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PubMed2005

Training professionals to engage with and promote self-management.

We have set out to investigate an approach to improve patients' ability to self-manage chronic illness. For effective health care in chronic disease, we believe patients need to work in partnership with their doctor; patient-centred consultations are one way to achieve this. This report describes our experience of training specialists in gastroenterology to consult in a patient-centred style as part of a complex self-management intervention in a randomized controlled trial (RCT) involving 700 patients with established inflammatory bowel disease (IBD) attending outpatient clinics. The training session aimed to provide specialists from nine randomly selected intervention sites with the basic skills to carry out the intervention. The training lasted 2 hours, and included background on the research and intervention, a demonstration video, role-play, and video-feedback training. The main findings of the RCT are presented (service use, enablement and satisfaction), and discussed in the light of the views of consultants and patients on the experience of putting the training into practice. The findings of our study confirm and highlight the value of training in patient-centred communication and its potential for promoting self-management effects; the training proved effective in enabling consultants in gastroenterology to establish guided self-management in patients with IBD.

Adolescent↗

PubMed1986

Teaching medical students about neurosis.

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.

Clinical Clerkship↗

PubMed1991

Factors influencing the communication skills of first-year clinical medical students.

The aim of this study was to examine the factors influencing medical students' communication skills. The sample comprised all first-year clinical students. Thirty-two received teaching in communication skills during the year; the remaining 56 did not. Students' career preferences, attitudes towards communication skills and confidence in their ability to communicate with patients were assessed by questionnaire at the beginning and end of the year. At the end of the year each student was videotaped interviewing a simulated patient. Students' communication skills were assessed on the basis of this interview by raters using a standardized rating scale, and by patient questionnaires. While there was some evidence that brief communication skills training improved skills, sex of student was a more significant predictor of level of skill. Students who perceived communication skills as less relevant to medicine and those who were more confident about their own communication skills were more likely to prefer a career in hospital medicine. Students' judgements of their ability to communicate effectively were poor. In the main there was no relationship between confidence and level of skill: where they were related, the association was negative. The benefits from communication skills training might be enhanced by involving hospital doctors in the teaching, and providing students with detailed video feedback on their skills at the outset.

Attitude of Health Personnel↗

PubMed1992

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners.

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.

Clinical Competence↗

PubMedDate not supplied

Luminance range compression for video film digitizers.

Video cameras are used in many film digitization and teleradiology systems. However, the density range of medical radiographs often exceeds the dynamic range of the camera, and all diagnostic information in the original image may not be captured. Information in both the high and low density areas of the film can be captured in a single video frame if the transmitted luminance range of the radiograph is reduced. This can be accomplished by spatially modulating the back illumination of the film such that areas of lesser density receive less illumination while areas of greater density receive greater illumination. In this work, the use of a video monitor is shown to be an effective means to provide spatially modulated light for compressing the transmitted luminance range and thereby expanding the apparent dynamic range of the video camera. A simple computer-interfaced video feedback system that determines the appropriate compression mask and a scheme for linearization of system response are described. This system provides an interactive means for control of the degree of range compression.

Analog-Digital Conversion↗

PubMedDate not supplied

Patient-provider interactions and patient outcomes.

Research shows that a number of provider interactional skills are empirically related to patient adherence, making interaction skills a necessary and important part of clinical competence. These skills fall into three broad categories: techniques to elicit and modify patients' health and treatment beliefs, to aid recall of information, and to aid adherence. Specific skills in each category are discussed. Research further shows that health care providers can be taught effective communication skills, and that one of the most effective teaching techniques is audio or video feedback in which the provider's interaction with a patient is judged by tutor and peers using explicit, empirically based criteria.

Attitude to Health↗

PubMed1998

Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom.

PURPOSE: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. METHODS: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. RESULTS: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P < .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would "definitely" recommend them to colleagues. CONCLUSION: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians.

Communication↗

PubMed1997

Intervention in transmission of insecure attachment: a case study.

Several attachment-based intervention studies have been performed, with varying success. An important question is whether short-term interventions can be successful in promoting parental sensitivity and security of infant-parent attachment as well as in changing parental representations of attachment. We investigated this issue in an exploratory way in a case study. A short-term home-based intervention with written material and video feedback, which was effective regarding parental sensitivity and infant security in a former study, was provided a parent who revealed an insecure attachment representation in the Adult Attachment Interview. The intervention sessions were expanded with discussions about past and present experiences of attachment. After four intervention sessions the mother's behavior towards her child was rated as more sensitive than before the intervention. Also, the infant-mother attachment, as observed in the Strange Situation, appeared to be more secure. Nevertheless, in a second Adult Attachment Interview administered after the intervention, the mother showed again an insecure representation of attachment. Possible implications of these results are discussed.

Adult↗

PubMed2001

Child'sTalk--for children with autism and pervasive developmental disorder.

A research assessment protocol and early intervention approach designed for use by multi-disciplinary professionals with children who have the severe social communication deficits of early autism and pervasive developmental disorder (PDD) are described. The assessment analyses the specific pattern of social communication impairment in each child and defines the characteristics of the dyadic communication between parent and child. The intervention aims to identify facilitative strategies, using video feedback, which lead to close interpersonal interaction between the child and their parents. Parents can reflect on their own interaction and identify which strategies successfully engage their child. Child'sTalk aims to facilitate adaptations to the child's level of communication by sensitively and finely tuning the interaction and mutual sharing of intentions as a fundamental agent for the emergence of communication.

Autistic Disorder↗

PubMed2004

How to improve mental health competency in general practice training?--a SWOT analysis.

It is quite evident there is room for improvement in the primary care management of common mental health problems. Patients respond positively when GPs adopt a more proactive role in this respect. The Dutch general practice curriculum is currently being renewed. The topics discussed here include the Strengths, Weaknesses, Opportunities and Threats (SWOT) of present primary mental healthcare teaching. What works well and what needs improving? Integrated teaching packages are needed to help general practice trainees manage various presentations of psychological distress. Such packages comprise training videotapes, in which models such as problem-solving treatment (PST) are demonstrated, as well as roleplaying material for new skills, self-report questionnaires for patients, and small-group video feedback of consultations. While GP trainees can effectively master such skills, it is important to query the level of proficiency required by registrars. Are these skills of use only to connoisseur GPs, or to all? More room for specialisation and differentiation among trainees may be the way forward. We have just developed a new curriculum for the obligatory three-month psychiatry housemanship. It is competency oriented, self-directed and assignment driven. This new curriculum will be evaluated in due course.

Curriculum↗

PubMedDate not supplied

Nursing interventions for health promotion.

Selected nursing interventions for health promotion in well individuals are described. Over a two-year period, two clinical nurse specialists developed and used client record keeping, role playing, audio and video feedback, imagery, visual mapping and experimentation as health promotion interventions. Clinical examples and client outcomes are discussed. Health promoting interventions are clearly distinguished from disease prevention approaches as described in the literature.

Adult↗

PubMed1994

[Teaching communication skills].

Curriculum of medicine on most of medical faculties reshapes rapidly in last decades. The main afford aims to reform the classic curriculum so that students would be able to enter actively the teaching process and acquire the theoretic knowledge in course of solving practical medical problems. This trend led to complete restructuring of medical curriculum on Mcmaster university in Canada and Maastricht university in the Netherlands. Further medical faculties introduce since early eighties workshops on communication skills. Those skills create and maintain the doctor-patient relationship, gather the relevant verbal information and contribute to the solution of the problem. Workshops on communication skills use video feedback and feedback provided by the group. The role playing, simulated patients and the real patients are used. It is essential for the productivity of learning process to have an nondirective supportive teacher and to make students responsible for the progress. The First Medical Faculty of the Charles University adopted the teaching model developed on basis of experience with postgraduate education of general practitioners.

Communication↗

PubMed1975

[The use of videotape recordings in behavior therapy in children (author's transl)].

The vast majority of disturbances of child behavior are due to improper methods of upbringing. Alteration of the child's misbehavior is therefore best done by re-education of the parents. In this paper, a model for the modification of the behavior of mother and child by means of videotape recordings is described and illustrated by a report of treatment. Because of the high efficiency of video feedback for the conversion of parental educational style, its use in behavior therapy work is recommended unconditionally in spite of the very high costs and a considerable expenditure of time.

Behavior Therapy↗

PubMed2006

Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.

BACKGROUND: The debriefing process during simulation-based education has been poorly studied despite its educational importance. Videotape feedback is an adjunct that may enhance the impact of the debriefing and in turn maximize learning. The purpose of this study was to investigate the value of the debriefing process during simulation and to compare the educational efficacy of two types of feedback, oral feedback and videotape-assisted oral feedback, against control (no debriefing). METHODS: Forty-two anesthesia residents were enrolled in the study. After completing a pretest scenario, participants were randomly assigned to receive no debriefing, oral feedback, or videotape-assisted oral feedback. The debriefing focused on nontechnical skills performance guided by crisis resource management principles. Participants were then required to manage a posttest scenario. The videotapes of all performances were later reviewed by two blinded independent assessors who rated participants' nontechnical skills using a validated scoring system. RESULTS: Participants' nontechnical skills did not improve in the control group, whereas the provision of oral feedback, either assisted or not assisted with videotape review, resulted in significant improvement (P < 0.005). There was no difference in improvement between oral and video-assisted oral feedback groups. CONCLUSIONS: Exposure to a simulated crisis without constructive debriefing by instructors offers little benefit to trainees. The addition of video review did not offer any advantage over oral feedback alone. Valuable simulation training can therefore be achieved even when video technology is not available.

Adult↗

PubMed1988

Modifying food purchases in supermarkets with modeling, feedback, and goal-setting procedures.

We compared several procedures designed to modify consumer food purchases with the objectives of reducing fat and increasing carbohydrate content, and reducing dollar expenditures on food. Participants were 126 volunteer community households which, after a 7-week baseline period, were randomly assigned to video-modeling, video-modeling-feedback, video-lecture, video-lecture-feedback, participant-modeling, video-modeling-discussion, and control conditions. The main dependent measure was a weekly record of food purchases, convertible to percentages of nutrients and dollar expenditures. Results indicated that modeling-feedback and participant-modeling procedures were most effective (e.g., 6% reduction of total fat consumption, 19% dollar savings). Strategies to refine and automate modeling and feedback in supermarkets that may benefit consumers, corporations, and government are discussed.

Journal Article↗

PubMed2006

Integrating haptic-tactile feedback into a video-capture-based virtual environment for rehabilitation.

Video-capture virtual reality (VR) systems are gaining popularity as intervention tools. To date, these platforms offer visual and audio feedback but do not provide haptic feedback. We contend that adding haptic feedback may enhance the quality of intervention for various theoretical and empirical reasons. This study aims to integrate haptic-tactile feedback into a video capture system (GX VR), which is currently applied for rehabilitation. The proposed multi-modal system can deliver audio-visual as well as vibrotactile feedback. The latter is provided via small vibratory discs attached to the patient's limbs. This paper describes the system, the guidelines of its design, and the ongoing usability study.

Computer Simulation↗

PubMedDate not supplied

The influence of external loads on movement precision during active shoulder internal rotation movements as measured by 3 indices of accuracy.

CONTEXT: Using constant, variable, and absolute error to measure movement accuracy might provide a more complete description of joint position sense than any of these values alone. OBJECTIVE: To determine the effect of loaded movements and type of feedback on shoulder joint position sense and movement velocity. DESIGN: Applied study with repeated measures comparing type of feedback and the presence of a load. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty healthy subjects (age = 27.2 +/- 3.3 years, height = 173.2 +/- 18.1 cm, mass = 70.8 +/- 14.5 kg) were seated with their arms in a custom shoulder wheel. INTERVENTION(S): Subjects internally rotated 27 degrees in the plane of the scapula, with either visual feedback provided by a video monitor or proprioceptive feedback provided by prior passive positioning, to a target at 48 degrees of external rotation. Subjects performed the internal rotation movements with video feedback and proprioceptive feedback and with and without load (5% of body weight). MAIN OUTCOME MEASURE(S): High-speed motion analysis recorded peak rotational velocity and accuracy. Constant, variable, and absolute error for joint position sense was calculated from the final position. RESULTS: Unloaded movements demonstrated significantly greater variable error than for loaded movements (2.0 +/- 0.7 degrees and 1.5 +/- 0.4 degrees, respectively) (P < .05), but there were no differences in constant or absolute error. Peak velocity was greater for movements with proprioceptive feedback (45.6 +/- 2.9 degrees/s) than visual feedback (39.1 +/- 2.1 degrees/s) and for unloaded (47.8 +/- 3.6 degrees/s) than loaded (36.9 +/- 1.0 degrees/s) movements (P < .05). CONCLUSIONS: Shoulder joint position sense demonstrated greater variable error unloaded versus loaded movements. Both visual feedback and additional loads decreased peak rotational velocity.

Journal Article↗

PubMed2006

The use of video self-modelling and feedback to teach cooking skills to individuals with traumatic brain injury: a pilot study.

OBJECTIVE: To evaluate the effectiveness of video self-modelling plus prompting and feedback to teach a cooking skill to people with traumatic brain injury (TBI) and to examine skill generalization to a novel food item. RESEARCH DESIGN: Multiple probe across participants. METHODS AND PROCEDURES: Four individuals with TBI received instruction in cooking. They watched videotapes of themselves cooking and practiced that skill while receiving prompts and feedback. Treatment effects were evaluated by comparing performance before, during and after training and at a 2 and 4 week follow-up. Additionally, cooking performance on a novel food item was examined. MAIN OUTCOMES AND RESULTS: Three of the four individuals achieved criterion performance within four training sessions. Those individuals also substantially maintained their skills 2 and 4 weeks following training and generalized their skills to a novel food item. CONCLUSIONS: Video self-modelling plus prompting and feedback appears to be an effective treatment for teaching simple cooking skills to individuals with TBI. Further research should examine whether the video alone is sufficient for skill acquisition and evaluate the effectiveness of video self-modelling to teach other skills.

Adolescent↗