Health Education for Patients and Community Members

Merton Lee, Pharm.D.

Geriatric Pharmacotherapy Fellow

Peter Lamy Center on Drug Therapy and Aging

    Effective teaching may be important in better health outcomes for patients, at least according to one review drawing on 56 publications that attempted to quantify the clinical and economic impact of patient education by Stenberg et al. (2018). [1] That review reasons that as patients are increasingly included in the management of their care, educating patients becomes critical for their health. Though the range of approaches to patient education and measures of cost and benefit for those interventions vary widely, Stenberg et al. found that patient education decreased hospitalization and visits to the emergency department and was beneficial in quality adjusted life years, based on their review of 56 studies. [1] About 40% of the interventions were group based and led by a health professional, and the objective of these patient education sessions were very similar to the more familiar setting of classroom education: not only the transfer of knowledge (of disease states and treatment) but also higher level learning of applying their knowledge to their own conditions and the changing course of illness. [1] And while their literature review approach limits the amount of detail Stenberg et al. can devote to any particular study, their findings broadly suggest an overlap between instructional design in more traditional academic settings, such as the didactic classroom of pharmacy school, and teaching community members. 

    One didactic approach used in pharmacy schools, possibly familiar to readers of this blog, is case-based lessons. Though case-based approaches vary widely, the defining trait of case-based education is that they are story-based and use that story to achieve set learning outcomes. [2] Using stories to transmit health messages are among the core strategies that Adam et al. (2019) describe as consistently successful in their five years of creating video-based health education programs. [3] Adam et al. (2019) note that embedding health information in entertaining stories has been especially important, especially stories with characters the audience can invest in. [3] While Adam et al. (2019) report specifically on video-based lessons, and thus some of their key findings, such as the importance of good production values, does not apply to other educational settings, their insight that education works when the learner sees themselves in the stories that are teaching them is consistent with case-based learning in school and engaging patients in education as described by Adam et al. 

    It’s possible that stories may not be critical to successful patient education. Kerkhoff et al. (2020) report on an intervention on a community-based program to care for and isolate COVID-19 positive community members in a socioeconomically vulnerable population in San Francisco California. [4] While patient education is only a part of their overall program, Kerkhoff et al. note that they key element of their education was using community-based workers to contact and educate patients. [4] By sharing community, these educators were able to perform a function somewhat like an engaging character in an entertaining video, their patients were able to see themselves safely isolating and following the best health practices promoted by their community health educators. [4] Thus, in the end, it may be a more basic part of education that determines success in patient or classroom settings: the ability to connect with the learner and make the information feel relevant, important, and connected to the learner’s own goals and life. 

References:

1.  Stenberg U, Vågan A, Flink M, Lynggaard V, Fredriksen K, Westermann KF, Gallefoss F. Health economic evaluations of patient education interventions a scoping review of the literature. Patient Educ Couns. 2018 Jun;101(6):1006-1035. doi: 10.1016/j.pec.2018.01.006. Epub 2018 Jan 12. PMID: 29402571.

2.  Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, Purkis J, Clay D. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34(6):e421-44. doi: 10.3109/0142159X.2012.680939. PMID: 22578051.

3 . Adam M, McMahon SA, Prober C, Bärnighausen T. Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach. J Med Internet Res. 2019 Jan 30;21(1):e12128. doi: 10.2196/12128. PMID: 30698531; PMCID: PMC6372941.

4 . Kerkhoff AD, Sachdev D, Mizany S, Rojas S, Gandhi M, Peng J, Black D, Jones D, Rojas S, Jacobo J, Tulier-Laiwa V, Petersen M, Martinez J, Chamie G, Havlir DV, Marquez C. Evaluation of a novel community-based COVID-19 'Test-to-Care' model for low-income populations. PLoS One. 2020 Oct 9;15(10):e0239400. doi: 10.1371/journal.pone.0239400. PMID: 33035216.

Whole Brain Teaching

 

Kayla Bourgeois, PharmD 

PGY1 Pharmacy Resident 

University of Maryland Medical Center

Whole Brain Teaching is a relatively new method of teaching that requires high-enthusiasm mixed with constant stimulation of both the left and right sides of a student’s brain in an attempt to foster deeper learning by increasing classroom engagement.¹ This way of teaching aligns with the movement over the last few decades which recognize that children often come to school with all types of disparities, abusive homes, racism, classism, neglect, you name it, which often puts these students at a deficit. Research indicates that there is a strong relationship between the learning process of the brain and emotion, so when we heighten emotions whether good or bad, it reinforces learning.¹ This knowledge has begun to influence educators across various backgrounds and settings.

The basis of this style is built upon seven core teaching techniques to repetitively active most of the brain. Number one, “Class – Yes,” is meant to grab the learner’s attention by utilizing a common phrase to address the class and for that to warrant a response of some form of “yes” at the beginning and throughout the lesson.² This is aimed at the prefrontal cortex and prepares the brain to be receptive and induces reasoning.³ Number two, “The Five-Rules,” incorporates rehearsed rules and gestures that go hand-in-hand which requires up to seven areas of the brain associated with speaking, listening, generating emotion, memory, visualizing and kinesthetic.^2,3 Number three, “Hands and Eyes,” is a way to regain attention where saying this will elicit the class to repeat back these same words and give you their attention in the form of doing something with their hands and locking focus on the teacher.² Number four, “Teach-ok,” involves mimicry and partnering among students to teach one another.^2,3 Number five, “Switch,” involves pulling a chord, or flipping an imaginary light switch to signify switching roles where it is time for another student to speak and teach something to the others.^2,3 Number six, “Mirror,” means you have the students mirror you in every way.^2,3 This allows for story telling or complex tasks that require multiple steps to capture the audience and keep them active throughout. Lastly number seven, “Score board,” is a method of incentivizing students with games or competition by splitting the class into teams with a plus and minus system which aggregates throughout the day or weeks and at the end yields a reward.² By keeping these games close, it activates the reward pathway while having continuity of engagement.³

Traditionally, these tactics have been used in younger-aged children kindergarten to fifth-grade when students’ attention spans run on the shorter end and the responsibility of ensuring learning is felt more heavily on the side of the educator.² Unbeknownst to me, throughout pharmacy school, I would always watch videos on YouTube on a channel “KISS: Keep it simple stupid” who in some degree employed very similar tactics and to this day when the topics come up I can remember the songs or rhythms or gestures behind the knowledge. This wasn’t necessarily due to me spending more time on this subject than any others, I was having fun while I was learning and although it was over the internet, I participated in speaking aloud and being engaged as if I were actually there.  To an extent, those cores seven techniques can be adjusted to a more mature audience and achieve the same results. Even though as one gets older, the responsibility for the learning shifts toward the student having more autonomy over their learning it is important for educators not to lose sight of the goal.

Whole Brain Teaching may be especially beneficial in courses like pharmacology, communication, and select skills labs or mock learning scenarios where the basis of establishing key concepts comes through repetition before real world application. For instance, imagine a patient counseling scenario where you would like three main questions answered: What is this medication for? How did your prescriber tell you to take this medication? And What can you expect from taking this medication? In this scenario, the “Teach-ok” method may be useful in utilizing the mimicry and partnership to solidify usage of these cornerstone counseling questions. Now imagine the engagement that could arise from using the “Scoreboard” method in a course such as pharmacology where some students may find it more challenging and are reluctant to participate. Perhaps, encouraging the entire class to be involved by incentivizing them with points for participation and additionally correct answers may assuage the fear of getting an incorrect answer. Additionally, this can reveal to a professor areas and topics that they need to re-address once seeing where lapses in learning may exist.

These are just a few examples of how Whole Brain Teaching could be incorporated into pharmacy education. I encourage educators of all levels to push the envelope and continue looking for signs that a student or classroom may need a little more attention and may benefit from a rather non-traditional way of thinking. Always be willing to evolve your methodology and teaching styles as new research and helpful tactics arise in the world of education. 

1. Brophy, J. E. (1986). Teacher influences on student achievement. American Psychologist, 4, 1069–1077.

2. Biffle, C. (2013). Whole Brain Teaching for Challenging Kids. Yucaipa,CA: Whole Brain Teaching, LLC.

3. Willis, J. (2007). Brain-Based Teaching Strategies for Improving Students' Memory, Learning, and Test-Taking Success. Childhood Education, 83(5), 310-315.