Advanced Interview

Skills Training
(AIST)
Clinical Skills Courses 4A and 5

Robert Gee, Ed.D.

Professor, Department of Behavioral
Sciences
RGee@RossU.edu
ROSS UNIVERSITY SCHOOL OF MEDICINE
Learning Objectives

After this lecture, students will be able to:

1. Discuss and describe the AIST program’s goals, structure, and process

2. Explain and define the AIST Practical Examination, including the grading
rubric(s) and expectations (e.g., Stanford Interview Checklist, Interviewer
Observer Feedback Form, Physical Exams, and Verbal Report)

3. Recite and understand the minimum passing requirements and scoring process
for the AIST examination

ROSS UNIVERSITY SCHOOL OF MEDICINE

1. Discuss and describe AIST’s goals, structure, and process

IMIGCS SGL-IST CIST SIST

• Structure and • Clinical • Communication, • Emotional
content of the
medical
interview
reasoning,
content, and
process skills
and special
topics skills
charged
interviews AIST
• Clinical • Patient
• Clinical reasoning education and
reasoning clinical reasoning

1. AIST builds upon basic clinical training from previous semesters

2. AIST will allow for a better transition to clinical rotations, culminating in
the Step 2 CS Exam

ROSS UNIVERSITY SCHOOL OF MEDICINE

1. Discuss and describe AIST’s goals, structure, and process

AIST – Semester Structure

1) Orientation and training session - 1.5 hours
2) Standardized patient (SP) encounter - 0.5 hours
3) Techniques and demonstrations session - 1.5 hours
4) AIST practical examination - 0.5 hours

• Check to see that you have each of these on your eValue schedule!

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1. Discuss and describe AIST’s goals, structure, and process

1) Orientation & Training Session

• Review - Stanford Interview Checklist and Interviewer

Observer Feedback Form

• Outline the AIST Practical Examination

• Evaluate/score a patient interview, using interactive video

exercise

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1. Discuss and describe AIST’s goals, structure, and process

2) Standardized Patient Encounter

• Each student will medically interview and physically examine a SP, providing relevant
patient education

• This encounter will mimic the structure of the AIST practical examination (e.g., timing,
expectations, etc.)

• This encounter will be challenging, requiring process and communication skills, and
encompass the full content (e.g., CC, HPI, PMH, FH, SH, ROS) of an initial medical
interview, including appropriate physical examination task(s)

• Students will receive feedback from the SP (process from the SIC)

• After the encounter, students may review their video, in order to self-assess/reflect

ROSS UNIVERSITY SCHOOL OF MEDICINE

1. Discuss and describe AIST’s goals, structure, and process

Standardized Patient - Feedback

Verbal Feedback - a global assessment of:

1) Professional demeanor
2) “Bedside manner” including ability to develop rapport, communicate
respectfully and clearly
3) Ability to make the patient feel comfortable and respected
4) Non-cognitive qualities that would influence the patient to retain you as
his/her personal physician
Written Feedback - a specific assessment of:
1) Coverage of the content aspects of the interview
2) Coverage of the process aspects of the interview
3) Physical examination

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1. Discuss and describe AIST’s goals, structure, and process

3) Techniques and Demonstrations

• After the SP encounter, students will bring their written patient

feedback, as well as, any questions or concerns to a follow-up group
session

• Interview techniques and tools will be reviewed/presented in a brief

didactic session

• Specific technique questions will be answered and demonstrated

ROSS UNIVERSITY SCHOOL OF MEDICINE

1. Discuss and describe AIST’s goals, structure, and process

4) AIST Practical Examination

• Medical interview content, organization, process

• Clinical reasoning; hypothesis driven questions and physical

examination, formation of assessment and plan

• Professionalism: dress, grooming, demeanor, concern for patient

comfort, use of orienting statements

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2. Explain and define the AIST Practical Examination

AIST Practical Examination - Structure

• Pre-examination
– Punctuality / Check-in
– Professional dress (e.g., white coat, ID badge, clothing, tools, etc.)
– Briefing
– Greet proctor and present ID
– Proctor will provide instructions
– Students will have 30 seconds to prepare your hands and read the door notes

• Patient interview
– Interview must include described process skills (SIC)
– Interview must cover relevant content (e.g., CC, HPI, PMH, FH, SH, and ROS)
– Interview must include patient education, as well as, proper closing

• Physical exam
– PE must include a screening heart and lung examination
– PE must include one other physical exam task appropriate for the patients presenting problem
– PE must be performed smoothly and to technical standards

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2. Explain and define the AIST Practical Examination

AIST Practical Examination - Timing

• Interview & Physical Examination = 17 minutes

– 17-minutes (total) to complete the focused interview, physical examination, including providing
patient education and closing the encounter
– Students will receive a 5-minute warning and may request a 1-minute warning before the end of
the examination

• Summary/Wrap up Duration = 3-4 minutes

– Students will be asked to present a verbal report after the 17-minute encounter is complete
– Students will be asked to present: 1) an assessment of the patient problem(s) and 2) plan(s) for
management

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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Stanford Interview Checklist
Opening
– Allows patient to complete opening statement w/o interruption
– Asks to elicit full set of concerns
– Explains or negotiates an agenda for the visit
Relationship Skills
– Greets and shows interest in patient as a person; uses patient’s last name
– Introduces him/herself
– Aware of personal space. If patient is not comfortable, doesn't force it
– Establishes initial rapport and patient comfort
– Uses words that show care and concern
– Uses tone, pace, eye contact and posture showing care/concern
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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Stanford Interview Checklist – Continued
Information gathering
– Begins with the patient narrative, using open-ended questions
– Clarifies details as necessary, using closed-ended or yes/no questions
– Summarizes and checks accuracy with patient
– Transitions/segues effectively to additional areas
Elicits the patient's perspective
– Asks about events, circumstances, other people that might affect health
– Elicits patient's beliefs, concerns, expectations concerning illness and treatment
– Responds explicitly to patient statements concerning ideas, feelings, values

ROSS UNIVERSITY SCHOOL OF MEDICINE

2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Stanford Interview Checklist – Continued
Patient Education (ASK-TELL-ASK)
– ASK the patient what they know about their condition (Assess the patient's understanding of the problem & desire for
more information)
– TELL the patient what they should know (e.g., additional information; fill in the gaps), using words the patient
understands
– Checks for mutual understanding
– ASK the patient if they have understood everything (repeat back), Ask if patient has any questions
Closing
– Clarifies follow-up and/or contact arrangements
– Asks if the patient has questions or concerns for next time
– Summarizes (or asks patient to summarize) plans until next visit
Flow
– Interview moves smoothly from one component to another, with key points summarized and ending with a smooth
closure

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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Interviewer/Observer Feedback Form - Students will be expected to complete a
thorough medical history database:

• History of Present Illness (HPI) - explore with sufficient depth

• Past Medical History (PMH) - as it relates to chief complaint

• Family History (FH) - as it relates to chief complaint

• Social History (SH) - as it relates to chief complaint

• Review of Systems (ROS) - thorough

• Case Specific Content - Demonstrate content familiarity related to assessment and management of
special patient populations

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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Physical Examination
• Perform screening heart and lung examinations (auscultation only)
• Perform one other physical examination task, appropriate for the patient’s presenting problem
• Perform all PE Skills smoothly and to technical standards
– Position patient properly
– Do not examine through clothing
• Demonstrate professionalism and respect for patient comfort
– Provide orienting statements
– Protect patient modesty
– Pull out the table extension when the patient lies down

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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Verbal Report - Summarize the patient encounter for the proctor using your notes - be succinct and
organized; do not ramble!

• State patient’s name, age, demographics and chief complaint

• Subjective information first, including pertinent positives and negatives

• Objective information next your physical examination findings including pertinent positives and
negatives

• Assessment, including differential diagnosis(es) and what you think is the patient’s
problem/diagnosis

• Plan, including any investigations that are indicated and what you would for follow-up or
management

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2. Explain and define the AIST Practical Examination

AIST Examination – Grading Rubric

Verbal Report Example
Mr. Joseph is a 45-year-old Dominican male, with a history of hypertension. He state he is here today for a follow-
up visit. Mr. Joseph reported that he was first diagnosed with hypertension 5-years ago, during a routine check-
up. He reported that he is taking hydrochlorothiazide and captopril for his hypertension and claims he is
compliant with his medications. However, he reported that he does not monitor his blood pressure at home. His
last blood pressure was taken at a health fair 6-months ago and was 132/82, at that time. He states he has been
feeling well and denies any headaches, dizziness, or vision changes. He denies any past medical history of stoke,
diabetes or heart disease. He reports having a good relationship with his wife and things at work are going well.
He drinks 1-2 beers on weekends and denies any tobacco or drug use. He denies any anxiety, depression, or any
weight changes. On physical exam, patient’s BP was 134/82 mmHg, sitting. On cardiovascular examination, S1
and S2 were normal with no murmurs, rubs or gallops audible.

My assessment is that Mr. Joseph’s hypertension is under control.

I will continue to monitor his blood pressure and provide further education about hypertension, including dietary
management.

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3. Recite and understand the minimum passing requirements and scoring process for the AIST examination

AIST Examination – Grading

The AIST practical exam counts for 30% of the CS course grade.

Students will need an overall grade of 70% or

higher in order to PASS
Failure to pass the exam results in a “0” for this part of the CS
course.

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Summary - Tips for the AIST Examination
• Fully engage in the AIST process

• Read all of the AIST documents posted on eCollege

• Practice the list of physical examination skills tasks that have been posted

• Thoroughly understand and demonstrate all of the SIC process elements

• Gather all of the medical history data, with little hesitation or missed data, including
the ROS

• Practice time management!!

• Practice conducting an excellent, succinct verbal report

ROSS UNIVERSITY SCHOOL OF MEDICINE