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Physicians get primer on teaching patients
Several workshops offered to physicians at Kaiser Permanente Northern California are designed to improve educational opportunities at health care facilities. This is accomplished by equipping physicians with the skills they need to be effective teachers. Physicians are taught the following techniques:
• communication skills;
• establishing rapport and soliciting the patient’s point of view;
• solving problems;
• skills for working with difficult patients or challenging situations;
• behavior change counseling.
"Much of teaching is based upon a foundation of an ability to communicate effectively with the patient," explains Cecilia Runkle, PhD, MPH, training and development consultant in Physician Education and Development at Kaiser Permanente Northern California in Oakland. These workshops are provided so the time physicians spend educating patients about their condition is fruitful.
There are three basic programs offered by the communication skills division of the physician education and development department. They include:
• Five-Day Residential Program.
This program is for clinicians who desire to improve their communication skills with patients. During the teaching sessions, physicians work in small groups with a trained communication specialist who is either a physician or a psychologist. The communication specialists critique audiotapes of patient encounters that the physicians bring with them to the sessions. They also coach physicians during scenarios in which professional actors play the role of a difficult patient in several problematic situations, such as a patient who is noncompliant with his or her recommended diet, angry, or emotionally distant.
• Patient-Provider Interaction.
This four session, facility-based program teaches basic communication skills. During the sessions, which are each two hours long, physicians learn how to establish rapport with patients by soliciting their point of view; how to solve problems; how to work through challenging situations; and how to effectively close a visit. "At the close of the visit, the physician would summarize the action steps that have been agreed upon during the appointment by the physician and patient," explains Runkle.
• Thriving in a Busy Practice, Thriving Two, and Thriving Three.
These three one-day programs focus on skills to foster improved communication and health behavior change in patients. Thriving in a Busy Practice and Thriving Two teach communication skills, but the second program also offers an opportunity for physicians to practice with a trained actor. For example, they may work on a situation where the patient is angry or is not following his or her medication regimen. "It’s small-group work with about six to eight clinicians and a trained facilitator. In the group, we coach using scenarios that are particularly challenging to the clinician," says Runkle.
Thriving Three teaches counseling for health behavior change. This program is called Brief Negotiation and is based upon principles of motivational interviewing. The teaching is a combination of brief presentations about the theory of behavior change and the model they are using, along with small group work. Hour-long coaching sessions are conducted twice during the day-long seminar. Each group has a facilitator and professional actor who portrays the patient. Using common clinical scenarios, each group of physicians is coached on the application of the Brief Negotiation model. The scenarios include the following:
• a diabetic patient who is not checking his or her sugar levels;
• a patient who experiences chronic pain and wants more medication but is unwilling to go to a pain management course;
• a patient who is experiencing a lot of stress at work and wants the physician to provide medication (the physician wants to work on other options for helping the patient manage stress);
• a patient with chronic back pain who wants a note from the physician so he or she doesn’t have to go back to work. In the physician’s professional judgment, the patient needs to go back to work and learn to manage pain more effectively.
"The Brief Negotiation model is effective because it allows our clinicians to establish a partnership with the patient. Clinicians assess the patient’s readiness and competence in being able to change and adapt the intervention to the patient’s stage of readiness," says Runkle. n
For more information about classes to improve physician education skills, contact:
• Terry Stein, MD, Robert Tull, PhD, or Cecilia Runkle, PhD, MPH, Training and Development Consultants, Kaiser Permanente Northern California, Physician Education and Development, 1800 Harrison, 21st Floor, Oakland, CA 94612. Telephone: (510) 987-1868. Fax: (510) 873-5142. E-mail: Cecilia.Runkle@kp.org.