Using the Patient Centered Observation Form to Give Quality - - PowerPoint PPT Presentation

Using the Patient Centered Observation Form to Give Quality Feedback

Based on Work and Slides by Larry Mauksch M.Ed Clinical Professor Emeritus UW Department of Family Medicine Presented by Valerie Ross MS UWFM Residency Director of Behavioral Science Curriculum End of Quarter Clerkship Meeting 10/18/2019

Miller’s Assessment Pyramid

• Faculty observation (with real

patients)

Does

• Standardized patients

Shows how

• Matching or critical

response questioning

Knows how

• Multiple choice

questions

Knows

2

Impact on the patient

Miller, G. E. The assessment of clinical skills/competence/performance. 1990 Acad Med 65(9 Suppl): S63-7. Adapted from Holmboe and Hawkins. Evaluation of Clinical Competence, Mosby 2008

Mastering a Skill Domain

Practice

• Real situations
• Learned from

expert:

• description
• demonstration

Feedback

• Specific
• Sensitive
• Developmentally

appropriate

Reflection

• Promotes analysis
• Synthesis
• Integration

Observation Form Purpose and Training

The value

• Structures vision
• Creates and standardizes vocabulary

Primarily for formative assessment and to strengthen the “observer self” (mindfulness)

PCOF Use

Behavior in either of the columns to the right of thick vertical line is in the competent range

Observers mark accurately and avoid giving the benefit of the doubt

Feedback is best: When solicited Specific, rather than general Curious, not judgmental

Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Language Structures Thought and Behavior

Inarticulate

• The art of medicine
• Good bedside manner
• TLC
• Touchy-feely stuff
• Engagement
• Listening

Articulate

• Emotional and cognitive cues
• Agenda setting
• Teachback
• Continuer phrases
• Transparent thinking
• Illness explanatory Model

Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Relationship Communication and Efficiency: Creating a Clinical Model from a Lit Review

Mauksch et al, 2008, Arch of Intern Med, 168 (13) 1387-1395

Ongoing influence

Rapport and Relationship Mindfulness Topic Tracking Empathic response to cues

Sequential

• 1. Upfront

collaborative agenda setting

• 2. Hypothesis testing

and understanding the patient perspective

• 3. Co-creating

a plan

SMS: problem solving

It is more about you than the tool

van der Vleuten et al The assessment of professional competence: building blocks for theory

• development. Best Pract Res Clin Obstet Gynaecol. Dec 2010;24(6):703-719

Trained faculty offer formative assessment influenced by context and focused on need in ways that checklists can not provide Multiple observations with purposeful sampling by multiple expert raters offering authentic assessments may provide a more valid picture of “does” than quantitative tools

Video 1

Discuss

Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Find a partner:

• What was done well?
• What could be improved?
• What would be your first

suggestion for improvement?

Video 2

Discuss

Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Find a partner:

• What was done well?
• What could be improved?
• What would be your first

suggestion for improvement?

Share: Success, Challenges, Tips

Form a small group at your table. Think about and then share:

• What successes have you had using the

PCOF and giving formative feedback? What are you doing that contributed to successful feedback and learning on the part of your students?

• What challenges have you had?
• What are possible solutions or tips to

address those challenges?

• New ideas as a result of today?