Video Review

Getting prepared takes a little planning.

• Seeing yourself on camera is not easy.  Please, as part of your preparation, read the section on "making it feel safer to be on camera".
• Set aside some time. 
  • Plan a "Video  Day" - proactively record more than one patient interview
  • Schedule this "Video Day" 4 times a year
  • Engage the Clinic in this plan
• Get consent: Residents, Preceptors, or Medical Office Assistants (with the endorsement of the Preceptor) may acquire the consent of patients to be recorded
• Never record any physical examination. Record only the History and management.  
  • Interviews with children are allowable with the permission of the parent(s) or guardian on the consent form.
  • Choose a straightforward case to start.
• Set the camera up so that it captures both Resident and Patient.
• Review the recording promptly.
  • Your Site will direct the review of Video Recordings
    • Sites vary; –some arrange for one on one review with the primary preceptor, some do reviews with small groups of peers.  
    • See the section on Consent to be clear on your obligations to the patient about who views the video. 

Important points for security and setup:

Security

• A recorded Resident/Patient interview is part of a medical record.    See the College of Physicians and Surgeons of BC Policy for your obligations. 
• Use the camera or equipment provided by your site. 
  • A Smart phone with no SIM card, reserved strictly as a camera may be used. 
  • Never use an internet-enabled smartphone for recording.  
  • The airplane mode is NOT sufficient protection. 
• Keep the recording safe from recording to erasure.  A locked cupboard and a password-protected device (e.g. disabled smartphone or USB) are a minimum.
• Viewing the interview must be done on a secure computer.  E.g. a password-protected, encrypted institutional computer.
• Ensure all copies of the recording are erased promptly after viewing. 
• Here is an FAQ on Video Recording for you.

The 2012 UBC Family Medicine Consent Form must be used at all sites. 

• Consent must be obtained from the patient before recording the interview.   
• The consent process requires initial consent, and a re-iteration of the consent immediately after the recording.  The Consent form requires two patient signatures one before, and one after recording. 
• Keep the signed consent form in the patients file. 
• Residents are responsible to ensure such consent is given.  
• Residents must make clear to the patient:
  1. The purpose of the recording,
  2. Who will be viewing the recording  (i.e. only my preceptor and I will view this.; only my site director and I will view this etc.)
  3. The process for deletion of the recording. 
• Residents must offer the patient an option to view the recording, and erase it immediately, should the patient rescind their consent.
• A new consent form must be used for each recording, even for the same patient.

Residents tell us they feel very awkward doing video recordings with patients.  Any of us who have been recorded knows how it feels. 

Patients do want to help with training young doctors!  

Finding ways to normalize this process helps. Preceptors know their patients well and can assist by:

• Selecting appropriate patients
• Modeling the importance of feedback, 
• Addressing the awkward feelings (empathy and stories help), 
• Adding value to the review by coaching on the nuanced skill of the Medical Interview

Video Review is versatile, and can be used for observation and review of many aspects of the patient interview, including but not limited to:

• The Patient-Centered Approach
  • Engaging the patient
  • Skillfully applying FIFE (feelings, ideas, function, expectations) 
  • Collaborative management
  • Follow up
• Clinical Reasoning and Selectivity 
• Communications Skills with patients
  • Verbal
  • Non-verbal
• Interview flow and efficiency

Set aside at least 15 minutes to review a selected small portion of the interview.

For Residents:

• Set one or two learning goals in advance:
  • what is it you really need to work on to be proficient at the 10 minute medical consultation?  
  • Important targets include: 
    • efficient history taking
    • your Patient-Centred Approach  
    • interpersonal and communications skills, 
    • mannerisms,
    • interview flow and timing,
    • time management.
• Start your first review with a successful encounter.  You be the judge.
• Review your video on your own first, and choose what area you want to work on. 
• Review your video with a preceptor or faculty member.
• Document  - either a site-based form or a Field Note – as directed by your site,  to show:
  • what you have learned, and 
  • what you will improve on next time.
• Later in your program chose a more challenging encounter, one where you believe you could really benefit from coaching.

For Preceptors:

• This Guide from St Paul's Site may be useful to you.
• Encourage goal setting.
• Review only a small portion of the interview – the Resident may select this, or you may choose an area together.
• Target one thing that went well related to the desired goal
• Help formulate a learning goal for one thing to improve. 
• If you note a "stop! Important correction" do discuss this. Again, empathy and stories really help residents to hear difficult feedback.