Pedagogical Methods to Teach the Students to Coach Patients - Summary of Literature Review by UMCH

Introduction:   

Pedagogy refers to an art and science of teaching where different methods used in different combination to enhance the learning outcomes. It supports intellectual engagement, connectedness to the wider world, supportive classroom environments and recognition of differences (9). Health coaching refers to providing patients with appropriate knowledge, skills, tools and confidence so that they can actively participate in their own care to achieve certain health goal (10). According to different studies, quality care and education can be ensured if students are involved in patient education (8). This literature review will discuss about the pedagogical method to teach students in order to coach patients. The research question for this literature review was, “What pedagogical methods are used to teach health care students to coach the patient?”. 

Result: 

We searched two Databases (Pubmed Advanced and Google Scholar) for studies on pedagogical methods that are used to teach healthcare students to coach the patients published between 2015 to 2020.After removal of duplicates, the remaining records were assessed for relevance based on abstracts. References of included studies were checked for other relevant studies. Total 120 records were identified, out of which 8 articles matched the inclusion criteria and were included for this review. The process used to reduce and evaluate the records is illustrated in Prisma diagram (Appendix 1). The results of the included articles answering the research question were extracted (Appendix 2: Summary of the included articles) and analyzed (Appendix 3: Analysis) using qualitative content analysis. 

 The literature review revealed three sets of pedagogical methods to teach healthcare students to coach patients, namely, theory based active learning sessions, hands-on training of mixed approaches and teacher’s support throughout the learning process. 

Theory based active learning sessions included set of learning sessions about counseling skills (3), use of photos of selected topic to enable learning patient counseling (4), observations of multiform demonstrations of patient support activities (1,7) and discussions of assigned topics about patient counseling (4). 

The set of learning sessions about counseling skills contained three hour long weekly sessions involving taught components and description of the skills to train the students about counseling skills (3). The photos of selected topic were used to represent assigned topic to make short presentation by the instructor to use it in a lecture and viewing them to the students in the class (4). In addition, observations of multiform demonstrations of patient support activities were done by viewing video of role-play demonstration, real clinical demonstration (1, 7), real life scenarios through one-way screen and videos by the trainees (7) while methods of discussions of assigned topics about patient counseling included discussion of the photos representing the assigned topic by the students during demonstration of the photos by the instructor in the class as long as needed to demonstrate to learn about of the component, discussion of the assigned topic in class meetings by the students, using presentation by the instructor in class meetings to guide the discussion by the students about the assigned topic and keeping focus of the discussion on the assigned topic by the instructor during class (4).   

Teachers provided hands-on training of mixed approaches through student-provided patient education (8), school-based simulation trainings (5,7), role play of patient coaching sessions (2,3,7) and practical sessions in real clinical settings (1,7,8).  

Students were involved in patient education with various forms through providing courses to the patients and their family members, arranging programs for various patient groups, providing a patient education health fair and providing a summer clerkship for patient education (8). School based simulation was done by using high fidelity manikins and adult patient simulators as real patients to practice and improve non-technical performances (5,7) along with formation of team to work in the same simulation which helped learning from each other (6). In addition, role play of patient coaching sessions involved actors to role play to create a simulation in a real-life setting (2,7). Students role played as both counselor and observer during training of counseling skills (3) as well.  Real clinical scenarios were used to provide health education (1), to develop and improve non-technical skills (7) along with providing orientation and training sessions to the students with real patients before any practical experience (8) as practical sessions in real clinical settings. 

Teachers supported the students through orientation to study coaching of the patients (4, 5, 7) and learning-promotive feedback (7,8) throughout the learning process. Students were oriented with the course or topic through introduction and description of the goal of the course using presentation (7) and provision of clear instruction regarding simulation to know what steps to follow in real situation. (5). However, assigning of a topic to the students relating to counseling for students to take photos (4) also helped in learning process. Teachers provided feedback by videotaping the trainees during showing the videos (7) along with oral and written feedback to help learning achievement (8).  

Conclusion: 

The pedagogical methods used to teach health care students to coach their patient were reviewed where we found different methods used in different combination to enhance the learning outcomes of the students. We propose combination of these three sets of pedagogical methods to teach healthcare students to coach patients, for better learning outcome. However, while the mentioned approaches might be easy to apply, some of them, for example, simulation through high fidelity manikins, might still be challenging to implement considering the technological development of our country. 

References: 

1. Wallace LM, Ma Y, Qiu LQ, Dunn OM. (2018). Educational videos for practitioners attending Baby Friendly Hospital Initiative workshops supporting breastfeeding positioning, attachment and hand expression skills: Effects on knowledge and confidence. Nurse Educ Pract.; 31:7‐13. doi: 10.1016/j.nepr.2018.04.005
2. Mortel VD, T., Bird, J., Chown, P. et al. (2016). General practitioners as educators in adolescent health: a training evaluation. BMC Fam Pract 17(5):24-29.. https://doi.org/10.1186/s12875-016-0432-0
3. Smith, K. (2016). Learning from triads: training undergraduates in counselling skills. Couns. Psychother, Res., 16: 123-131. doi:10.1002/capr.12056
4. Robert J. Zeglin, Danielle R. M. Niemela, Kara Rosenblatt & Jacqueline Hernandez-Garcia. (2019). Using Photovoice as a Counselor Education Pedagogical Tool: A Pilot, Journal of Creativity in Mental Health, 14:2, 258-268, DOI: 10.1080/15401383.2019.1581116
5. Amod, H.B. & Brysiewicz, P. (2019), ‘Promoting experiential learning through the use of high-fidelity human patient simulators in midwifery: A qualitative study’. Curationis 42(1), a1882. https://doi.org/10.4102/curationis.v42i1.1882
6. Sadideen H, Wilson D, Moiemen N, Kneebone R. (2016). Using “The Burns Suite” as a Novel High-Fidelity Simulation Tool for Interprofessional and Teamwork Training. J Burn Care Res. 2016;37(4):235‐242. doi:10.1097/BCR.0000000000000262
7. Heaton SR, Little Z, Akhtar K, Ramachandran M, Lee J. (2016). Using simulation to train orthopaedic trainees in non-technical skills: A pilot study. World J Orthop; 7(8): 475-480. doi: http://dx.doi.org/10.5312/wjo.v7.i8.475
8. Vijn TW, Fluit CRMG, Kremer JAM, Beune T, Faber MJ, Wollersheim H. (2017). Involving Medical Students in Providing Patient Education for Real Patients: A Scoping Review. J Gen Intern Med.;32(9):1031‐1043. doi:10.1007/s11606-017-4065-3
9. Bhowmik M, Roy BB, Banerjee J. (2013). Role of Pedagogy in Effective Teaching. Basic Research Journal of Education Research and Review. ISSN 2315-6872 Vol. 2(1) pp. 01-05. http//www.basicresearchjournals.org 
10. Heather D. Bennett, MD, Eric A. Coleman, MD, MPH, Carla Parry, PhD, MSW, Thomas Bodenheimer, MD, MPH, and Ellen H. Chen, MD. (2010). Health Coaching for Patients With Chronic Illness.; Fam Pract Manag 17(5):24-29. http://www.aafp.org/fpm/20100900/p24