HHC Training Program Using Young Patient Actors Helps Physicians Improve Communication, Better Treat Adolescents
Jan 23, 2014
The New York City Health and Hospitals Corporation (HHC) has completed the first round of a physician training program designed to help healthcare providers improve communication with their teen and adolescent patients and adopt best practices in caring for teens. The program features a cadre of young patient actors who play the role of teens with complex social and medical needs. To date they have helped coach over 100 HHC care providers to improve their understanding of issues that may hinder adolescent healthcare, providing the feedback physicians need to best treat the hundreds of adolescents who seek primary care at HHC daily.
HHC’s Teen Health Improvement Program developed the Adolescent Standardized Patient Program, which trains young men and women to visit primary care physicians and simulate a typical adolescent-physician interaction. Doctors are evaluated on their ability to engage the patient actor and elicit information needed to provide proper care. They are also assessed on whether they provide appropriate counseling and screening, and whether they prescribe and explain a care plan that is suitable for the simulated scenario.
“This particular patient population, where pediatric and adult issues collide, often presents a unique set of challenges for pediatricians and other primary care physicians,” said HHC President Alan D. Aviles. “They may face adult challenges, including those relating to becoming sexually active, but be uncertain about how or whether to share their worries with us. Their complex realities and concerns about confidentiality require physicians to establish trust and clear, honest communications. Only by fully understanding a young person’s needs can we determine the best course of treatment for him or her.”
10 Tips For Communicating With Adolescents
Dr. Janet Siegel, Director of Adolescent Services at Elmhurst Hospital Center in Queens, offers these tips for caregivers and parents on communicating with the adolescents in their lives:
- Listen to the adolescent without preconceived notions or biases.
- Express warmth and respect for their issues.
- Be patient and flexible, focusing on teachable moments.
- Provide boundaries and expectations.
- Highlight the positive. Do not be relentlessly negative.
- Be honest. Even one lie can destroy your credibility.
- Maintain confidentiality if you want the adolescent to ever trust you again.
- Do not lecture or admonish. Have a two-way conversation.
- Do not attempt to be “cool.” Remain the adult in the conversation.
- Spend time with the adolescent. Don’t seem like you only care when something goes wrong.
Monique Collier Nickles, MD, Chief of Adolescent Medicine at Lincoln Medical Center in the Bronx, said, “All doctors are required to receive continuous medical education, but often it’s at conferences or lectures. This program provides real-time patient interaction that doctors don’t typically receive from other training methods. Most providers who’ve gone through the training see this as an opportunity to obtain candid feedback about interactions with patients. A lot has changed in adolescent medicine over 25 years, and some of the more experienced pediatricians said it gave them exposure to new best practices and guidelines, and enhanced their patient interviewing skills. It would be helpful for doctors who treat adolescents to experience this every few years.”
Deadra Caleb, 26, from Brooklyn, who works part-time at HHC as a Standardized Patient and as Program Assistant for the Teen Health Improvement Program of the Office of Healthcare Improvement, said, “The job of a Standardized Patient is to act out a case with a healthcare provider and rate the provider’s skills to help them learn how to improve. We were trained to give constructive feedback to the provider. Most doctors really appreciated the feedback and were open to trying new methods of communication so that they can communicate with the adolescent patient more effectively.
“So many adolescents are afraid to see a doctor because they fear that a healthcare provider will treat them differently,” Ms. Caleb said. “This job has opened my eyes to some of the issues that adolescents face today, especially regarding their sexual and reproductive healthcare needs. I think this is an excellent program that benefits both providers and their adolescent patients.”
HHC’s Standardized Patient Program worked with physicians in pediatric and adolescent clinics at 15 HHC sites. The trained patient actors presented with common issues affecting teens, including needs for birth control and STI testing and symptoms related to depression. At the conclusion of the scenario, the standardized patients provided immediate feedback to the doctors and completed a written survey on the provider’s performance. Participating physicians then receive an individualized report, and will be directed to training and resources to support his or her knowledge and confidence in addressing topics relevant to adolescent. Feedback from participating providers found that they all thought the experience to be a useful one, and over 95 percent felt that the Standardized Patient Program could improve primary care provided to adolescents at HHC.
The program was piloted in summer 2012 in pediatric clinics at five HHC facilities when 12 adolescent subjects were trained and acted out scenarios with 25 care providers. Although the strengths and weaknesses of the providers varied widely all 25 agreed that the experience would help them improve the care they provide. The adolescent subjects also reported that the experience made them feel able to get the most out of their future healthcare, and that they would share that knowledge with others in their communities.
The pilot program was developed in partnership with the NYU Langone Medical Center’s Program for Medical Education Innovations and Research (PrMEIR). PrMEIR staff are experts in the use of the standardized patient model with adult patients, but had not previously adapted the model for use with adolescents.
Healthcare providers volunteered to participate in the program and were aware that they are working with a trained standardized patient. However, the scenarios played by the actors were not shared with the physicians in advance. Visits cover counseling only and do not include physical exams, vital signs measurements, or lab work.
Eventually, the program aims to reach all pediatric clinicians at HHC, featuring different standardized patients and various scenarios emphasizing the challenges of treating adolescents.
Contact: Ian Michaels (HHC)
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlusHealth, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.