Small Group Session 20

SMALL GROUP SESSION 20 February 6th or February 8th

Groups 1-12: Hospital Interview

Readings for this week:  Review the process and content forms  Review lecture notes from HPI and Past Medical History (contains review of systems)

Prepare by:  Dressing professionally  Completing and bringing your written assignment from last week.  Preparing to present your learning objective from last week

Session Overview

Section 1. Touch base

Section 2. Hospital Interviews

Section 3. Present Hospital Interviews

Section 4. Evaluation

University of Virginia 2007 1 D:\Docs\2018-04-15\03fd0b8b9ffcb32b396a17978b505812.doc Part 1. Touch base (30 minutes)

Use this time to allow group members to present and discuss the learning objectives from last week. Discuss what students learned about the information resources they used. Mentors should discuss how they organize and conduct a complete history. This is the first time we will ask students to obtain a review of systems. Please discuss how you go about this part of the history.

Part 2. Hospital Interview (90 minutes)

Goal: Obtain a complete history from a patient using a patient-centered interviewing approach.

Objectives:  Obtain a history of present illness  Includes the patient’s beliefs about their illness, how it is affecting their life, and how they are coping with their illness  Obtain a thorough past medical history  Includes past medical and surgical history, drug allergies, substance use history, diet history, family history and patient profile. Does not include sexual history.  Includes a brief review of systems

Logistics:

 Mentors will receive the group’s list of patients via e-mail. It will also be posted to the POM web-site.  Break up into pairs  Each student will interview a patient  Interviews done in pairs  One student interviews, the other student observes  The observer gives the interviewer focused feedback  Go onto the next patient and switch roles  Mentors should observe students

Part 3. Presentations

 Gather back in your meeting room  Students should take 5 to 10 minutes to gather their thoughts  Students present their patients’ history  Students identify a learning objective for next week derived from their patient’s illness.

University of Virginia 2007 2 D:\Docs\2018-04-15\03fd0b8b9ffcb32b396a17978b505812.doc Part 4. Evaluation  Take some time to discuss how students managed this longer interview. What problems did they encounter? What worked well? What would they do differently next time?

Assignment

You will write up this history. The write-up should include all components of the history of present illness and past medical history. If you did not address an area in the past medical history, bullet that item and write “did not address.”

Write-up grading:

2 points: Write-up includes all pertinent elements of HPI, PMHx elements (including medical and surgical history, hospitalizations, social history, including health habits, and family history) and psychosocial context (effect and meaning of illness for patient and family, and coping strategies) and review of systems. Write-up is well-organized and clear and gives a sense of the patient as a person and the course of the patient’s illness.

1 point: Write-up is sketchy in details of HPI, PMHx and psychosocial context, or it is not clearly organized, or does not give a sense of the patient as a person.

0 points: Not turned in.

University of Virginia 2007 3 D:\Docs\2018-04-15\03fd0b8b9ffcb32b396a17978b505812.doc Practice of Medicine-1 Process Interview Feedback Form

Interviewer’s Name______Evaluators’ Name______Date______

SKILLS DONE OK, NOT NOT WELL COULD DONE APPLICABLE BE OR BETTER DONE POORLY 1. Introduces self and explains purpose of interview. 3 2 1 N/A 2. Attends to the patient’s comfort and privacy. 3 2 1 N/A 3. Allows patient to describe the illness/chief 3 2 1 N/A complaint. 4. Uses the following techniques effectively (Note: you don’t have to use them all!) 3 2 1 N/A Open-ended questions 3 2 1 N/A Reflection/Repetition 3 2 1 N/A Clarification 3 2 1 N/A Silence 3 2 1 N/A Facilitators (nods, uh-huh, etc…) 3 2 1 N/A Summation 3 2 1 N/A OVERALL USE OF INTERVIEWING TECHNIQUES 5. Balances listening with structure. 3 2 1 N/A 6. Follows up on cues and vague statements. 3 2 1 N/A 7. Attends to patient’s nonverbal cues. 3 2 1 N/A 8. Responds empathetically and supportively. 3 2 1 N/A 9. Closes interview appropriately. 3 2 1 N/A COMMENTS:

University of Virginia 2007 4 D:\Docs\2018-04-15\03fd0b8b9ffcb32b396a17978b505812.doc Practice of Medicine-1 Content Interview Evaluation Form

CONTENT INTERVIEWING SKILLS DONE OK, COULD NOT DONE NOT WELL BE BETTER OR DONE APPLICABLE POORLY Defines chief complaint* Identifies reason for patient presenting now* Obtains history of present illness* Nature of symptom (quality) Severity Location (and radiation) Timing and duration Precipitating/aggravating factors Alleviating factors Context Obtains patient’s perspective about illness* How it affects them and family What patient thinks is cause Determines other active problems/issues* Past Medical History Major illnesses* Hospitalizations* Surgeries* Accidents/Injuries Medications* (including OTC, herbal, vitamins and supplement) Complementary& alternative practitioners Allergies* Immunizations* Transfusions Gynecologic and obstetric history (LMP/birth control method)* Family History Patient Profile Demographic Occupational/Educational history Travel The usual day Health Habits/Lifestyle Diet Exercise Tobacco Alcohol Drugs Relationships Sexual history Spirituality Review of Systems * These items should be obtained (either from patient or review of chart), at each interview

University of Virginia 2007 5 D:\Docs\2018-04-15\03fd0b8b9ffcb32b396a17978b505812.doc