LAUSR

To the Editor: In clinical settings, we traditionally expect the most novice (usually a medical student) to begin the interview and then hand it over to the senior if there is any hesitation. Taking over an interview in this way can feel evaluative to the learner and also is less effective because any feedback then has to be given after the patient interaction has ended. What if we instead observe the student’s process and unobtrusively provide feedback that allows them to correct their own path during the interview itself? Real-time coaching is a technique within teacher training that is possible with recent technological advances that allow the use of a wireless earpiece to give moment-to-moment feedback [1]. A coach “whispers in” the ear of the trainee as they deliver a lesson so that the feedback is immediately available for the trainee to course correct. Ample research shows that feedback is most effective if provided immediately and applied during the task [2–4]. This technique is perfectly suited to teaching within psychiatry when the patient interactions involve telehealth. During COVID-19, I have seen patients over video from my home office, joined frequently by medical students participating in clinical rotations from physically distant locations. We meet in a virtual “room” to conduct the appointment, and after introductions and permissions, I prompt the student to begin the interview. This interaction might then proceed as normal (i.e., with the student collecting interval history and checklist review of systems until they stall), if not for the simple fact that I am simultaneously guiding the student using a secure chat text messaging function within the electronic health record. All that is required is that the student has the ability to view both the video and the chat box simultaneously. In a typical exchange over chat during an interview, I guide the student to reword a question, to inquire into specific symptoms, or to reflect the patient’s emotion. I also praise effective interviewing technique. In one case, I was seeing four consecutive patients with a student who had been rotating with various providers in the outpatient psychiatry clinic for about a week. The student said she was comfortable leading the initial interview, and I explained that I would refrain from interrupting by sending pertinent chat messages for her reference during the process. Here is a composite transcript simulating the dialogue (for example, midway through the first medication management appointment, at a point when the student began asking somewhat repetitive yes/no questions):