, everyone will have an
opportunity to take the doctor’s role. The exercise’s success depends on all students
being prepared to take the patient’s role seriously.
This is the students’ opportunity to experience both sides of a medical interview. It is
important for the person doing the interview that they make the patient as realistic as
possible, adding their own interpretation of the patient's emotional response to the
objective material they have prepared. Students should use their imaginations; add some
interesting twist; they may even wish to bring in props.