by Christof Daetwyler MD Drexel University College of Medicine , Philadelphia, PA

1. The story of doc.com: development of on-line tools for the teaching and learning of medical communication skills by Christof Daetwyler MD Drexel University College of Medicine, Philadelphia, PA Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

2. Background Effective physician-patient communication is the sine-qua-non of effective patient care. A physician's communication skills determine the nature and quality of diagnostic information elicited from patients and the quality of the physician's counseling. Communication determines the patient's trust in the physician, which is strongly linked to patient adherence and satisfaction. However, studies suggest that many physicians do not practice effective physician-patient communication. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

3. Dennis had a dream Dennis Novack MD, Assoc. Dean for Medical Education at DUCom and one of the founding members of AAPP* had a dream: developing a set of online-teaching modules that would role-model best practice of medical communication skills. *The American Academy on Communication in Healthcare AACH is the institution who started training physicians in the U.S. to do patient-centered interviewing, a technique developed by George Engel and his disciples. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

4. We gave him a headache When Dennis became aware of the program "Headache interactive"* at a “Slice of Life” meeting about computers in medical education, he realized it’s potential to help in the learning of communication skill. In a short demo I will show how it combines role-modeling of best practice with an opportunity to pick the brain of the specialist, revealing “hidden layers” of stories and experience. *"Headache Interactive" developed by Marco Mumenthaler and Christof Daetwyler received the European Academic Software Award in 2000. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

5. About Learning Paradigms After my graduation from Medical School in 1993 I started my career as developer of educational media at the Department for Educational Media at the University of Berne in 1994. At this time, Multi-Media was hip and became the “word of the year 1995” in Germany. The catch-words were self-guided, self-paced and so on. Around 1998 the focus shifted to Problem Based Learning and to “pure” constructivistic concepts - away from any cognitive influence. In Berne, the facilitators initially were forbidden to know anything about the topic.. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

6. About PBL Paradigms Teaching how to fish(!) Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

7. About Learning (for what?) The “pure” PBL paradigm in Berne was re-considered, and now also content experts are facilitators (or mentors?) . I guess that one of reasons this happened is that only happy teachers are good teachers - and good teachers care for their students, and that is what really counts. Showing experts demonstrating best practice and allowing learners to watch them has become acceptable again. Burt Landau, a very experienced teacher, told me once that “I think that the students try harder for a teacher they like.” I understand now that learning means to add meaningfully information to pre-existing knowledge - and who could better do this than a caring teacher who know the students? So I shifted my focus to the development of tools who emphasize on the process of learning, assisting the teachers and the learners.. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

8. What we had in place • High stakes exams test for proficiency in communication skills were put in place - need for educational tools • 200,000.-grant from the Arthur Vining Davis Foundations • The “Annotated Videos” technology • DUCOM’s Standardized Patients Program • AAPP’s renowned Experts on Communication Skills • My Expertise as developer, team-leader and project manager (Joe’s Interactive Media Lab @ Dartmouth) Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

9. CORE CONCEPTS Overview Integrating self-reflection and self-awareness Therapeutic Aspects of Medical Encounters Balance, Self Care ESSENTIAL ELEMENTS Structure and content of the interview Builds a Opens the discussion Gathers information Understands the patient’s perspective Shares information Reaches agreement Provides closure ADVANCED ELEMENTS Responding to strong emotions Non-verbal and Paraverbal Aspects of Communication Cultural Issues in the Interview Promoting Behavior Change and Adherence Informed Decision-Making Exploring sexual issues Exploring Spirituality & Religious Beliefs COMMUNICATING IN SPECIFIC SITUATIONS Family Interview The Pediatric Interview The Adolescent Interview The Geriatric Interview Smoking Cessation Diet/ Exercise Anxiety/Panic Disorder Depression Domestic Violence Alcoholism Diagnosis and Counseling Drug Abuse Diagnosis and Counseling Medically Unexplained Symptoms and Somatization Advanced Directives Giving Bad News Terminal care Discussing Medical Error Terminating the Doctor/Patient Relationship COMMUNICATING WITH COLLEAGUES The oral presentation Communication within Health Care Teams Talking with Impaired Colleagues Principles of Teaching Medical Students and Residents Our task: Address 40 different topicsusing text and annotated videos(Academic Medicine, Vol. 79, No. 6 / June 2004 pp 495 - 507) Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

10. To tape the videos, we needed a studio - and we found one.. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

11. The first shoot (module 6) Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

12. Show how it works (hopefully) • http://webcampus.drexelmed.edu/doccom/materials • Offers a demo of doc.com featuring 3 complete modules • 01 Overview with Geoff Gordon • 06 Building the relationship with Julian Bird • 13 Dealing with strong emotions with Barry Egener • Besides it allows for a 15 days trial-subscription • to all existing modules! Look there for Calvin Chou’s • module about “Cultural Issues” for example. Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine

13. THANK YOU! Christof J Daetwyler MD <christof.daetwyler@drexelmed.edu>, Technology in Medical Education and Medical Skills Teaching and Assessment – Drexel University College of Medicine