In a UC San Diego clinic, a patient is describing his symptoms to a medical student. The student asks questions and listens closely to discover the patient’s chief concern.It’s a normal part of her fourth-year clinical training – except that another medical student is observing and filming the entire encounter.

When the visit is over, she’ll watch the video and listen to the other student’s comments about her communication skills.Then he’ll hand her the camera. He’ll interview the next patient, and she’ll do the filming and the feedback.They’re taking part in the Paired Observation and Video Editing (POVE) project at UC San Diego.

The project is testing a new method for teaching and learning the skills that make a doctor a good communicator.

Kristin Bell, MDUC San Diego is one of 10 centers participating in the 3-year POVE project. The project is conducted as a fourth-year elective, MED 472, in the School of Medicine curriculum.

Peer learning is powerful

Year 1 of POVE has just ended, with medical students Christine Lee and Ninad Athale completing the elective last December.“The feedback they gave one another was amazing,” says Dr. Kristin Bell, Associate Professor of Medicine in the Division of General Internal Medicine. “They taught each other.”

As Principal Investigator of the POVE Project site at UC San Diego, Dr. Bell is the course director.“It was really great to watch their progress, and it was a unique learning experience for me as well,” she says.“I think it’s very powerful to learn from your peers.”

The goal is to teach the skills that make a doctor a good communicator.

Students produce a “before and after” video

The POVE course is a four-week, full-time intensive in doctor-patient communication. The medical students work in pairs, taking turns at filming and critiquing.All of the filming is done with the patients’ consent.The students meet with Dr. Bell and Ellen Lavin, Ph.D., a clinical psychologist, in weekly video review sessions to talk about the interactions they find challenging.

The film footage records their progress.

At the end of the course, the students extract the best “before” and “after” clips and produce a video essay that highlights the interactions they found difficult and the ways they addressed them.

“You can learn a lot from your medical student peers.”

On December 7 of last year, POVE students Lee and Athale presented their video essays at an interactive seminar for fellow students, residents, and faculty.“They did an amazing job,” Dr. Bell says.The students’ videos will become resources for medical centers across the nation after the study is concluded.

UC San Diego part of “a nationwide learning community”

Seeing the videos and having the immediate peer feedback, which Dr. Bell says was delivered with great sensitivity, helped the medical students pinpoint the interactions they found challenging.The goal is to train the students to be their own observers. Once they are able to recognize precisely the communication skills they want to refine, they are better equipped to improve their interactions with patients.

Studies show that when a doctor communicates in an effective and caring way, patient satisfaction goes up and the average length of a clinic visit actually goes down. Both doctor and patient find the experience more positive.

A University of Washington therapist and educator is the POVE project leader.

A total of 4 students from UC San Diego will be part of the POVE study, but more may enroll in the course if they are interested. Dr. Bell is now recruiting two students for the Fall 2008 session.The POVE project is headed by the Department of Family Medicine at the University of Washington. Larry Mauksch, M.Ed., a University of Washington family therapist and the overseeing investigator, calls it “a nationwide learning community.”Funding for the POVE study comes from the Arthur Vining Davis Foundations, whose healthcare grants are devoted to advancing caring attitudes in medical professionals.

The participating centers include community-based clinics as well as academic Family Medicine and Internal Medicine departments.

Dr. Bell credits many individuals who have worked to make the POVE project possible here. Many School of Medicine colleagues have been greatly supportive, she says, including Jess Mandel, MD, Associate Dean of Undergraduate Medical Education (UGME), and the UGME Electives Committee.

Looking to the future

Dr. Bell considers how the POVE experience will influence the medical school curriculum in the future.

“Can you do more peer learning?” she says. “I think you can. You can learn a lot from your medical student peers. It’s instruction from someone you can relate to.”

“It’s powerful to see a video. As a teaching tool, it’s just limitless.”

She hopes that the POVE course concept will eventually be incorporated into the new curriculum in a different form.“As it is, the course is very time consuming,” she says. “When we design a course for the new curriculum, we need to set aside enough time to make it effective for student learning, and at the same time keep it sustainable with the faculty resources available.”“It’s powerful to see a video. As a teaching tool, it’s just limitless.”

More about Kristin Bell, M.D.

Dr. Kristin Bell has been a primary care physician and educator at UC San Diego since 2001. She is based at the VA San Diego Healthcare System’s Vista Clinic, where she is Physician Site Leader.Challenged to help veterans manage chronic pain conditions, she has trained as an acupuncturist and founded an acupuncture clinic at the VA.

A grateful patient nominated her for the American Medical Association’s Young Physician Award, which was granted to her last fall.An emphasis upon doctor-patient communication was built in to her own residency training, she says. She’s a graduate of the Primary Care track in the Medicine program at UC San Francisco.

“For me, the POVE project
is a great learning experience.”

She’s relatively new to video production, but she has a longtime passion for medical education.She chose to develop a new behavioral medicine curriculum in her project for her National Center of Leadership in Academic Medicine (NCLAM) course.It grew into an addition to the third-year Medicine Core Clerkship.

That course also uses video, among other teaching methods, to teach medical students behavioral change counseling and motivational interviewing. The goal is to help patients make healthy lifestyle changes.

It has been a required part of the curriculum here for the past three years.

Dr. Bell acknowledges and thanks her mentors Shawn Harrity, M.D., and Peggy Wallace, Ph.D., for encouraging her and helping her attain success in this area of education.

Dr. Harrity is Clinical Professor of Medicine in the Division of General Internal Medicine. Dr. Wallace is Associate Adjunct Professor of Medicine and Director of the Professional Development Center in the Office of Undergraduate Medical Education.

“For me,” Dr. Bell says, “the POVE project is a great learning experience. I learn from the other POVE faculty, and especially from our students.”

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