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MOC Tip of the Month

By Dr. Raheem B. Kherani

Want to improve your consultation skills? Try video.

MOC Tip of the Month - By Dr. Raheem Kherani

As a medical student and resident, you probably remember receiving lots of valuable coaching. But how many opportunities for mentorship do you have now?

I teamed up with four colleagues to study how we could get more coaching and mentorship opportunities throughout our practice. Since we work in different locations, we could not just directly observe each another. Instead, we set out to discover (in a pilot study being published soon):

  1. whether peer-based video evaluation in practice would be feasible and;
  2. whether it would be acceptable as a CPD activity (MOC Program Section 3 Assessment credits).

(Spoiler alert: it is!)

With ethics approval and patient consent, we videotaped ourselves in practice:

  • We taped 40 videos of ourselves individually treating patients (each of the five rheumatologists was taped eight times)
  • We each reviewed eight colleague-videos (10-20 mins/video)

Here’s what we learned:

Video can give you a deeper appreciation of the way you practice.

It was not just about what we did and how, but also our body language, our approach and the extent to which we were actually addressing our patient’s concerns. From the way I arrange furniture, to where I seat my patient, to how I capture their information — I do all of these things differently now as a result of watching videos of myself in practice.

Feedback is all the more powerful when paired with replay.

We used software developed at the University of British Columbia that allowed us to annotate feedback at specific time stamps in the videos. We wrote free-text notes, such as “You did a great job here advising the patient there may be a problem with their lab test” or “You explained the patient’s exam findings here in a very helpful way.”

Sometimes the best feedback is constructive.

I learned, for example, that I spend too much time looking at screens and typing, which disengaged my patients. Now that I am aware of this tendency, I am trying to correct it and I have made changes to how I engage with patients as a result.

To be effective, you must have a “commitment to change”

After reflecting on the feedback we received, each of us completed a “commitment to change” form with three questions (which are very similar in spirit to the outcomes we are prompted to document in MAINPORT ePortfolio):

  1. What information did you find useful from the feedback?
  2. Did the feedback highlight any gaps in your current practice?
  3. As a result of the feedback, what will you change in your current practice?

Be prepared - all of this evaluative work is very time intensive, but so worth it!

My colleagues and I have mentored each other throughout this process and we’re developing exemplary consultation skills as a result. Not only is video assessment a great way to claim MOC Program Section 3 Assessment credits, I promise you will be inspired to change your practice and improve the way you interact with patients.

Why not team up with one or more trusted colleagues and try it for yourself?

With video equipment Most centres with a medical school have rooms with video recording equipment. Use this space, even if it is just for a self-assessment using your smartphone’s video app.

OR

Try your own assessment by investing in an affordable tripod and taping yourself with a consenting patient in your office.
Without video equipment Do a low-fidelity assessment for Section 3 credits! Team up with a colleague and complete a mini chart review of each other’s patients (10 patients each). Compare and provide feedback.

Read more about the original study by Dr. Kherani and his colleagues in their abstract from the 2017 Canadian Conference on Medical Education.

Dr Raheem KheraniDr. Raheem Kherani


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