|About This Program||System Requirements||How to Use This Software||Concepts Covered||Credits||About the Documentation|
This program was written as a practice exercise for BI 371 "Patient-Centered Medical Interviewing", a first-year medical school course at Brown University. The design team consists of four students from CS 92 "Educational Software Seminar", a course offered jointly by Brown University's Education and Computer Science departments. The purpose of this program is to give students an exercise which will help them identify important information from an interview with a patient in that patient's own words.
The content of the program is a set of 7 video clips of a patient being interviewed. The clips are ordered by complexity. After each clip, the student is provided with a space to write a brief case history detailing the chief complaint and history of the present illness. To aid the student, an on-screen notepad is provided to type notes during the interview. These notes can be referred back to during the process of writing the case history.
The interface of the program has been designed to focus the student's attention on the video clips. There are very few user options and the flow of the program is highly directed so that the student can concentrate on extracting the appropriate information while the video clip is running. After the video is over, the student will write the case history of the patient. When the student is finished, the case history that he or she has written will be displayed next to a professional case history, so that the student compare his or her effort to what would actually be used in a medical environment.
It is our hope that this program will be useful for students in preparing for the interview experience.
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This program requires at least Power Macintosh running System 7.5.1 or higher, 16 MB of RAM, a CD-ROM drive, Apple Quicktime 2.5 or better, and a sound card with speakers or headphones.
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|Note: It is recommended that you close all other application while running this program. The video clips that are included take a significant amount of RAM and processor time. Macintosh System Extensions can be left running.|
The program splash screen is displayed, followed by a screen prompting you to select "New User" or "Returning User". Selecting "New User" will display a program tutorial, which identifies the various elements of the software screen, and a review of the concepts which are used in the program. The "Returning User" option allows you to select which interview to start with. This feature is included in case you have to interrupt your session and wish to return without viewing previous videos.
After you complete the tutorial (Returning users: After you select which interview to start from) the main program screen is displayed. On the left hand side of the screen are a set of status indicators which reflect your position in the program. The main indicator is the Video List. This list consists of seven images of the patients in the program. Black and white stills indicate videos which have not been viewed. Next to each patient's image is a bar which indicates the complexity of the video. A green bar indicates beginner, orange indicates intermediate, and red indicates advanced. Next to the Video List is an arrow which points toward the current interview.
On the bottom right-hand corner of the screen is a toolbar which accesses the common functions of the program. Placing your cursor over the "?" icon will display a pop-up indicator which provides small descriptions of the on-screen elements. The "Tutorial" icon provides access to the program tutorial. Clicking "Concepts" will display a summary of the concepts involved with writing a case history. Next to "Concepts" is the Notepad icon. Clicking this button displays or hides an on-screen Notepad which provides a space for you to write down information from the video. Next to the Notepad icon is the Save button which allows you to save your case history to a text file. The Print Icon allows you to print out your case history. Clicking the "Quit" button exits the Medical Interviewing program.
|Video List: This is a list of each of the available videos in the program. Black and white patient images indicate videos which have not been viewed.|
|Complexity Indicator: These bars indicate the complexity of the video. Green bars indicate beginner, Orange bars indicate intermediate, Red bars indicate advanced.|
|Current Interview Indicator: This indicator indicates the video currently being displayed.|
|Video Screen: The Video Screen displays the current video. Beside the video is the patient's personal information. Below the video is a status bar which show the amount of video remaining.|
|Help Icon: Placing the mouse cursor over this icon displays a pop-up identifying the functions of the interface.|
|Tutorial Icon: Click this icon to see the program tutorial|
|Concepts Icon: Click this icon to display the concepts covered in the program.|
|Saves your case histories.|
|Prints your case histories.|
|Quits the program.|
When the main screen is displayed, the current video clip will start. For new users, this clip will be the first beginner clip. Returning users will see the clip they selected on the starting screen. The clip will start automatically. It may paused and resumed, but not rewound.
When the video clip is finished playing, the case history screen appears. Use the notes you made while watching the video (either in the on-screen Notepad, or written notes if you prefer) to compose your case history. When you are finished writing, click "Done Writing". A professional case history will appear which will demonstrate how a physician may have written the history. When you are finished reviewing the professional history, click "Proceed" to continue on to the next video.
Note: You may return to previously completed videos by clicking on their representation in the video list.
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A complete medical history is essential for effective and consistent care of patients. The case history covers everything from why the patient is at the hospital to the results of his or her physical exam. Although the style in which it is written may vary slightly, the content falls under established categories and criteria. This provides consistent information for anyone who must read the history. A thorough understanding of the patient's past and current status is thus readily available on an as needed basis.
The key to patient-centered medical interviewing is practice. Learning to gather and filter information obtained from a patient is not as easy as it would seem. Experience with the interview itself remains the most effective way to understand and become familiar with the process. The following program is intended to augment first-year medical students' initial experience of patient interviews with an exercise to help students identify and extract important medical information from patients' statements "in their own words." The goal is to be able to create part of a patient's case history from the information that would be gathered during the interview.
The program has three main objectives. The first is to become comfortable and familiar with the patients' stories and how they relate to the medical history. Second is to be able to readily identify relevant medical information from the patient's statements. The final one is to practice how to gather and present that information in a clear, organized manner. Keep in mind that although in some cases the questions being asked may help suggest good interviewing techniques, the focus of this program is not on how to interview. Instead, we will focus on writing two main parts of the case history: the chief complaint and the history of the present illness. These are outlined below:
This is the patient's primary complaint, concern, or other reason that led him or her to seek medical care. Put more simply, why did the patient come to the hospital or clinic? One may either summarize the complaint or use the patient's words directly. The former method is more commonly used and is recommended here. It is also good practice to include the duration of how long the complaint has been happening whenever possible.
This section expands on the chief complaint. It details the complete development of the patient's various symptoms, including all past events related to the present problem. Any related information from the patient's previous case histories would be included here when available. Through experience one will often be aware of other problems and symptoms commonly associated with the current complaint. The inclusion of whether the patient has experienced anyof the typically related problems is also important here. This is often referred to as including the positives (symptoms the patient has or is experiencing) and negatives (absence of symptoms that will help in diagnosis). Even though the interviews presented here may not go into such details, keep these points in mind for future reference.
Though the exact organization of the information may vary, it is essential that the history be written clearly in a chronological fashion. There are two basic formats for creating the time-line of events. One can start with the last time the patient was well and continue through to the present reason the patient came to the hospital. Alternatively, one can start with the most recent events, then go back to when the patient was last well and work back up to the current complaint. Either style is fine as long as all the key points are covered.
In terms of writing style, the case history should be based on the interviewer's interpretation of the information gathered with the patient's own terms used as needed for clarity. Many of the patient's comments and descriptions can be more efficiently and effectively phrased without altering the original meaning. Often patient responses can be wordy and contain irrelevant information. Summing up the key points may actually help clarify the main problem or problems being expressed. When the interpretation is somewhat ambiguous, the patient's actual words may be used as an illustration to further clarify the problem. In this program, the expert case histories prepared for the patients you will be seeing were written in this style. However, since first year medical students have not been trained on the technical jargon, the use of medical terms was restricted to what a first-year medical student could understand. The main points to cover in the history of the present illness are as follows:
This is the patient's primary complaint, concern, or other reason that led him or her to seek medical care.
It is important to include the following points as detailed as possible for each symptom:
Detail the onset, duration of symptoms, and the patient's experiences with the present illness from the first noticeable change in health status.
Cover the psychosocial context of the onset of the symptoms: Where was the patient when the symptoms occurred? What activities was the patient engaged in? Who else was present?
Explain what the patient has done about the symptoms other than seeking health care. For example: Taking over the counter remedies, home remedies, rest, and other activities that the patient has used to attempt self-treatment.
Tell what activities of life the symptoms interfere with: Work, family role responsibilities, social activities, and self-care.
Include the patient's ideas and feelings about the causes, the implications of the illness, and the patients' fears or other emotions involved. This would be the patient's explanation for the symptoms, and would be their answer to the question, "What do you think is causing this?"
These points are covered in the context of the history of the present illness. Other areas covered in a complete medical history include the past medical history, social history, family history, a review of systems, physical exam results, any laboratory data, a working diagnosis, and finally an assessment. For the purposes of this program, we will focus on gathering the information needed to establish the chief complaint and to complete the history of present illness. Feel free to refer back to this information at any time.
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This documentation is targeted toward the student user of the Medical Interviewing Program, with the exception of the section "About the Program", which covers why this program exists, and the goals of the software.
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