Medical misinformation and disinformation have long been issues in public health, but during the COVID-19 pandemic, these concerns intensified, presenting a particularly challenging problem for many health care providers. Countering these harmful and highly prevalent mis- and disinformation campaigns has been at the center of a cooperative agreement between the Centers for Disease Control and Prevention and the AAMC.
The recently concluded AAMC Health Professions Education Curricular Innovations Grant Program funded through this partnership represented an opportunity to address medical misinformation and the phenomenon of mistrust through focused curricular additions to health professions education, explains program leader Andrea Anderson, MD, MEd, FAAFP, associate chief of the division of family medicine with GW Medical Faculty Associates and chair of the clinical subcommittee, committee on undergraduate medical education curriculum at George Washington University School of Medicine in Washington, D.C. (Anderson served as senior medical education consultant to the AAMC on the grant.)
“We know that patients deal with a large variety of health professionals in the course of their interactions with the medical field. It’s not just their physician,” Anderson notes. Getting all of these professionals aligned to address medical misinformation, and vaccine hesitancy in particular, was a key focus area for the grant program.
“We wanted to really make sure that we looked at ways to educate all members of the team and that the grantees that we selected really emphasized interprofessional education in their work.”
Anderson hastens to add that the aim of the program is not to “change anyone’s mind,” or to “force a narrative…. It’s to capitalize on the inherent trust and the inherent position of authority or confidence that a medical professional has with a patient and to allow the patient to get the right information and be able to make the right decision.”
Over the course of the grant period, four schools developed innovative, interdisciplinary programs to help health professions learners boost their understanding of the impact of medical misinformation and learn how to engage patients constructively to move them toward better health outcomes.
Below are details of how the four grantees approached this project. Anderson notes that across these programs, “all of the innovations showed an increase in confidence in the learners and in discussing these items with their patients.”
Zucker School of Medicine at Hofstra/Northwell
Led by Marie C. Petrizzo, MD, MSEd, Associate Dean for Medical Education and Samara Ginzburg, MD, Vice Dean for Medical Education
In her role as associate dean for education at the Zucker School of Medicine at Hofstra/Northwell, Petrizzo, an allergist and immunologist, had a front-row seat to the importance of dispelling mis- and disinformation during the COVID-19 pandemic. “It all came to a boiling point and became very divisive during that time, and we needed to address this with our students very early on,” she says.
Helping learners have difficult conversations with patients about vaccinations isn’t always easy, but Petrizzo says the grant program provided “a real opportunity to teach future doctors, nurses, and other practitioners how to handle these uncomfortable situations very early on.”
Although the school’s curriculum has long included training in communicating with patients, how to talk about misinformation or disinformation became a new focus. As part of the grant program, they developed three new ways of applying motivational interviewing and shared decision-making in the context of mis- and disinformation. Aimed at second-year medical students, these techniques were later reinforced during the third and fourth year.
In 2021, students who had gone through this communications training attended a health fair in Queens and spoke with patients about vaccinations, and COVID vaccination in particular. “They talked the patients through the myths and the things that were inhibiting them from getting vaccinations, and this was amazing real-life practice for the students,” Petrizzo says.
Students were also graded during an assessment role-playing exercise where they talked with an actor playing a hesitant patient.
The final piece of the program involved the students creating electronic infographics that students and faculty could keep on their mobile devices. These graphics, called JITTTs, or “Just in Time Teaching Tools,” are essentially small PDF files that can be accessed on a mobile device. Students and faculty are encouraged to consult these resources just before heading in to talk with a patient about a vaccine, as a “little cheat sheet on how to approach the conversation,” Petrizzo says.
Going forward, the group hopes to adapt the various tools they’ve developed for use beyond vaccines. “There’s misinformation and disinformation around other things in medicine, not just vaccines,” Petrizzo notes, pointing to surgical procedures as a specific area where this can be problematic.
For example, some individuals may fear undergoing a surgical procedure after hearing about the possible, but rare, adverse effects of anesthesia. But, applying “these skills that we practiced and honed and applying them in different scenarios,” could help students address any concerns from patients that are stopping them from getting the care they need, she explains.
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Led by Nicholas M. Fusco, PharmD clinical professor and division head of education and teaching innovation at the School of Pharmacy and Pharmaceutical Sciences
The University of Buffalo team focused much of its efforts on strengthening “teamwork, communication, understanding of each other’s roles and responsibilities within a team, and then how the team can help elevate the care that’s provided to patients and populations,” Fusco says.
He notes that conversations related to vaccines or misinformation can occur in any health care setting and may involve virtually any health care provider, which underscored their aim to integrate the messaging across disciplines. Students in medicine, nursing, pharmacy and public health have been involved in the program, which consists of three elements:
- Foundational online modules. These modules present students with baseline information about vaccine hesitancy, medical misinformation, and communication strategies. They also include abbreviated training sessions to help students learn motivational interviewing strategies that can be deployed in conversations that involve mis- or disinformation.
- Online simulations. These simulations involved selecting conversational inputs from a series of options that reflect different points of view and then reviewing and assessing these conversations and determining which strategies worked best.
- Live simulations. Students paired up with another health professions learner from a different program and role-played with an actor in various situations. After these conversations, they would debrief and talk about the simulation and the students’ approach to the conversations. These simulations required students to think on their feet and work together.
“The idea was really for each segment to build on each other,” Fusco says, as students progressed through the levels of training.
Students were very receptive to the program, Fusco says. “They learn about this information in their discipline-specific curricula, but they don’t get a ton of opportunity to practice engaging in those conversations.”
Plus, getting to engage with other health professions learners and working collaboratively like they often will in the real world reinforced what they were learning. “There’s different pieces of knowledge and experience that each brings to that conversation and they can work together to have that conversation.”
Going forward, Fusco says the team is interested in continuing to develop the program and expanding the number of health professions that they’re engaging. They’re also looking at other ways to expand their reach. “There’s a lot of other misinformation that exists beyond just vaccines,” Fusco says.
Maine Medical Center/Tufts University School of Medicine — MaineTrack
Led by Jennifer L. Hayman, MD, Assistant Dean for Education
Hayman notes that heading into this grant program, her team was well aware that “Maine had some of the worst COVID outcomes when you look at people of color and other underrepresented folks, so we knew we had work to do in Maine about COVID misinformation and vaccine hesitancy,” she says.
To do that, the team focused specifically on dispelling fears about the vaccine, and approached the problem with a multi-phased project that led to the creation of a multi-part teaching toolkit for health professions students.
- The first is a medical primer on COVID itself “to make sure that all the learners come in with the same baseline understanding of what COVID is, how vaccines are made, side effects, etc. It’s just normalizing everybody’s knowledge based around COVID,” Hayman says.
- The second part teaches learners how to hold effective patient-centered conversations.
- The third part involves an online platform that teaches learners about how to work in interprofessional teams and why that’s important when working with patients. This section is “go at your own pace, self-didactic, and it has some interactivity and different embedded exemplar videos that show the students how to have these conversations,” Hayman explains.
The video series offers a few different example interactions, and demonstrates various motivational interviewing techniques and other ways to talk with patients to begin moving them toward vaccine acceptance.
Making those videos was an intensive undertaking that involved conducting focus groups with different interprofessional health students, including nursing, physical therapy, occupational therapy, pharmacy, and medical students to ask what they’re seeing in their clinics as barriers for why patients mistrust the COVID vaccine.
One of the issues they hoped to address was the sometimes conflicting or disparate messaging coming from different providers that doesn’t help a hesitant patient feel particularly comfortable accepting the COVID vaccine.
For example, one video shows a physician who’s encouraging a patient to take the vaccine alongside a medical assistant who’s uncomfortable with the vaccine. “This one gives students examples of when there’s discord in your interprofessional team,” and how to have conversations with colleagues who may be approaching the situation from a different perspective, Hayman says.
To create effective content around this delicate issue, Hayman says the team approached it with care. “We don’t approach it that Provider A’s responsibility is to convince Provider B that they’re wrong. It’s not about that, it’s about saying, ‘OK, we both want what’s best for the patient. We can agree on that. We have different ideas around what that means, where can we find the common ground and keep the patient at the middle of it? What can we do to make sure that we are giving the patient a unified message in such a way that both of the providers are feeling like they’re not going against what they think is best or saying something wrong?’”
Students also undertook live training sessions, where they paired up with other health professions learners and prepared for an encounter with a standardized, COVID-vaccine hesitant patient by planning their discussion and then meeting with that patient.
“The students have about 15 minutes to talk to that patient and use each other’s different professional capacities and knowledge base to answer the patient’s questions and come up with a plan for moving forward,” Hayman says.
The pilot runs have been successful and students have appreciated it, Hayman reports. “We’ve actually studied their self-assessed knowledge skills and attitude pre- and post-doing the plot and they showed good improvement,” which suggests the program is an effective teaching tool.
“As such, we’ve decided to embed it permanently in our curricula, in both our Maine Track Medical School and the School of Pharmacy.” They also hope to be able to expand the offerings to other health professions students in the future.
In time, they plan to add more video scenarios to the training library to show the various situations where these types of conversations may crop up and how different professions can best counter misinformation when they encounter it in the field.
University of Chicago Pritzker School of Medicine
Led by Vineet Arora, MD, MAPP, Dean for Medical Education
The final group that took part in this grant program was led by Vineet Arora, MD, MAPP, Dean for Medical Education at the University of Chicago Pritzker School of Medicine. There, an established program, GME’s Community Champions, was already helping medical residents connect with underserved communities on the South Side of Chicago.
The Community Champions program “is for residents to engage with community members on scientific topics,” Arora says. The program also works to facilitate COVID-19 vaccinations in South Side communities, so it made sense to leverage the AAMC/CDC grant funding to improve residents’ communication skills when encouraging vaccination.
“Addressing myths that come up was an important need that had been identified (by program participants), so we incorporated training in partnership with our librarians, a science communicator, and others on how to identify credible sources of information,” Arora explains.
This approach is a little different from some of the other programs in that it was aimed at supporting residents in their field work, rather than students still in the classroom or clinical portions of their education.
“Our focus was on training residents who were already accepted into the Community Champions program,” Arora says. “Part of their experience in residency is to actually do community engagement, so that was the group we were working with.”
The goal, she says, was “really about making people feel more confident that they could have conversations about sources of information and how to address myths they encounter” when meeting with a patient.
The feedback on the program has been “very positive,” Arora says, “because the residents describe having been given a framework and tools to address those myths that come up in a non-judgmental, inquiry-driven way. They can use these tools in their current practice.”
This is another unique feature of the UChicago team’s approach: “Even though the AAMC portfolio is focused a lot on medical or interprofessional students, it takes some time before you see those clinical outcomes.” In working with residents, “they’re able to put these skills into practice almost immediately,” Arora says.
The team is now partnering with researchers to evaluate the curriculum’s effectiveness in training community leaders and members with the support of an NIH grant. This is enabling the team to continue building a toolkit and other materials to further its work. “It’s been exciting to be part of an NIH-funded team examining whether training community members to address health myths that they’re seeing in our communities is helpful,” Arora says. “The educational innovation grant from AAMC/CDC has served as a catalyst to secure additional funding from the NIH which will allow us to continue to evaluate the curriculum’s effectiveness.”
“We are thrilled with the innovative approaches these health professions educators have taken to better equip clinicians with the skills to address inaccurate information, pseudoscientific myths, and harmful disinformation,” says Lisa Howley, PhD, Senior Director for Transforming Medical Education at the AAMC. “We are confident their tools will be valuable to the broad community of health professions and the communities they serve.”