Digital Medical Interview Assistant AnCha for Obtaining the Medical History in General Medicine: Case study (Preprint)

BACKGROUND Collecting information on the medical history of a patient is an important step during the diagnosing process. Besides the interrogation by the physician, computerized questionnaires are used to collect the data. To facilitate interaction, implementation of digital medical interview assistants (DMIA) using conversational user interfaces (CUI) gain in interest. OBJECTIVE The aim of this research is to assess patient’s and physician’s perceptions towards a DMIA with CUI. Beyond, we want to understand how such DMIA can be used in real-world context, what issues and barriers exist in their usage. METHODS We developed a web-based DMIA with CUI (referred to as AnCha for anamnesis chatbot) as a research prototype in a participative and iterative development process. We conducted a pilot trial in a practice for general medicine. Patient perceptions were collected and physicians were interrogated regarding usefulness of collected information. RESULTS 31 patients were approached, and 9 participants were included in the pilot trial; 3 conversation protocols were used by the physicians to prepare for the encounter. Participants spanned all age groups from digital natives (n=5), and digital workers (n=3) to digital seniors (n=1). Patients can easily interact with AnCha and are willing to provide information to the digital tool. They recognize benefits while using the dialog system compared to the existing process. Important insights into practical implementation and integration into practice workflows could be gained. CONCLUSIONS Providing information on complaints and medical history before the actual encounter is considered useful. In order to be supportive for physicians, information has to be made available in a sufficient time frame before the encounter. Future work has to assess in particular whether AnCha is also well accessible for digital seniors.

SP4.1.8 Patient satisfaction with telephone versus face-to-face consultations during the COVID-19 pandemic

Aims Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. During the COVID-19 pandemic, several face-to-face appointments in the outpatient clinics have been converted to telephone consultations. The aim of this study was to compare patient satisfaction following telephone consultations over face-to-face appointments in General Surgery. Methods A retrospective survey on consecutive patients (n = 63) was conducted over the telephone by independent interviewers. Group I (n = 36) consisted of patients who had telephone consultations and Group II (n = 27) of patients who had face-to-face appointments. Patient satisfaction was recorded using the Generic Medical Interview Satisfaction Scale (G-MISS) questionnaire as it has been validated for use in General Surgery. Statistical analysis was performed to assess for any differences between the two groups in the cumulative satisfaction scores and the three dimensions of the G-MISS questionnaire, “relief”, “compliance” and “communication”. Results Median, Q1-Q3 of the satisfaction score in Group I (77.3, 62.1-93.3) did not statistically differ compared with Group II (76.5, 62.5-93.3, p = 0.91). “Relief” in Group I (78.1, 57.0-92.9) did not significantly vary compared with Group II (75.0, 53.1-93.7, p = 0.85). “Compliance” in Group I (62.5, 50.0-96.8) was very similar with that in Group II (75.0, 50.0-100.0, p = 0.82). “Communication” in Group I (87.5, 71.8-98.9) was also very similar compared with Group II (87.5, 75.0-100.0, p = 0.74). Conclusions We demonstrated high levels of patient satisfaction with telephone consultations. Therefore, during the pandemic the services of the outpatient department remain of high quality. Considering the economic benefits to the NHS, telephone consultations might be “here to stay”.

How Do Simulated Interviews Increase the Self-efficacy of Medical Students? - Quasi-experimental Research-

Background Self-efficacy is crucial in improving medical student communication skills. This study aims to clarify whether the self-efficacy of medical students conducting medical interviews increased after simulated interviews or after feedback discussions. Methods A total of 162 medical students (109 men, 53 women) in their fourth or fifth year at a university in Japan participated in this study. The degree of self-efficacy in medical interviewing was measured before and after a medical interview with a simulated patient, and after the subsequent feedback session. Results ANOVA analysis revealed that self-efficacy for medical interviews was higher after both the interview and the feedback session than before the interview. Self-efficacy was highest after the feedback session among all three time points. Conclusions Feedback following a simulated interview with a simulated patient is important to improve the self-efficacy of medical students learning medical interviewing skills.

How to interpret diagnostic tests

Healthcare professionals make decisions in a context of uncertainty. When making a diagnosis, relevant patient characteristics are categorized to fit a particular condition that explains what the patient is experiencing. During the diagnostic process, tools such as the medical interview, physical examination, and other complementary tests support this categorization. These tools, known as diagnostic tests, allow professionals to estimate the probability of the presence or absence of the suspected medical condition. The usefulness of diagnostic tests varies for each clinical condition, and studies of accuracy (sensitivity and specificity) and diagnostic impact (impact on health outcomes) are used to evaluate them. In this article, the general theoretical and practical concepts about diagnostic tests in human beings are addressed, considering their historical background, their relationship with probability theories, and their practical utility with illustrative examples.

Methods for the formation of communication skills among medical students

Цель статьи заключается в раскрытии проблемы формирования коммуникативных навыков у студентов медицинских вузов. Отмечается особое значение развития коммуникативной компетентности как важнейшей составляющей общей профессиональной компетентности будущего медицинского работника. В работе описаны различные способы формирования коммуникативных навыков, получившие применение в Саратовском ГМУ им. В.И. Разумовского. Среди них наиболее продуктивными оказались: разбор ситуационных задач; самостоятельное составление ситуационных задач, приближенных к настоящим; написание развернутых диалогов, своеобразных сценариев общения с разными типами пациентов; анализ реальных диалогов врачей с пациентами; написание речевых модулей, включающих два типа фраз: конструктивных, создающих позитивный настрой и, наоборот, недопустимых в общении с пациентом, содержащих экспрессивную и оценочную лексику, способную обидеть больного, вызвать у него страх, агрессию, стыд и другие негативные эмоции; проигрывание медицинского интервью или его отдельных этапов; применение инновационной технологии «Печа-куча». Подчеркивается необходимость целенаправленной и системной работы по формированию коммуникативной компетентности будущих медицинских специалистов различного профиля. The purpose of the article is to reveal the problem of the formation of communication skills among students of medical universities. The special importance of the development of communicative competence as the most important component of the general professional competence of the future medical worker is noted. The paper describes various methods of forming communication skills that were used in the Saratov State Medical University named after V. I. Razumovsky. Among them, the most productive were: analysis of situational tasks; independent compilation of situational tasks that are close to the present; writing detailed dialogues, original scenarios of communication with different types of patients; analysis of real dialogues between doctors and patients; writing speech modules that include two types of phrases: constructive, creating a positive mood and, conversely, unacceptable in communicating with the patient, containing expressive and evaluative vocabulary that can offend the patient, cause fear, aggression, shame and other negative emotions; playing a medical interview or its individual stages; the use of innovative technology "Pecha-kuch". The necessity of purposeful and systematic work on the formation of the communicative competence of future medical specialists of various profiles is emphasized.

Vertigo as One of the Symptoms of Lyme Disease

Objectives: The aim of the study was to evaluate the frequency of vertigo symptoms and potential labyrinth damage in patients with diagnosed Lyme disease (LD). LD can affect the vestibulocochlear nerve, leading to hearing loss and vertigo/dizziness. Material and Methods: The study included a group of 38 patients between the ages of 20 and 77, who were hospitalized due to vertigo/dizziness between 2018 and 2019. All of the patients underwent a detailed medical interview and an otolaryngological and neurological examination, including video electronystagmography (VENG), in addition to audiological and diagnostic tests. Additionally, ELISA and Western blot tests were performed to confirm the diagnosis of LD. Results: In 20 patients (53%), the Romberg trial was positive (p < 0.001). The degree of vestibular dysfunction as shown by the VENG test was associated with the rate of hearing loss as confirmed by the Auditory Brainstem Response (ABR) test (p = 0.011), and it mainly concerned high-frequency sounds (p = 0.014). Conclusion: Vertigo can be a symptom of LD. It is often associated with labyrinth and hearing-organ damage, which can imply that the inner ear or nerve VIII is dysfunctional in the course of this disease. Antibiotic therapy is effective in reducing otoneurological symptoms.

Could Vitamin D3 Deficiency Influence Malocclusion Development?

The abnormal growth of the craniofacial bone leads to skeletal and dental defects, which result in the presence of malocclusions. Not all causes of malocclusion have been explained. In the development of skeletal abnormalities, attention is paid to general deficiencies, including of vitamin D3 (VD3), which causes rickets. Its chronic deficiency may contribute to skeletal malocclusion. The aim of the study was to assess the impact of VD3 deficiency on the development of malocclusions. The examination consisted of a medical interview, oral examination, an alginate impression and radiological imaging, orthodontic assessment, and taking a venous blood sample for VD3 level testing. In about 42.1% of patients, the presence of a skeletal defect was found, and in 46.5% of patients, dentoalveolar malocclusion. The most common defect was transverse constriction of the maxilla with a narrow upper arch (30.7%). The concentration of vitamin 25 (OH) D in the study group was on average 23.6 ± 10.5 (ng/mL). VD3 deficiency was found in 86 subjects (75.4%). Our research showed that VD3 deficiency could be one of an important factor influencing maxillary development. Patients had a greater risk of a narrowed upper arch (OR = 4.94), crowding (OR = 4.94) and crossbite (OR = 6.16). Thus, there was a link between the deficiency of this hormone and the underdevelopment of the maxilla.

The effect of Humanitude care methodology on improving empathy: a six-year longitudinal study of medical students in Japan

Background Empathy, which involves understanding another person’s experiences and concerns, is an important component for developing physicians’ overall competence. This longitudinal study was designed to test the hypothesis that medical students’ empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech. Methods This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE. Results The mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect. Conclusions The Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

Diagnosis of Synovial Chondromatosis of Temporomandibular Joint: Case Report and Literature Review

Synovial chondromatosis is a non-cancerous tumor characterized by the formation of multiple nodules of cartilage due to metaplastic development of the synovial membrane. Etiology can be a primary lesion, of which pathogenesis remains unknown, or low-grade trauma or internal disorders. This pathology can long remain undiagnosed and leads to therapeutic wandering, especially since clinical manifestations are non-specific. Symptoms may mimic temporomandibular disorders and dental orthopantomogram does not always show intra-articular calcified bodies. Cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) are tests of choice for the diagnosis of this pathology. This case report describes the clinical manifestations, diagnosis and management of a case of synovial chondromatosis involving the temporomandibular joint, in a 21-year-old woman who was initially treated for two years for a common temporo-mandibular disorder. The evidence gathered during the medical interview and clinical examination led us to suspect synovial chondromatosis of the temporomandibular joint. Prescription of a CBCT and MRI confirmed the diagnosis of her temporomandibular joint disorder and led to a successful arthroplasty.

Difference in the general medicine in-training examination score between community-based hospitals and university hospitals: a cross-sectional study based on 15,188 Japanese resident physicians

Background The general medicine in-training examination (GM-ITE) is designed to objectively evaluate the postgraduate clinical competencies (PGY) 1 and 2 residents in Japan. Although the total GM-ITE scores tended to be lower in PGY-1 and PGY-2 residents in university hospitals than those in community-based hospitals, the most divergent areas of essential clinical competencies have not yet been revealed. Methods We conducted a nationwide, multicenter, cross-sectional study in Japan, using the GM-ITE to compare university and community-based hospitals in the four areas of basic clinical knowledge“. Specifically, “medical interview and professionalism,” “symptomatology and clinical reasoning,” “physical examination and clinical procedures,” and “disease knowledge” were assessed. Results We found no significant difference in “medical interview and professionalism” scores between the community-based and university hospital residents. However, significant differences were found in the remaining three areas. A 1.28-point difference (95% confidence interval: 0.96–1.59) in “physical examination and clinical procedures” in PGY-1 residents was found; this area alone accounts for approximately half of the difference in total score. Conclusions The standardization of junior residency programs and the general clinical education programs in Japan should be promoted and will improve the overall training that our residents receive. This is especially needed in categories where university hospitals have low scores, such as “physical examination and clinical procedures.”