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Paired Observation and Video Editing (POVE)

Paired Observation and Video Editing (POVE). Blending Continuous Peer Feedback and Reflection to Strengthen Communication Training Larry Mauksch, M.Ed, University of Washington. Acknowledgments. Angel Platus, MD Kim O’Conner, MD Stu Farber, MD Tom Greer, MD, MPH Many in this room.

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Paired Observation and Video Editing (POVE)

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  1. Paired Observation and Video Editing(POVE) Blending Continuous Peer Feedback and Reflection to Strengthen Communication Training Larry Mauksch, M.Ed, University of Washington

  2. Acknowledgments • Angel Platus, MD • Kim O’Conner, MD • Stu Farber, MD • Tom Greer, MD, MPH • Many in this room

  3. Without protected time, it is difficult for learners to intentionally…. Practice Define Reflect upon A challenge in teaching and assessingcommunication in medicine… • Refine the use of • Assess • Integrate …communication skills

  4. Goals: Paired Observation and Video Editing • To help students develop a lasting, articulate “observer self”--the ability to reflect on and refine (communication) skill use to optimize interactions with patients. • To demonstrate “growing competence” in using core communication skills. • To create a learning laboratory for faculty

  5. Course Philosophy • Clinicians have a strong, but often undisclosed desire to become more effective communicators. • They experience ineffable inadequacy • If given the language, time, and responsibility, trainees will help one another increase competence. • Assessment and learning should be part of one integrated, ongoing process.

  6. Differentiation Precedes Integration • Observing and categorizing behavior enhances articulation • One’s precision (differentiation) in describing skills is proportional to one’s ability to be creative in skill application (integration). With a distant reference to Michael Polyani’s book, Personal Knowledge

  7. Course Design: 4 weeks • Paired Observation Phase • 3 weeks • Video Editing and Presentation Phase • 1 week

  8. Paired Observation: First 3 weeks • Students see patients on preceptors’ schedule • They always see patients together alternating roles as observer and “physician” • Tracking forms are used to: • structure observation and feedback • catalog interviews for video editing • Instructor(s) give mini didactics, review videos and discuss encounters with students • Interviews are videotaped, with patient consent

  9. Orientation to course Giving and receiving feedback Video recording, editing and patient consent Overview: relationship, communication and efficiency Mindful practice Upfront, collaborative agenda setting Eliciting the patient perspective Reaching common ground Family assessment Behavior change / primary care counseling Requested topics Mini Talk Topics4 week course (12-14 hours of presentation)

  10. Schedule: Paired Observation

  11. Video Editing-4th week • Students create a video essay examining their growth • Students design, film and edit a role-played teaching tape • Students present their work in one or more interactive seminars to fellow students, residents and faculty

  12. Videotape Editing: Instructions for Students • For video essay, “study your growth by including..”: • Baseline skills • Struggles • Best performances • Use protected time to review, catalog and edit • Create a teaching tape • Be creative and have fun!

  13. Schedule: Video Editing

  14. Summary of a 4 Week Course • Student pairs see 50-60 patients in 3 weeks • 75% of patients consent to be videotaped • Video essay is 25- 30 minutes. • Video essay presentations easily take 90 minutes because discussion is expansive. • Teaching tapes have been used to train hundreds of students and faculty

  15. All students demonstrate growth in: • Upfront collaborative agenda setting • Picking up on patient cues and exploring patient, family and cultural perspective • Expression of empathy • Reaching mutual agreement on a plan • Efficiency

  16. Student Evaluations( 11 pairs of 4th year students) • “Peak experience” • “Best course in medical school” • Students feel: • More organized • More able attend to the patients • More able to learn about disease, because they are… • Less anxious about time management • Interviewing is less mysterious

  17. POVE - secondary outcomes • Faculty learning • Students learn teamwork skills • Student pairs are efficient • Contribution to the educational community

  18. Other Applications • Use only Paired Observation (no video): • Medical student / Residency training on a larger scale • Faculty development • CME • Conceptual preparation can be done without faculty time: videos, reading, Powerpoint • Videotapes(or CDs or DVDs) become portfolios

  19. Limitations • Not all rotations would work • Decreased patient volume? • Start-up cost for AV and computer equipment • Some people may have difficulty learning to accept and give feedback • Paired observation may feel burdensome to preceptors (…but it takes no more time) • POVE design deserves research…

  20. Video Editing Tips • Orientation takes < 40 minutes (iMovie 2) • Introduce students to editing by using three, one minute clips of themselves in role plays • Use software tutorial programs • Tapes should be no longer than 30 minutes • Use short clips, 15 seconds to 3 minutes • Clips should include enough lead to create context for the viewer-- 3-10 seconds

  21. Video Editing- Costs and Equipment • Current prices of PCs and Macs between $1100 and $2500 and beyond • Get lots of RAM - at least 512; 1gig better • Consider buying extra hard drive for storage and faster editing • Using analog cameras requires purchase of analog to digital converter, about $300 • Cost of VCR, monitor and tapes

  22. Logistical Considerations • Preceptors must be oriented, trained if possible • Great way to reinforce resident learning and educate faculty • Distribute precepting across several senior residents and faculty • Nursing staff need to be included to make sure patient flow is not adversely affected • Protect time in the preceptor’s schedule • Distribute schedules ahead of time to all involved

  23. Logistical Instructions for Students • Meet nursing staff and preceptors in advance of each clinic • Protect time for video review and logging • Never see two patients at the same time, especially with the same preceptor • Protect time in advance for student video presentation

  24. POVE DISSEMINATION PROJECT • Funded by Arthur Vining Davis Foundations • Three year program to create a learning community with 9 medical schools

  25. Goals • To disseminate the POVE model • To stimulate faculty exploration of how to teach and how students learn • To provide an in-house resource for the creation of training tapes • To study the learning process of medical students and their teachers

  26. Participants Receive • Three day training in Seattle (winter, 07’) • Computer with video editing software • Curriculum and site visit • Three day learning & evaluation conference in Seattle for one faculty and two students (fall, 08’)

  27. POVE Research • Web surveys of faculty and students • Qualitative and Quantitative • Learning and Evaluation conference • Focus groups • Faculty • Students • Video essay reviews • Teaching tape reviews • Pre-post tape comparison

  28. www.fammed.washington.edu/pove

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