Thursday, May 19, 2011

Making a case for importance of clinical skills - PollEverywhere + Human Histogram

Setting:A course for Educators in the Health Professions.
Some of the audience was international and some did not have a clinical background.
There were about 75 people in the audience.

I was trying to make a case for the importance of clinical skills in helping make the correct diagnosis - this was to be done in about 10 min before moving on to some tools to help teach clinical skills. What would be the best way to make a convincing case while engaging the audience?

This is what I came up with:
Step 1. 
Do a poll asking the audience
"What percentage of cases in an ambulatory practice can be correctly diagnosed with a good medical interview and physical examination?"
Here are the results of the poll (done on http://www.polleverywhere.com).

Create your own sms poll at Poll Everywhere

Step 2. 
Provide some references that show that the correct answer is 70-80%.

Step 3. 
Do a Human Histogram - I learned this simple but very effective tool from Ken Locke a clinican educator from Toronto - he used this at a recent Society of General Internal Medicine workshop.  The following slides show how I used it.  FIRST ASK EVERYONE TO STAND UP.  (make a wisecrack about this being "active" learning")
Everyone stayed standing

2-3 people sat down

Almost everyone sat down

I asked the audience to interpret what they had just observed.  There was no doubt in anyone's mind how one or two critical bits of information can help confirm a diagnosis and rule out another.  They also saw how medical interviewing is a very dynamic process of deductive reasoning and how the physician is constantly matching the story with patterns of disease and looking for pieces to complete the jigsaw puzzle.  This is very different from the checklist approach of history of present illness, review of symptoms etc. that we teach our medical students. 
This helped set the stage for discussing various options for making sure our medical trainees get to learn this deductive approach.

Looking back I was struck by how using a web-based polling system where the audience submitted their responses using laptops, smartphones and SMS and combining it with a simple classroom technique of the Human Histogram worked out so well. 

In case you are wondering, Poll Everywhere is a free tool for limited audience sizes and has some great features for submission of responses via web, sms, twitter, and for starting and stopping the poll, clearing results and sharing the data.  You can also embed the poll on a blog and share results with the readers.