Monday, April 12, 2010
Did you ever think speed dating would be part of your medical training? Well, in one NUHS class called "The Clinical Encounter," you won't actually find speed dating, but you will find an exercise modeled after the popular meet-and-greet process.
"In one of my classes, half of the students play the patients, while the other half play the doctors. They form two circles and take turns pairing up and play-acting a doctor and patient's first meeting - ala 'What brings you in today?' Then they switch partners every few minutes so they can have many opportunities to play their roles," says Professor Robert Shiel, PhD. "Each student spends half an hour playing a patient with several doctors, and then another half hour playing doctor to several patients. This way, each student sees about eight doctors and eight patients."
"The Clinical Encounter" class at National University of Health Sciences is where future physicians and health care professionals learn how to build effective doctor-patient relationships. The skills they learn here will help them make better diagnoses, better treatment decisions, and build productive relationships with patients, improving their career success.
"The main theme of the course is to look at all the different aspects of the encounter with the patient and to review the research about what's effective. We break down the material into six different elements: Initiating the Session; History Collection; Report of Findings and Treatment Planning; How to Close with a Patient or a Closing Session; Providing Structure for the Patient; and Building a Relationship," says Dr. Shiel, who earned his PhD in counseling psychology from the University of Notre Dame, and has served on National's faculty for 28 years.
The course alternates each week between group exercises such as speed dating night, and working with standardized patients in National's Treatment and Assessment Center.
For speed dating, students have had a week's notice to prepare as patients, bringing real or imagined conditions to the class. When it's over, Dr. Shiel challenges them with a series of questions: "What was the encounter like?" "Did you like how the doctors approached you?" "Did you find that the story you told changed based on how the doctor approached you?" The student often answers that indeed, how the doctor approached them affected and changed the nature of the information they gave as a patient.
Dr. Shiel strives to impress upon his students that the very first questions a doctor asks when meeting a patient will influence how that patient feels and behaves from that moment on, and will influence the quality of information the patient gives, which can in turn affect the physician's diagnosis.
"Research says that after the doctor asks that opening question of 'What brings you in?' most doctors will then interrupt the patient with another question after about 20 seconds," Dr. Shiel explains. "Once the doctor interrupts, the patient almost never goes back and finishes their story. It creates a context where the patient expects that they should only answer the questions that the doctor asks. So pretty quickly, the doctor ends up playing the health care version of '20 Questions' because the patient stops volunteering information. So we endeavor to train our students to ask questions in a way that encourages the patient to tell their whole story.
"In many other classes the students learn about the content of the information they need to collect - pathology, anatomy, physiology. In this class we talk about the process of collecting that information. We don't want them to confuse content with process. Content is generally organized in ways that are doctor-friendly. Process has to be something that's patient-friendly," says Dr. Shiel.
"If you organize your information collection around content, it will seem like an interrogation to the patient, and they will perceive you as not caring about them but only caring about the disease."
The Clinical Encounter class is one place where students study together, whether they are enrolled in the DC, ND or MSOM programs. "Different professions will have different content that they want to collect, because they make their diagnoses differently and use different treatment modalities," says Dr. Shiel. "However, the process with the patient remains the same."
Dr. Shiel takes credit for lobbying the university to make The Clinical Encounter class part of its curriculum. "There has been quite a bit of research coming out about how effective interaction with patients results in improved health care," he says. "We need this type of class to stay on the cutting edge."