Objective: Internal medicine residency training programs typically emphasize biomedical learning, but relatively few provide opportunities for residents to improve outpatient interviewing skills or to address challenging patient encounters. Even fewer programs provide resources to assess patient-resident relationship skills. To address these issues, we developed a curriculum that is designed to enhance patient-centered interviewing techniques in residents.
Description: At the UCSF-VA PRIME residency program, interns on ambulatory block attend three didactic sessions that introduce basic medical interviewing techniques, including elicitation of patient concerns and mutual agenda setting, biopsychosocial interviewing, and conflict resolution in the patient-physician relationship. These sessions are taught using role-play exercises and interactive, case-based discussions. Second- and third-year residents on ambulatory block participate in an ongoing small-group seminar in which they present videotapes of their interviews with patients. To make these tapes, residents arrange to see patients in a clinic room where a videotape recorder is mounted on the wall. Patients who consent to be videotaped complete a form stating that the tapes are to be used solely for educational purposes. Twice a year, each of our 16 residents selects one encounter that highlights personal learning goals related to interviewing and presents those learning goals with associated videotape clips in a 90-minute seminar. Each seminar is devoted to two residents, who facilitate a discussion of the effectiveness of the interview and solicit feedback about potential methods for improvement.
Discussion: When the seminars were originally developed, we anticipated that this innovative combination of traditional individual videotape review with small-group learning would encourage self-directed learning. Indeed, over the last three years, residents have become more confident with their interviewing capabilities and less self-conscious about showing their own videotaped interviews. As a result, the seminars have unexpectedly evolved into a highly sophisticated series of learning modules, in which residents seek their most challenging patient encounters to videotape and show to the group. Residents have presented complicated scenarios involving critical patient-physician conflicts, somatizing patients, cross-cultural communication difficulties, overzealous family members, patients with substance abuse, and bad-news interviews. These dilemmas represent fundamental management challenges that are difficult to discuss in a more didactic format, and the immediate case-based nature of the interviews makes these often-emotional issues come alive. The group videotape reviews also give residents opportunities to reflect on their own interviewing encounters, to observe other interviewing styles and techniques, and to provide support to their fellow residents after particularly emotional interviews. An ancillary benefit of these exercises is that we have now developed a library of challenging interviews, which are easily accessible for further teaching seminars. Our residents consider this learning experience to be one of the most positive of their residency and valuable for their professional development. Residents report that this small-group seminar series has markedly improved their communication with patients, and they now clamor for the opportunity to present interviewing dilemmas. We believe that similar curricula can be readily instituted at other residency programs.