Do clinical interview transcripts generated by speech recognition software improve clinical reasoning performance in mock patient encounters? A prospective observational study.

BACKGROUND: To investigate whether speech recognition software for generating interview transcripts can provide more specific and precise feedback for evaluating medical interviews. METHODS: The effects of the two feedback methods on student performance in medical interviews were compared using a prospective observational trial. Seventy-nine medical students in a clinical clerkship were assigned to receive either speech-recognition feedback (n = 39; SRS feedback group) or voice-recording feedback (n = 40; IC recorder feedback group). All students' medical interviewing skills during mock patient encounters were assessed twice, first using a mini-clinical evaluation exercise (mini-CEX) and then a checklist. Medical students then made the most appropriate diagnoses based on medical interviews. The diagnostic accuracy, mini-CEX, and checklist scores of the two groups were compared. RESULTS: According to the study results, the mean diagnostic accuracy rate (SRS feedback group:1st mock 51.3%, 2nd mock 89.7%; IC recorder feedback group, 57.5%-67.5%; F(1, 77) = 4.0; p = 0.049), mini-CEX scores for overall clinical competence (SRS feedback group: 1st mock 5.2 ± 1.1, 2nd mock 7.4 ± 0.9; IC recorder feedback group: 1st mock 5.6 ± 1.4, 2nd mock 6.1 ± 1.2; F(1, 77) = 35.7; p < 0.001), and checklist scores for clinical performance (SRS feedback group: 1st mock 12.2 ± 2.4, 2nd mock 16.1 ± 1.7; IC recorder feedback group: 1st mock 13.1 ± 2.5, 2nd mock 13.8 ± 2.6; F(1, 77) = 26.1; p < 0.001) were higher with speech recognition-based feedback. CONCLUSIONS: Speech-recognition-based feedback leads to higher diagnostic accuracy rates and higher mini-CEX and checklist scores. TRIAL REGISTRATION: This study was registered in the Japan Registry of Clinical Trials on June 14, 2022. Due to our misunderstanding of the trial registration requirements, we registered the trial retrospectively. This study was registered in the Japan Registry of Clinical Trials on 7/7/2022 (Clinical trial registration number: jRCT1030220188).

Assessing data gathering of chatbot based symptom checkers - a clinical vignettes study.

BACKGROUND: The burden on healthcare systems is mounting continuously owing to population growth and aging, overuse of medical services, and the recent COVID-19 pandemic. This overload is also causing reduced healthcare quality and outcomes. One solution gaining momentum is the integration of intelligent self-assessment tools, known as symptom-checkers, into healthcare-providers' systems. To the best of our knowledge, no study so far has investigated the data-gathering capabilities of these tools, which represent a crucial resource for simulating doctors' skills in medical-interviews. OBJECTIVES: The goal of this study was to evaluate the data-gathering function of currently available chatbot symptom-checkers. METHODS: We evaluated 8 symptom-checkers using 28 clinical vignettes from the repository of MSD-Manual case studies. The mean number of predefined pertinent findings for each case was 31.8 ± 6.8. The vignettes were entered into the platforms by 3 medical students who simulated the role of the patient. For each conversation, we obtained the number of pertinent findings retrieved and the number of questions asked. We then calculated the recall-rates (pertinent-findings retrieved out of all predefined pertinent-findings), and efficiency-rates (pertinent-findings retrieved out of the number of questions asked) of data-gathering, and compared them between the platforms. RESULTS: The overall recall rate for all symptom-checkers was 0.32(2,280/7,112;95 %CI 0.31-0.33) for all pertinent findings, 0.37(1,110/2,992;95 %CI 0.35-0.39) for present findings, and 0.28(1140/4120;95 %CI 0.26-0.29) for absent findings. Among the symptom-checkers, Kahun platform had the highest recall rate with 0.51(450/889;95 %CI 0.47-0.54). Out of 4,877 questions asked overall, 2,280 findings were gathered, yielding an efficiency rate of 0.46(95 %CI 0.45-0.48) across all platforms. Kahun was the most efficient tool 0.74 (95 %CI 0.70-0.77) without a statistically significant difference from Your.MD 0.69(95 %CI 0.65-0.73). CONCLUSION: The data-gathering performance of currently available symptom checkers is questionable. From among the tools available, Kahun demonstrated the best overall performance.

Artificial intelligence approach for recommendation of pupil dilation test using medical interview and basic ophthalmologic examinations.

Purpose: To evaluate the value of artificial intelligence (AI) for recommendation of pupil dilation test using medical interview and basic ophthalmologic examinations. Design: Retrospective, cross-sectional study. Subjects: Medical records of 56,811 patients who visited our outpatient clinic for the first time between 2017 and 2020 were included in the training dataset. Patients who visited the clinic in 2021 were included in the test dataset. Among these, 3,885 asymptomatic patients, including eye check-up patients, were initially included in test dataset I. Subsequently, 14,199 symptomatic patients who visited the clinic in 2021 were included in test dataset II. Methods: All patients underwent a medical interview and basic ophthalmologic examinations such as uncorrected distance visual acuity, corrected distance visual acuity, non-contact tonometry, auto-keratometry, slit-lamp examination, dilated pupil test, and fundus examination. A clinically significant lesion in the lens, vitreous, and fundus was defined by subspecialists, and the need for a pupil dilation test was determined when the participants had one or more clinically significant lesions in any eye. Input variables of AI consisted of a medical interview and basic ophthalmologic examinations, and the AI was evaluated with predictive performance for the need of a pupil dilation test. Main outcome measures: Accuracy, sensitivity, specificity, and positive predictive value. Results: Clinically significant lesions were present in 26.5 and 59.1% of patients in test datasets I and II, respectively. In test dataset I, the model performances were as follows: accuracy, 0.908 (95% confidence interval (CI): 0.880-0.936); sensitivity, 0.757 (95% CI: 0.713-0.801); specificity, 0.962 (95% CI: 0.947-0.977); positive predictive value, 0.878 (95% CI: 0.834-0.922); and F1 score, 0.813. In test dataset II, the model had an accuracy of 0.949 (95% CI: 0.934-0.964), a sensitivity of 0.942 (95% CI: 0.928-956), a specificity of 0.960 (95% CI: 0.927-0.993), a positive predictive value of 0.971 (95% CI: 0.957-0.985), and a F1 score of 0.956. Conclusion: The AI model performing a medical interview and basic ophthalmologic examinations to determine the need for a pupil dilation test had good sensitivity and specificity for symptomatic patients, although there was a limitation in identifying asymptomatic patients.

Avoidance of nocebo effects by coincident naming of treatment benefits during the medical interview for informed consent-Evidence from dynamometry.

Introduction: In the context of giving risk information for obtaining informed consent, it is not easy to comply with the ethical principle of "primum nihil nocere." Carelessness, ignorance of nocebo effects and a misunderstood striving for legal certainty can lead doctors to comprehensive and brutal risk information. It is known that talking about risks and side effects can even trigger those and result in distress and nonadherence to medication or therapy. Methods: Recently, we have reported on significant clinically relevant effects of verbal and non-verbal suggestions on maximal muscular arm strength in healthy volunteers and in patients at two time points before surgery. Maximal strength during arm abduction was measured by dynamometry of the deltoid muscle group. Suggestions from clinical everyday life were formulated as presumed negative and neutral versions. Results: Here, we report on the effects of two versions of risk information in 45 patients. After sole mentioning risks of a puncture for the placement of a pain catheter, the maximal arm muscle strength was significantly reduced to 83% of baseline several days (T1), and to 84% the evening before surgery (T2). Strength was not significantly decreased and close to baseline at T1 and T2 when risks and benefits of a pain catheter were combined in one sentence. The difference between both versions was significant. With persistent normal distribution of values, the effect was due to uniform reactions of many patients, not to strong reactions of a few. High suggestibility and increase of anxiety with approaching surgery were identified as influencing factors for the neutralizing effect of modified wording. Conclusion: We not only suggest an alternative formulation for risk information to avoid nocebo effects but present an objective method to quantify and compare effects of different wordings. Thereby, we provide evidence that concurrently given positive aspects can neutralize negative effects during medical interview.

The Diagnostic Medical Interview.

The diagnostic medical interview spans from the chief concern to the formation of a differential diagnosis. The patient's unique expression of their symptoms is the central component of this conversation. The interview should begin by eliciting the patient's chief concern with an open-ended question and then move through 3 nonlinear phases: open-ended elicitation, guided elicitation, and hypothesis-driven elicitation. Performing a comprehensive medical interview by obtaining background health information and the review of systems can help to expand or shrink the differential diagnosis. Clinicians should obtain information about specific symptoms and background information with a significant likelihood to narrow the differential diagnosis.

[Development of an Online Role-play-based Medical Interview Training Method for Fourth-year Pharmacy Students].

With the coronavirus disease 2019 pandemic, businesses are rapidly expanding their online practices, and the online medical care system has been established and is growing. The field of pharmacy education is also looking for ways to conduct practical online training. Hence, we developed an online role-play-based medical interview training method for fourth-year pharmacy students. The purpose of this study was to describe in detail this method and to clarify the effect of online on medical interviewing practice. The training sessions were conducted using video teleconferencing software. Two settings were used for the role-play scenarios: the pharmacy and hospital. To evaluate the effectiveness of the sessions, a questionnaire was sent to the students, and the results were analyzed using text mining. The most important requirement for successfully conducting the interviews was a stable voice connection, and we reduced audio interruptions and delays by connecting the host personal computer to a wired local area network. We also solved the problem of howling when multiple terminals were installed in the same room by muting all devices in the room. Results of the analysis of the questionnaires suggested that students were more tense online. We also found that students perceived a difference between online and face-to-face interviews in terms of eye contact and the presentation of documents. In this way, we succeeded in conducting smooth online role-playing sessions while taking countermeasures against infection. In the future, it will be necessary to devise nonverbal communication methods and digital methods of presenting the training material.

Teaching "medical interview and physical examination" from the very beginning of medical school and using "escape rooms" during the final assessment: achievements and educational impact in Japan.

BACKGROUND: There is no consensus regarding the best time to teach two fundamental pillars of clinical medicine: medical interview and physical examination. We investigated the impacts of teaching the course "Medical Interview and Physical Examination" in Japan from the very beginning of medical school. In addition, we also evaluated the educational value of using "Escape Rooms", a series of timed, game-based scenarios using simulators, as a part of the final assessment of the course. METHODS: At the end of the course, the interview capabilities of 140 first year medical students at International University of Health and Welfare (Japan) were assessed by physicians who acted as simulated patients. Physical examination skills were assessed using the "Escape Room" team task method. Students also self-assessed their confidence in their physical examination skills pre and post "Escape Rooms." A day prior to the final assessment, students completed an anonymous course evaluation. RESULTS: The average global rating of the students' medical interview skills using a rating scale from 1 to 6 (1-fail 6-outstanding, no different from practicing junior physician's level) was 4.6. Twenty-two students scored the highest mark of 6. An average of 89% of "Escape Room" teams finished all the physical examination tasks correctly within the allotted time. All teams that could not finish in time completed all tasks correctly when given an additional 3 to 5 min. Students' self-assessed confidence in their physical examination skills increased from 49 to 73 (out of 100) pre and post "Escape Rooms." In the course evaluation questionnaire, 99% of students answered "this course enhanced their motivation" (response rate 89%) and 99% also answered "this course was interesting and useful" (response rate 86%). CONCLUSIONS: This descriptive study analyzing both quantitative and qualitative data showed that the course not only achieved the intended objectives of successfully conducting comprehensive medical interview and basic physical examination skills, but also enhanced student motivation. "Escape Rooms", used for the course assessment, in itself enhanced students' self-perceived physical examination skills and had an added educational value.

Relationship Between Medical Questionnaire and Influenza Rapid Test Positivity: Subjective Pretest Probability, "I Think I Have Influenza," Contributes to the Positivity Rate.

Introduction Rapid influenza diagnostic tests (RIDTs) are considered essential for determining when to start influenza treatment using anti-influenza drugs, but their accuracy is about 70%. Under the COVID-19 pandemic, we hope to refrain from performing unnecessary RIDTs considering droplet infection of COVID-19 and influenza. We re-examined the medical questionnaire's importance and its relationship to the positivity of RIDTs. Then we built a positivity prediction model for RIDTs using automated artificial intelligence (AI). Methods We retrospectively investigated 96 patients who underwent RIDTs at the outpatient department from December 2019 to March 2020. We used a questionnaire sheet with 24 items before conducting RIDTs. The factors associated with the positivity of RIDTs were statistically analyzed. We then used an automated AI framework to produce the positivity prediction model using the 24 items, sex, and age, with five-fold cross-validation. Results Of the 47 women and 49 men (median age was 39 years), 56 patients were RIDT positive with influenza A. The AI-based model using 26 variables had an area under the curve (AUC) of 0.980. The stronger variables are subjective pretest probability, which is a numerically described score ranging from 0% to 100% of "I think I have influenza," cough, past hours after the onset, muscle pain, and maximum body temperature in order. Conclusion We easily built the RIDT positivity prediction model using automated AI. Its AUC was satisfactory, and it suggested the importance of a detailed medical interview. Both the univariate analysis and AI-based model suggested that subjective pretest probability, "I think I have influenza," might be useful.

Psychoemotional disturbance in adult patients with temporomandibular disorders Research article.

Temporomandibular disorders (TMD) encompass a diverse group of abnormalities in the functioning of the masticatory muscles, temporomandibular joints, and surrounding structures within the facial skull. One of the important etiological factors, contributing to the development of TMD are psychoemotional disorders, which include: depression, dysthymia, personality disorders, panic attacks as well as states and anxiety neuroses.The aim of the study was to carry out a retrospective evaluation of the occurrence of psychoemotional disorders reported in the application form of medical interview of patients treated at the Consulting Room of Temporomandibular Disorders in Dental Institute (University Dental Clinic) for TMD. The research material consisted of a subjective survey according to the protocol of the RDC/TMD questionnaire, axis II, of the 360 patients (224 women, 136 men), aged 19 to 43 who came to the University Dental Clinic in Krakow due to TMD management. Result: The results of the conducted studies indicate the common occurrence of emotional disorders in the group of patients treated for TMD, both in the group of muscular and joint form of dysfunctions. The most often the patients selected: loss of sexual interest or pleasure, crying easily, feeling lonely, indifference to every- thing and feeling of worthlessness. These aspects show a significant influence of emotional factors on TMD. Conclusion: The results of the conducted research indicate a significant frequencies of psychological and emotional disturbances reported in a survey among patients with TMD.

Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review.

BACKGROUND: Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient. OBJECTIVE: Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions. METHODS: A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work. RESULTS: A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general. CONCLUSIONS: Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.

Aprender a preguntar: un recurso didáctico para el aprendizaje de la anamnesis médica / Learning to ask: a teaching resource for learning medical anamnesis

RESUMEN Introducción: La anamnesis médica es el proceso de comunicación interactiva entre el médico, el paciente, su familia o ambos, con el propósito de identificar y caracterizar los síntomas que expresan la realidad del estado de salud del paciente, para establecer el diagnóstico y la intervención médica. Objetivo: Diseñar un sistema de acciones didácticas que faciliten a los estudiantes de la carrera de Medicina el aprendizaje de la anamnesis. Método: En el Hospital General Docente "Dr. Agostinho Neto" se desarrolló un estudio de tipo pedagógico con dicho objetivo, donde se utilizaron los métodos: histórico- lógico, análisis y síntesis e inducción-deducción. Se empleó, además, la modelación para la elaboración del modelo de preguntas y el enfoque sistémico para determinar su estructura y establecer las relaciones entre ellas. Resultados: El empleo de procedimientos (trasmisión de experiencias, ejemplos prácticos, modelos memorísticos basados en la imitación), sin un sustrato teórico estructurado, dificulta la aplicación plena de los contenidos médicos en pacientes concretos en condiciones reales semejantes o diferentes a las aprendidas, lo que constituye una limitación para la formación de esta habilidad en la asignatura Propedéutica Clínica y Semiología Médica. Conclusiones: Se ofrece un modelo de aprendizaje por preguntas, con el cual se dota al estudiante de un recurso didáctico-metodológico para la comunicación interactiva con el paciente, lo que facilita el aprendizaje de la escucha activa y la comprensión del paciente por el estudiante. Contribuye, además, con la calidad de la confección de la historia clínica.

ABSTRACT Introduction: Medical anamnesis is the process of interactive communication between the physician, the patient, his or her family, or both, for the purpose of identifying and characterizing the symptoms that express the reality of the patient's state of health, in order to establish the diagnosis and medical intervention. Objective: To design a system of didactic actions that will make it easier for medical students to learn the anamnesis. Method: At the General Teaching Hospital "Dr. Agostinho Neto" a pedagogical study was developed with this objective, where the methods used were: historical-logical, analysis and synthesis and induction-deduction. In addition, a modeling was used to develop the question model and the systemic approach to determine its structure and establish the relationships between them. Results: The use of procedures (transmission of experiences, practical examples, memory models based on imitation), without a structured theoretical support, makes it difficult to fully apply the medical content to specific patients in real conditions similar to or different from those learned, which constitutes a limitation for the training of this skill in the subject Clinical Propedeutics and Medical Semiology. Conclusions: A question-based learning model is offered, in which the student is equipped with a didactic-methodological resource for interactive communication with the patient, which facilitates the learning of active listening and the understanding of the patient by the student. It also contributes to the quality of the preparation of the clinical record.

Improving Patient-Provider Relationships to Improve Health Care.

Changes in our health care system have posed challenges for the patient-provider relationship (PPR) and may have negative consequences. For the clinician, due to lower reimbursements from third party payers, and increased administrative tasks such as the electronic medical record (EMR) and certification requirements, clinic visit time is now one-fifth that of decades ago. Clinicians may order diagnostic studies and imaging as a substitute for face to face time as it is seen to save time and increase relative value units (RVUs). As a result, the medical interview is very abbreviated, and the physical examination is disappearing. This occurs at the expense of the physician-patient relationship. Now there is limited time to gather relevant information, to understand the context of the illness, and address patient needs. For the clinician there is reduced satisfaction, loss of the meaningfulness of caring for patients, and possibly increased risk for burnout, and malpractice. This may lead to negative attitudes and behaviors toward patients, particularly for those with nonstructural diagnoses (eg, disorders of gut-brain interaction) which are given lower priority than those with acute or structural illness. In turn, patients experience a diminution in their role in the relationship and respond to adverse clinician behaviors with a lack of connection, frustration, and at times self-blame and stigmatization. To reverse this downward trend and re-establish an effective PPR changes are needed: 1) improving educational methods to provide skills to enhance patient-centered care, 2) incentivizing educators who teach and clinicians who practice patient-centered care, and 3) research support to demonstrate successful outcomes in satisfaction, adherence and clinical outcomes.

Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial.

BACKGROUND: Patient satisfaction in consenting is a major pillar of clinical governance and healthcare quality assessment. The purpose was to observe the effect of using 3D anatomical models of knee and shoulder joints on patient satisfaction during informed consent in the largest single-blinded randomised controlled trial in this field. METHODS: 52 patients undergoing elective knee or shoulder surgery were randomised into two groups when being consented. The intervention group (n = 26) was shown an anatomical model of the knee/shoulder joint while the control group (n = 26) was given only a verbal explanation without a model. Patients rated their satisfaction on the validated Medical Interview Satisfaction Scale (MISS-26) questionnaire. Semi-structured interviews were analysed for specific themes to determine key factors that influenced patient satisfaction. The mean score ±SD were calculated with significance set at p < 0.05. RESULTS: There was a significant difference in the overall satisfaction between the control and intervention cohorts (MISS-26 score 4.33 [86.6%] ± 0.646 vs 4.70 [94.0%] ± 0.335 respectively, 7.4% improvement, 8.5% difference, p = 0.01). Behavioural criteria showed a 13% increase in satisfaction (p = 0.02). Semi-structured interviews determined that the factors influencing satisfaction included the surgeon's interpersonal manner, the use of the visual aid and seeing the consultant surgeon in clinic. All patients in the intervention cohort identified factors contributing to their satisfaction, whereas a fifth of the control cohort claimed nothing at all made them feel satisfied. CONCLUSION: Anatomical models as visual aids significantly increased patient satisfaction during the consenting process and played an integral part of the surgeon's explanation. Patients exposed to anatomical models also claimed to be more satisfied with the surgeon's inter-personal skills. This study recommends the use of anatomical models, which are both cost-effective and easily implementable, during explanation and consent for orthopaedic procedures.

Rise of blood pressure value in young patients at first visit at a dental university hospital in Japan.

BACKGROUND/PURPOSE: Hypertension is a risk factor for stroke and heart disease. Psycho-social reasons are thought to influence blood pressure fluctuation in the dental clinic, but no previous studies have investigated these relationships. In this study, we analyzed a correlation between patients' blood pressure values and their backgrounds. MATERIALS AND METHODS: We measured blood pressure in 4990 outpatients at our hospital. After determining the age groups in which blood pressure deviated from national averages, patients were classified into the Hypertension group and Normal group. Differences between these groups with regard to the prevalence of systemic disease, dental history and reasons for dental consultation were analyzed. RESULTS: Average systolic blood pressure of males in their 20's, 30's, 40's and females in their 20's, 30's, 40's, 50's was significantly higher than national averages. In these age groups, disease prevalence was significantly higher in the Hypertension group than in the Normal group. Furthermore, the Hypertension group expressed psycho-social reasons for dental consultation more frequently than the Normal group. CONCLUSION: Relatively younger patients tended to show higher systolic blood pressure. It was suggested that psycho-social backgrounds as well as medical causes influenced the blood pressure increase.

La relación médico-paciente: ¿necesidad o conveniencia? / The doctor-patient relationship: need or convenience?

Se destaca la relación médico-paciente como un modelo singular de comunicación humana, el cual sirve de marco a la interacción intelectual y afectiva más importante de la práctica clínica: la que se lleva a cabo a través de la entrevista médica. Esta es herramienta fundamental para obtener una anamnesis fidedigna y establecer una relación médico-paciente sólida, perdurable y productiva, pues la habilidad para comunicarse eficientemente no solo consiste en saber expresarse, sino, sobre todo, en saber escuchar, con lo cual se comienza a cumplimentar el primer principio del método clínico, que es el de la profesión médica. El objetivo de esta investigación fue actualizar los conocimientos acerca de la relación médico-paciente de acuerdo con el método clínico. Para ello, se revisaron las contribuciones teóricas realizadas por prestigiosos internistas cubanos a lo largo de la historia, unidas a las posiciones asumidas por las presentes autoras a partir de sus propias experiencias. Sin dudas, el logro de una relación médico-paciente exitosa deviene una poderosa arma para el diagnóstico certero(AU)

The doctor-patient relationship stands out as a unique model of human communication, which serves as a framework for the most important intellectual and affective interaction of clinical practice, which is carried out through the medical interview. This is a fundamental tool to obtain reliable history and establish solid, lasting and productive doctor-patient relationship, since the ability to communicate efficiently is not only knowing how to express oneself, but also, and above all, knowing how to listen, which begins to complete the first principle of the clinical method, which is that of the medical profession. The objective of this research was to update the knowledge on the doctor-patient relationship according to the clinical method. To this end, we reviewed theoretical contributions made by prestigious Cuban internists throughout history, together with the positions assumed by the present authors based on their own experiences. Certainly, the achievement of a successful doctor-patient relationship becomes a powerful weapon for accurate diagnosis(AU)

Assessing the empathy of medical students during medical interview training in Japan by using mixed-methods surveys of simulated patients.

This article was migrated. The article was marked as recommended. Background: Medical interviews are performed during objective structured clinical examinations, to assess the communication skills of medical students. In particular, medical students are assessed regarding whether they demonstrate empathy during these staged interviews. However, no studies to date have analyzed the validity of the methods to evaluate empathy during objective structured clinical examinations. Aim: Here we sought to identify factors affecting whether simulated (standardized) patients (SPs) felt that the medical students had treated them empathetically during medical interview training. Methods: The training involved the participation of SPs during the bedside learning of fifth-year medical students in Japan. After the students completed medical interview training, we conducted a questionnaire-based survey. We developed the list of questionnaire items through semi-structured interviews asking SPs to describe when the student had been empathetic. Results: The item "I felt that the student was empathic throughout the interview" was significantly correlated with "I was given enough time to talk at the beginning of the interview," "The student made good eye contact," "The student's attitude was appropriate," "I was able to say enough of what I wanted to talk about," and "The student used phrases that expressed empathy." Multiple regression analysis revealed that "The student used phrases that expressed empathy" was the only independent predictor of "I felt that the student was empathic throughout the interview." Conclusions: The factor that correlated most strongly with the SP feeling that the student was empathic during a medical interview was "The student used phrases that expressed empathy." However, correlations also occurred with open-ended questions and the student's level of attention at the beginning of the interview and with the student's attitude. Together, these findings indicate that several types of both verbal and nonverbal communication determined whether SPs felt that medical students showed empathy during staged medical interviews.

Expectations for the Next Generation of Simulated Patients Born from Thoughtful Anticipation of Artificial Intelligence-Equipped Robot.

It is predicted that in the near future robot simulated patients (SPs) will come into use. Through the impressions of five SPs about robot SPs, we explored their vision of the future of medical education as an indicator of what ordinary citizens think. The opinions of SPs were collected using a semi-structured focus group interview, after which the perspectives provided were explored using a qualitative research method called Steps for Coding and Theorization (SCAT). Although SPs accepted the introduction of robot SPs, they regard them as potential substitutes. The use of robot SPs raised concerns about the level of response to human diversity and the level of emotional intelligence. The problem of how much diversity among patients and doctors is acceptable in the field of education was identified. On the part of citizens, there is not much expectation that artificial intelligence (AI) will lead to sophisticated machines capable of human conversation. However, looking ahead to the AI era, real SPs anticipate that, along with the evolution of AI, the next generation of SPs will have thought deeply about their role within a program employing both humans and robots.

Listen to the outpatient: qualitative explanatory study on medical students' recognition of outpatients' narratives in combined ambulatory clerkship and peer role-play.

BACKGROUND: Understanding patients' narratives has been associated with methods of improving care that go beyond what may be regarded as a "narrow" view of scientific medicine. Medical interview training in which medical students develop understanding of the importance of patients' narratives is receiving increased attention. However, students generally receive education on patients' narratives that does not distinguish inpatients and outpatients. No studies exploring the characteristics of outpatients' narratives have been reported. We developed an educational program combining ambulatory clerkship and peer role-play using actual narratives from outpatients that students had encountered during their clerkship. These narratives were used as peer role-play scenarios in which the students acted as outpatients. This study explored what and how medical students learned about the characteristics of outpatients' narratives through this original educational program. METHODS: Participants were 70 fifth-year medical students from Nagoya University, Japan. We conducted 13 focus groups, based on a convenience sample of 11 groups in 2012, one group in 2013, and one group in 2017 (from 17 clinical groups in each year). Focus group transcripts were analyzed using the "Steps for Coding and Theorization" qualitative data analysis method. We assessed medical anthropological findings regarding narratives in a conceptual framework. RESULTS: Patients' narratives as perceived by medical students were divided into four quadrants by two axes: medical versus lived content, and objective versus subjective structure. Students recognized that outpatients' narratives mainly used a subjective structure, but were mixed and crossed each quadrant. This was described as "irreproducibility." Students also recognized that narratives of simulated patients and inpatients were mainly limited to a medical-lived content with an objective structure. These differences in narrative characteristics were recognized through students' previous interactions with simulated patients and inpatients. CONCLUSIONS: Despite some limitations, medical students learn about patients' narratives in our original educational program in a way that would be difficult to achieve through training using simulated patients or inpatients.

Assessing the extent of utilization of biopsychosocial model in doctor-patient interaction in public sector hospitals of a developing country.

BACKGROUND: Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor-patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor-patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan. MATERIALS AND METHODS: The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data. RESULTS: The study revealed four emerging themes: (1) Lack of doctor-patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients' concern with their improvement in health and doctor's demeanor. CONCLUSION: The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.

How to succeed at medical interviews.

Few people truly relish being interviewed. But as a professional, you will go through a number of interviews in your life that will affect your career progression. In this article, we provide some tips on how best to prepare for a medical interview, both in terms of your portfolio and interview practice. Advice is also given on how to maximize performance during the interview and gain the most from reflection afterwards.