Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

The story of doc.com: development of on-line tools

for the teaching and learning of medical communication skills

by Christof Daetwyler MDDrexel University College of Medicine, Philadelphia, PA

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

BackgroundEffective physician-patient communication is the sine-qua-

non of effective patient care. A physician's communication skills determine the nature

and quality of diagnostic information elicited from patients and the quality of the physician's counseling.

Communication determines the patient's trust in the physician, which is strongly linked to patient adherence and satisfaction.

However, studies suggest that many physicians do not practice effective physician-patient communication.

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

Dennis had a dreamDennis Novack MD, Assoc. Dean for Medical Education

at DUCom and one of the founding members of AAPP* had a dream: developing a set of online-teaching modules that would role-model best practice of medical communication skills.

*The American Academy on Communication in Healthcare AACH is the institution who started training physicians in the U.S. to do patient-centered interviewing, a technique developed by George Engel and his disciples.

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

We gave him a headacheWhen Dennis became aware of the program "Headache

interactive"* at a “Slice of Life” meeting about computers in medical education, he realized it’s potential to help in the learning of communication skill. In a short demo I will show how it combines role-modeling of best practice with an opportunity to pick the brain of the specialist, revealing “hidden layers” of stories and experience.

*"Headache Interactive" developed by Marco Mumenthaler and Christof Daetwyler received the European Academic Software Award in 2000.

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

About Learning ParadigmsAfter my graduation from Medical School in 1993 I started

my career as developer of educational media at the Department for Educational Media at the University of Berne in 1994. At this time, Multi-Media was hip and became the “word of the year 1995” in Germany. The catch-words were self-guided, self-paced and so on.

Around 1998 the focus shifted to Problem Based Learning and to “pure” constructivistic concepts - away from any cognitive influence. In Berne, the facilitators initially were forbidden to know anything about the topic..

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

About PBL ParadigmsTeaching how to fish(!)

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

About Learning (for what?)The “pure” PBL paradigm in Berne was re-considered, and now also content

experts are facilitators (or mentors?) . I guess that one of reasons this happened is that only happy teachers are good teachers - and good teachers care for their students, and that is what really counts. Showing experts demonstrating best practice and allowing learners to watch them has become acceptable again.

Burt Landau, a very experienced teacher, told me once that“I think that the students try harder for a teacher they like.”

I understand now that learning means to add meaningfully information to pre-existing knowledge - and who could better do this than a caring teacher who know the students? So I shifted my focus to the development of tools who emphasize on the process of learning, assisting the teachers and the learners..

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

What we had in place• High stakes exams test for proficiency in communication

skills were put in place - need for educational tools• 200,000.-grant from the Arthur Vining Davis Foundations• The “Annotated Videos” technology• DUCOM’s Standardized Patients Program • AAPP’s renowned Experts on Communication Skills• My Expertise as developer, team-leader and project

manager (Joe’s Interactive Media Lab @ Dartmouth)

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

Our task: Address 40 different topicsusing text and annotated videos

(Academic Medicine, Vol. 79, No. 6 / June 2004 pp 495 - 507)CORE CONCEPTS• Overview• Integrating self-reflection and self-awareness• Therapeutic Aspects of Medical Encounters• Balance, Self CareESSENTIAL ELEMENTS • Structure and content of the interview• Builds a • Opens the discussion• Gathers information• Understands the patient’s perspective • Shares information• Reaches agreement• Provides closureADVANCED ELEMENTS • Responding to strong emotions• Non-verbal and Paraverbal Aspects of Communication• Cultural Issues in the Interview• Promoting Behavior Change and Adherence • Informed Decision-Making• Exploring sexual issues• Exploring Spirituality & Religious Beliefs

COMMUNICATING IN SPECIFIC SITUATIONS • Family Interview• The Pediatric Interview• The Adolescent Interview• The Geriatric Interview • Smoking Cessation• Diet/ Exercise• Anxiety/Panic Disorder• Depression• Domestic Violence• Alcoholism Diagnosis and Counseling• Drug Abuse Diagnosis and Counseling• Medically Unexplained Symptoms and Somatization• Advanced Directives• Giving Bad News• Terminal care• Discussing Medical Error• Terminating the Doctor/Patient RelationshipCOMMUNICATING WITH COLLEAGUES• The oral presentation• Communication within Health Care Teams• Talking with Impaired Colleagues• Principles of Teaching Medical Students and Residents

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

To tape the videos, we needed a studio - and we found one..

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

The first shoot (module 6)

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

Show how it works (hopefully) http://webcampus.drexelmed.edu/doccom/materials

Offers a demo of doc.com featuring 3 complete modules•01 Overview with Geoff Gordon•06 Building the relationship with Julian Bird•13 Dealing with strong emotions with Barry Egener

Besides it allows for a 15 days trial-subscriptionto all existing modules! Look there for Calvin Chou’s module about “Cultural Issues” for example.

Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

THANK YOU!