Why We Train & Coach Clinicians in Communication Skills and Motivational Interviewing

This video was developed by the Veteran Health Administration (VHA)'s National Center for Health Promotion and Disease Prevention (NCP) to help VHA clinicians and leaders recognize the value of participating in NCP's patient-centered communication training. NCP developed two training programs to meet clinicians' needs: 1) TEACH for Success (TEACH), which features basic communication skills in health education and health coaching: and 2) Motivational Interviewing (MI), a clinical method for identifying and building patients' motivation to actively engage in self-care and health behavior change. VHA's TEACH and MI programs were specifically designed for VHA primary care clinicians providing care in Patient Aligned Care Teams (PACT), VHA's version of the patient centered medical home.

The patient-centered communication skills featured in TEACH and MI training enhance clinicians' capacity to provide personalized, proactive, patient-driven care (PPPDC). These skills include relationship-building skills (e.g., open-ended questions to explore patient needs, values and concerns; reflections, empathy, respect); health education skills (e.g., sharing information, teach-back), shared decision making skills, and health behavior counseling skills (e.g., evoking change talk, goal setting, problem-solving).

In addition to participating in face-face, experiential TEACH and MI courses, clinicians are offered opportunities to participate in follow-up clinician coaching to help them apply TEACH and MI skills in clinical encounters with Veterans. To disseminate TEACH and MI training and follow-up clinician coaching, NCP trains and supports over 300 active TEACH and MI Facilitators, who are also extensively trained to provide learner-centered clinician coaching. TEACH and MI facilitators/coaches also serve as VHA facility-based Veterans Health Education Coordinators (VHECs), Health Behavior Coordinators (HBCs) and Health Promotion Disease Prevention Program Managers (HPDP PMs), and work collaboratively with PACT teams to integrate TEACH and MI skills with other tools, resources and programs that support PPPDC. These tools and resources include: an online health risk assessment tool, goal-setting and decision-making tools, an online Veterans Health Library; and access to VHA and community-based programs in tobacco cessation, weight management, self-management and other health behavior change areas.Training and clinician coaching in TEACH and MI is a key component of PACT's "roadmap" for operationalizing PPPDC in primary care.

In the "Why Train" video, PACT leaders, PACT clinicians and Veterans share reflections about the value and impact of TEACH and MI training on Veteran experience, the quality of care and health outcomes. Clinicians also share how training and coaching has enhanced their skills, their  morale and even their overall satisfaction with their work!

Several Recent Articles Stress the Value of Empathy in Medical Care.

The importance of empathy in medical care is the focus of several articles recently published in the medical literature. See below for a brief comment on each and a link or reference to the article.

In an article that appeared in the March, 2012 issue of Perspectives on Psychological Science, Hacque and Waytz include empathy reduction in clinicians as one of the "causes of dehumanization" in medicine. They suggest that clinicians have difficulty being empathic when actively engaged in demanding cognitive processes, such as diagnostic reasoning and problem solving. Empathy reduction can be countered, however, by strategies which promote clinician awareness of the human and emotional aspects of patient care, such as learning about the whole patient (e.g., interests, roles, values, preferences) and recognizing the dehumanizing aspects of medical settings, technology and the procedural elements of care. The article citation is: Hacque, OS, Waytz A. Dehumanization in Medicine: Causes, Solutions, and Functions. Perspectives on Psychological Science March 2012 vol. 7 no. 2 176-186. doi: 10.1177/1745691611429706                                 

In the May, 2012 issue of the Journal of General Internal Medicine, Helen Reiss and colleagues reported that training in empathy improves physician use of empathic skills. Reiss reports that providing three 60-minute empathy training modules to residents and fellows (physicians undergoing specialty training post medical school) produced significantly greater changes in a patient-rated measure of empathy than residents undergoing standard training. Trained physicians also showed greater changes in their ability to decode facial expressions of emotion. An abstract of the article can be found at: http://www.ncbi.nlm.nih.gov/pubmed/22549298

And, the most inspiring article of the recent articles was written by Bernie Lown, MD's on his personal blog. See: http://bernardlown.wordpress.com/2012/04/29/social-responsibility-of-physicians/ . Bernie is a renowned cardiologist, educator and researcher who has been a proponent of patient-centered care for 60 + years! Dr. Lown is a leading voice in medical ethics and social responsibility and was a recipient of the Nobel Peace Prize for his leadership of the Physicians for Social Responsibility during this organization's campaign to educate the public about the medical consequences of a nuclear catastrophe. He has also been an outspoken critic of overtreatment and
unnecessary use of medical technology, especially in advancing cardiovascular health,  and has emphasized the value of addressing health behaviors and promoting patient engagement and empowerment in his publications. The current article is a transcript of his address to the April, 2012 Avoiding Avoidable Care Conference held in Cambridge, MA. (See http://avoidablecare.org/ for more on the conference). Here is my favorite section:

Sixty years of doctoring has taught me that taking a history, namely listening, is the quintessential part of doctoring. Proper listening is a skill, an art and a core element of medical professionalism. History taking is far more than providing key elements for a diagnosis. It is the basis for nurturing trust. I am persuaded that nothing of science taught to medical students is as difficult to master as is the fine art of listening.

New Monograph on Communicating Risks and Benefits

For your interest, the Risk Communication Advisory Committee of the FDA recently published a monograph, entitled "Communicating Risks and Benefits: An Evidence-Based User's Guide". This is a valuable resource that provides readers, clinicians and public health folks with guidance about how to understand, interpret and communicate about risk. It is relevant to our discussion about the risk information provided by 23andMe and other genomic profiling services. I was fortunate to have the opportunity to serve on this committee, learn about this important topic and contribute to this effort.

Click on the title of this post or paste the link below into your browser to peruse or download the monograph:

http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM268069.pdf