Thomas Mitchell|Matthew Goldenberg
When Doctor Means Teacher: An Interactive Workshop on Patient-Centered Education
Yale University|Yale University
open accessdecember 10 2020when doctor means teacher interactive workshop patientcentered education thomas mitchell md matthew n goldenberg md msc thomas mitchell md httpsorcidorg0000000334014235 resident department psychiatry yale university school medicine email address email protected google scholar articles author matthew n goldenberg md msc httpsorcidorg0000000188596299 associate professor department psychiatry yale university school medicine google scholar articles author httpsdoiorg1015766mep2374826511053 sectionsaboutpdf toolsdownload citations sharefacebooktwitteremail abstract introduction increasingly health care delivered patientcentered model patients engage shared decisionmaking medical providers result medical educators placing emphasis patientcentered communication skills however published curricula currently offer comprehensive discussion skills providing patientcentered education pce key component shared decisionmaking developed interactive twosession workshop aiming improve students abilities provide pce methods workshop included didactic instruction group discussion interactive simulations workshop delivered 50 clinical clerkship medical students first session concentrated educating patients diagnoses second session focused providing patients information medications treatments used detailed realistic roleplay exercises core tool student practice demonstration confidence evaluate workshop used pre postsurveys results sessions well received students strongly agreed workshop pce important skill students also strongly agreed roleplay exercises effective tool learning pce demonstrated significant improvements confidence name important elements pce deliver pce future discussion workshop fills curricular gap offering comprehensive interactive curriculum improving students abilities provide critical pce format content easily adaptable various disciplines learners teaching modalities educational objectives end activity learners able 1explain importance providing patientcentered education diagnoses medications2describe five key elements patientcentered education diagnoses medications3demonstrate confidence patientcentered education diagnoses medications introduction recent decades health care increasingly delivered patientcentered model12 within model value placed individuals specific needs desired health outcomes become driving force behind health discussions decisions3 major role patientcentered health care providers educate equip empower patients shared decisionmaking sdm define patientcentered education pce providing patients information need meaningfully participate decisionmaking process4 paying particular attention level health literacy5 within sdm framework highquality pce shown improve variety outcomes including patient satisfaction treatment adherence even healthrelated measures68 additionally evidence qualitative studies eliciting perspectives patients variety settings suggests majority desire informed diagnoses treatments included decisions912 however similar studies also found disconnect patients often feel heard valued included912 doctors often fail communicate adequate information13 information communicated often difficult patients comprehend1415 medical schools steadily introduced curricula emphasizes patientcentered communication skills many focused building rapport using openended questioning conveying empathy delivering bad news1619 number experiential interventions involve students providing direct patient education20 isolated exercises translating medical documents plain language14 writing letters patients explaining common conditions21 following patients via telephone office visit22 explaining medications heart failure23 however cited interventions oneoff exercises specific clinical scenarios emphasizing different technique patient education workshop aims comprehensive training focused rationale techniques practice effectively educating patients families roleplay exercises frequently used skill development clinical education particularly access real standardized patients challenging despite mixed student sentiments associated roleplay exercises found useful educational tool especially roleplays sufficiently planned well structured include situations closely mirror learners reality24 highquality pce desired patients effective improving patient outcomes currently well executed providers given trend towards curricula emphasizing patientcentered skills necessary medical schools respond incorporating robust education provide pce seek fill gap interactive twosession workshop methods designed interactive twosession workshop aimed improving clerkship medical students abilities provide pce sessions included didactic instruction group discussion roleplay exercises described facilitator guide appendix sessions followed similar flow closely mirrored learning objectives 1 15minute instructorled introduction didactic portion presented background information subjective objective arguments convince students importance providing pce 2 20minute interactive portion focused discussing practicing necessary skills providing pce 3 45minute portion dedicated roleplay exercises demonstrate confidence pce 10minute wrapup period session lasted approximately 15 hours piloted first session late 2019 20 students primary care psychiatry clerkship close end clerkship year utilizing student feedback altered sessions slightly taught full workshop 2 consecutive weeks early 2020 new group students beginning clerkship year twentyseven students participated first session three additional students 30 total participating second session students encouraged read health literacy primary care practice5 prereading prior first session first session began presurvey appendix b guided powerpoint slides appendix c presenting background information slides 410 used video created institution author owned appendix slide 11 discuss key elements pce video showed student providing education patient diagnosis included combination positive negative elements participants could identify using lessons learned video referenced assigned reading formally delineate important skills needed providing pce slide 14 skills included avoiding medical jargon breaking information instructions small concrete steps limiting focus visit three key points tasks assessing comprehension discussed key elements pce referring agency healthcare quality researchs health literacy universal precautions toolkit slide 1525 provide specific instruction assessing comprehension explained teachback method26 detail offered examples slide 16 initiate skill using nonshaming openended questioning asked students pair practice skills breaking confusing medical terminology patientcentered language slide 17 exercise followed debrief address challenges key learning points remainder first session dedicated roleplay exercises focused providing pce three common diagnoses hypertension depression diabetes revision cases could altered reflect relevant conditions appropriate learners students separated groups three student opportunity play role doctor patient observer specific detailed case background instructions helpful hints given case role appendix e order mirror realistic patient interaction doctor patient consistent information also different ambiguous andor contradictory information also order facilitate active role observers given number specific tasks including keeping time monitoring detailed checklist facilitating effective feedback students sent various small breakout rooms enable privacy completing exercises time instructors floated groups observe offer realtime feedback upon completion instructor led short wrapup session administered postsurvey appendix f finally homework assignment appendix g second session handed assignment guided students systematically research characteristics three medications fluoxetine metformin lithium preparation similar roleplay exercise next session second session also guided powerpoint slides appendix h followed similar structure focus educating patients medications treatments session began brief recap first session given focus treatment instructor presented overview relevant concepts sdm informed consent slides 46 instructor shared background specifically pce medications important skill slides 79 article feng bell jerant kravitz13 cited highlight best practices important elements educating patients medications slide 11 shared conceptual framework discussing medication side effects slide 12 given challenge even experienced providers next asked students pair practice specific aspects medicationfocused education describing side effect rationale taking medication slide 13 exercise followed debrief address challenges key learning points remainder second session dedicated roleplay exercises appendix similar structure first session students played roles doctor patient observer specific realistic scenarios fluoxetine metformin lithium recommended students able use assigned research done medications aid roleplay exercises homework could conceivably revised cover education treatment interventionseg surgical procedures blood transfusion etcdepending audience session concluded 10minute instructorled wrapup session postsurvey appendix j evaluated workshop surveys featuring statements related learning objectives using likert scale level agreement also asked students experience roleplay scenarios given core component workshop students completed presurvey appendix b prior first session postsurveys appendices f j following session students also option provide additional feedback freetext response survey results pilot session used inform changes prior full implementation compiled analyzed responses first full twosession workshop results matched responses pre postsurveys compared using tests statistical significance defined p 05 results workshop implemented 50 students total late 2019 20 medical students participated pilot session primary care psychiatry clerkship early 2020 30 clerkship medical students participated one sessions workshop held consecutive weeks facilitated sessions lasted 15 hours conclusion sessions students felt educational objectives met see table 1 intervention students strongly agreed delivering pce important skill 49 preworkshop vs 49 postsession 1 49 postsession 2 significant change responses however students demonstrate significant improvements categories agreed strongly could name important elements pce 30 vs 42 45 reported feeling confident ability deliver pce 34 vs 39 41 increasingly agreed opportunities practice delivering pce 36 vs 45 46 finally though assessed presurvey students felt sessions roleplays effective tool learning pce 43 44 table 1 pre postsession survey resultstable 1 pre postsession survey results qualitative feedback freeresponse portion surveys largely positive summarized thematically table 2 main theme emerged ability engaging interactive realistic practice roleplay exercises areas improvement mostly centered around logistical concerns time constraints couple students feeling enough time complete exercise number students also commented desire faculty observe roleplay exercises could receive immediate feedback experience peers table 2 summary postsession comments grouped common themestable 2 summary postsession comments grouped common themes discussion workshop filled important gap published curricular offerings comprehensive interactive curriculum improving medical students abilities provide pce based survey evaluation students agreed important skill interactive workshop increased confidence deliver describe key elements pce found use roleplay exercises helpful enjoyable based qualitative feedback students generally enthusiastic interactive engaging nature workshop facilitators largely positive experience developing delivering workshop brief didactic portion workshop students seemed appreciate rationale teaching skills highly engaged interactive discussionbased portion sessions students active participants came meaningful responses finally though logistically challenging times roleplay exercises produced excellent interactions allowed students gain important insights experientially peers lowpressure environment moving forward plan develop streamlined practices handing materials grouping students separating breakout rooms recalling students wrapup portion session majority constructive feedback facilitator concerns stemmed logistical issues also considering recruiting additional facilitators observe roleplay exercises offer realtime feedback workshop delivered one institution primary care psychiatry clerkship two groups students two facilitators anticipate significant barriers generalizability across similar settings interactive exercises require level prerequisite medical knowledge students provide sufficient patient education one limitation workshop may fit well students early preclinical training though students demonstrated significant improvements confidence name use pce skills employ skillsbased assessment therefore unclear whether positive attitudinal changes translate meaningful improvements students ability educate patients furthermore known durable improvement student knowledge confidence time moving forward workshop continue delivered additional groups students institution believe easily used institutions within specific clerkships part overall clinical skills curriculum potentially workshop modified use different clerkships eg surgery obgyn etc though content roleplay scenarios may need adapted relevant diagnoses interventions workshop would particularly lend teaching number important patient education scenarios interactive way including informed consent procedures consent blood transfusions health wellness counseling workshop could also modified use residents faculty health care learners given appropriate alterations content though workshop developed prior widespread use virtual learning platforms coronavirus pandemic believe could adapted teleconference classroom teaching minor alterations would meaningfully change content experience sessions notably roleplay portion workshop could completed using breakout room function available many virtual learning platforms learners could still engage one another small groups handouts explaining roleplay scenarios could disseminated electronically could pre postsurveys might improve efficiency data collection analysis area study would follow students ascertain whether implementation workshop translates meaningful differences interaction patients time intermediate step could include simulations standardized patients would provide lifelike environment allow objective feedback performance increased emphasis within medical school curricula providing pce developing valuable skills benefit patients learners workshop model curriculum novel comprehensive interactive engaging modifiable multiple contexts references1 mead n bower p 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facilitator guidedocx presurveydocx session 1 patient education diagnosespptx videomp4 session 1 roleplay scenariosdocx session 1 postsurveydocx medication research worksheetdocx session 2 patient education medicationspptx session 2 roleplay scenariosdocx session 2 postsurveydocx appendices peer reviewed integral parts original publication download citationmitchell goldenberg mn doctor means teacher interactive workshop patientcentered education mededportal 20201611053 httpsdoiorg1015766mep2374826511053 copyright permissions 2020 mitchell goldenberg openaccess publication distributed terms creative commons attribution licensekeywordspatientcenteredcommunication skillspsychiatrypatient educationshared decisionmakinghealth literacyprimary careroleplayacknowledgmentswe wish thank dr walker kernan dr michael green help producing educational video used materials disclosures none report fundingsupport none report ethical approval reported applicable tabsloading