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ASSESSMENT INTERVIEW STRUCTURED CLINICAL OBSERVATION: DEVELOPMENT AND IMPLEMENTATION IN A SPECIALTY-BASED TRAINEE CLINIC Tracy Foose, MD UCSF Department of Psychiatry DISCUSSION BACKGROUND: RESULTS • The appreciable trend among the survey results reveals a willingness within the culture of our clinic, among both faculty and trainees, to consider using an observational tool as a means to facilitate, standardize, and improve direct-observation teaching. • Although evidence of a wariness toward “cookbook” or “checklist” teaching and feedback persists, the degree of initial qualitative success indicates potential for our clinic to embrace the SCO model. • The generalizability of the AI-SCO was informally demonstrated as trainees (residents) adopted it as an interview template and structured feedback tool for our rotating medical students, and several faculty endorsed its influence on their own interview technique. • The proportion of completed AI-SCOs to scheduled interviews reveals that they are being utilized in approximately 1/4 of interviews, about one time per month per team. It is our hope that frequent, repeated observations will give trainees opportunity to incorporate feedback toward mastery of the interview technique over the course of the year. • Implementation of the AI-SCO was inexpensive and demanded little in time and resources from clinic staff, faculty, and trainees. • This year, we move into the process of gathering data from the AI-SCO tool, having received 29 thus far: 0.88 per trainee/faculty pair/month. • We focus on the results of our initial implementation captured by response to an anonymous questionnaire provided subsequent to orientation to the AI-SCO tool. • Response to survey: 10/14 faculty supervisors, 6/14 residents • Distribution of responses presented in modified Likert scale with question material provided in the table below. • Faculty and trainee comments are provided in caption. • Teaching and evaluating interviewing technique in a specialty-based clinic structure poses unique challenges: • Balancing trainee observation and corrective feedback with delivery of clinical care. • Overcoming faculty and trainee discomfort with corrective feedback. • Protecting time for immediate feedback. PURPOSE • To standardize expectations and evaluation of psychiatric interview technique across diagnosis-specific specialty clinics. • To improve quality of formative feedback across varied specialty clinics. • To improve transparency of educational expectations by making methods of evaluating performance and competence available to trainees and faculty, alike. METHODS : • The Assessment Interview Structured Clinical Observation (AI-SCO) was designed as a single-page tool serving as both interview template and a means by which to organize qualitative feedback during a structured clinical observation. (Copies of AI-SCO provided, please help yourself.) • Its format was based on a design familiar to our faculty and trainees – the Pharmacologic Interview Structured Clinical Observation, with the hope this would facilitate its acceptance into clinic structure and ease of use. • Early development involved incorporating the collaborative suggestions, requests and feedback of experienced clinic faculty to create a tool that would capture the needs of a wide variety of specialty clinics. • Participating faculty and trainees received a 15-minute orientation to the background, goals, and intended application of the tool followed by an anonymous questionnaire to gather concerns, suggestions and initial impressions of the tool prior to its application. REFLECTIVE CRITIQUE • Incorporating the use of video vignettes of a psychiatric interview into orientation to the AI-SCO would have helped to standardize expectations of interview structure and technique. • Colleagues with expertise in education suggested descriptive rather than subjective anchors next to numerical ratings: i.e. replacing “done with suggestions for improvement” with “partially done,” given even superb interviewees can benefit from suggestions for improvement. • Adding the AI-SCO to the intake screening packet provided to the interviewing teams prior to the interview has markedly improved participation. • The initiation of quarterly meetings attended by all specialty-based clinic attendings will provide an efficient and accessible forum for feedback about the AI-SCO and its utility in varied clinics. Faculty Comments: Trainee Comments: • “This doesn’t need to be done every week- gets burdensome.” • “It should be structured so that more or less is expected depending on level of trainee.” • “Too cookbook - a double-edged sword – directs attention to specific tasks, but doesn’t capture subtle dynamic between patient and doctor.” • “One time per month should be sufficient.” • “This is too simplistic for residents, seems OK for medical students.” • “Starting or ending on time shouldn’t be on here – that’s under the control of the highest ranking person present – not the trainee.”