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In March, he came to the UNMC campus to teach medical school students.
His visit was part of a first-of-its-kind research study being done by UNMC’s Bill Lydiatt, M.D., and Virginia Aita, Ph.D., to determine if a unique three-part class featuring three experts in observation — a poet, an artist and an FBI agent — can improve the observation skills of second-year medical students. In addition to Clegg, others teaching the class were U.S. Poet Laureate Emeritus Ted Kooser and portrait artist Mark Gilbert.
“We want to find out if there is an effect on students’ abilities to better view patients through the combination of writing, drawing and using observation techniques,” said Dr. Lydiatt, a head and neck cancer surgeon in the otolaryngology-head and neck surgery department at UNMC. “Our ultimate goal is to introduce the class into the curriculum or Integrated Clinical Experience and make it part of the med school experience.”
After a short lesson on interview tips and techniques, Clegg put the students to the test. He had half the students wait in the hallway while the other half watched a video of a recreated bank robbery and homicide. Upon returning to the classroom, the students from the hallway were tasked to interview their peers about the crime they saw occur.
Paired up were Joslin Bowen as the witness and Jacqueline Wells as the investigator. Wells used the pointers taught by Clegg and asked open ended questions, listened actively and verified the information several times. She didn’t, however, probe for any specifics on the weapon or for an approximate height or weight of the suspect. Bowen’s descriptions are fairly accurate though she inaccurately described the suspect’s clothing and wasn’t able to provide a make, model or license plate on the getaway car.
Fifteen minutes later, Clegg had the interviewers inform him of the details they’d gathered from witnesses’ accounts. From those results, the suspect is black/white male, wearing a hooded sweatshirt/jersey and driving a two-door/four-door vehicle with an unknown license plate.
In other words, not much to go on. As Dr. Lydiatt would say, the students “saw, but did not observe.”
The exercise was designed not only to demonstrate the importance of details, but also to teach future doctors empathy for patients who may have trouble recalling signs and symptoms.
“Doctors get frustrated when people can’t tell them more,” Dr. Lydiatt said. “People want to tell you the right thing. The reality is it’s difficult.”
“I think what the FBI segment did was to get students to observe a series of events in context,” said Dr. Aita, a medical ethicist and associate professor of the College of Public Health. “We teach about observing a person, but not in context. We say that if you are a good listener, then the history will lead you to the diagnosis. Observational skills are critical to having good diagnostic skills because they can help one do a good history. The FBI segment really made you pay attention to the whole picture.”
Clegg noted that it is important to develop a rapport with patients through a proper introduction, friendly body language and the removal of barriers.
“Intimidation is an emotional barrier,” Clegg said. “As a doctor, you are much like an FBI agent in that you are an authority figure. That in itself is pretty intimidating.”
Questions like “How are you feeling?” or “If you were the doctor, what would you like to know?” are a good way to establish a common ground and break down communication barriers, Clegg said.
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“These skills can be taught,” he said.
Drs. Lydiatt and Aita hope so. In the coming months, they will know for sure.
Their study, which has been approved by the Institutional Review Board at UNMC, consists of 47 randomized students, including 23 who attend the observation classes and 24 who don’t. Next year, all 47 students will be evaluated in an observation skills assessment already part of the psychiatry rotation curriculum. In the assessment, students will watch a video of a patient interaction and then complete a standardized test. The results of the experimental group will be compared with the control group as well as all second-year medical students.
“We have no idea how it will turn out,” Dr. Lydiatt said. “It could be a great idea spoiled by the facts.”
Data will be collected between June 2008 and July 2009 and analyzed after that. Regardless of the results, Dr. Lydiatt hopes to publish their findings in educational journals.
For now, only anecdotal comments are available, such as those from second-year medical students Bowen and Wells, who both found Clegg’s class eye-opening.
“It made me more conscious of things we should be aware of, like how being more sympathetic makes it easier to relate,” Bowen said.
“The exercise helped you to understand that it’s easy to forget and really hard to remember everything,” Wells said.
Dr. Aita has heard similar comments from third-year medical students who participated in the pilot project last year, which only involved Kooser and Gilbert.
“Dr. Lydiatt and I had the general notion that the students would get something from the pilot project,” Dr. Aita said. “Essentially what happened was all the students thought it was worthwhile. Those students said they now think about observation in a new way.”
From those narratives, Drs. Lydiatt and Aita decided to develop a more structured, research-based class and add Special Agent Clegg to the lineup.
While other academic institutions have offered unique observation classes in the past, this study goes beyond what’s been done before.
“It’s a new way of thinking about teaching observation skills,” Dr. Aita said. “There are multiple ways in which we understand something. This class has students use their five senses — a different approach than we typically use in teaching students in the health are profession. It’s really an art.”