HealthPartners, the nation’s largest consumer-governed nonprofit health care organization with 1.2 million patients, regularly supports its multispecialty group of 1,800 physicians with a wide range clinical education and department learning opportunities. But one popular tool it had yet to add to its arsenal was podcasts.
That changed earlier this year with a series of simulated clinician-patient interactions focused on physician communication and patient experience that were developed in conjunction with Baby Boomers for Balanced Healthcare, a citizen advocacy group based in Minneapolis. In particular, the podcasts explore how physicians can talk to patients about overuse of medical services without creating conflict.
“We were looking for something different and more innovative in medical education,” said Christine Bloom, Quality Director for HealthPartners, adding that when physicians were asked where they would like to get medical education and in what formats, they said being able to listen in the car on the way to work would be a great use of their time. The use of downloadable podcasts came up as a convenient option for delivery of this content.
“We decided we really needed to explore podcasting,” said Bloom, “and with a limited budget, the use of audio was a good approach. The audio-only format also allowed for focus on the tone and reflective qualities of the communication.” HealthPartners physicians can access the podcasts from an internal webpage with other online clinical education tools; the series is also available on iTunes and Google Play.
The three episodes, which grew out of community conversations about medical overuse, each present a common scenario in which a patient or family member requests an unnecessary diagnostic test or more aggressive treatment plan than warranted, including overuse of antibiotics and long-term opioid prescribing for acute pain management.
For each scenario, the podcasts feature three types of skilled conversations followed by a debriefing between the physicians and the patient actors. The conversation is extemporaneous rather than scripted; the scenarios are defined, but the actual dialogue unfolds naturally, and the debriefing is used to tease out what occurred in the discussion.
The conversations are classified as simple, complicated and polarized. In the simple conversation, the physician’s intervention works quickly and the patient willingly accepts the alternate recommendation. In the complicated conversation, the physician asks questions (such as what fears the patient has that might be driving the request) instead of hammering away at medical evidence. In the polarized conversation, the physician focuses less on persuasion and more on keeping professional boundaries for ensuring appropriate, evidence-based clinical decision-making–while being respectful toward the patient and caregiver.
In the debriefing section, the podcast actors – creators Dr. Bill Doherty from Baby Boomers for Balanced Healthcare and family physician Dr. Cate McKegney – reflect on differences in tone, style and language and discuss the interaction through the eyes of both clinicians and patients.
Bloom said HealthPartners’ patient education department has developed a listening guide and patient materials to complement the podcast series, and that early feedback indicated physicians found the scenarios realistic and applicable to daily practice. Listeners particularly liked the unscripted role-play, the progression in conversation, and the closing commentary on the communication techniques and strategies employed and why.
She said HealthPartners is finding ways to embed the podcast series into existing clinical education programs, such as shadow coaching, family medicine residency training and as an educational intervention in their Maintenance of Certification (MOC) work. In addition, internal medicine physicians can receive credit for MOC Part IV and PI-CME (as a six-month self-directed quality improvement project) if they develop a personal action plan to adopt the skills demonstrated in the podcast series.