by Chris Dobroth,
Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy
“Excuse me. Where are
the paper towels? Oh, and I have a prescription to pick up.” Or "Really?
We have to talk to another person before we can be discharged?” Not an
auspicious start to a conversation, much less one regarding someone’s health.
This indifference by many patients combined with the many demands for the
pharmacist’s time calls for counseling sessions that are quick and efficient.
What makes these sessions both quick and
efficient as opposed to just
quick?
The American Society
of Health System Pharmacists (ASHP) in Guidelines
on Pharmacist-Conducted Patient Education and Counseling states that patient counseling and
education should be approached by pharmacists as “interrelated activities.”1 According to the American
psychologist Robert Gagne, there are nine events that should be included in
every instructional activity to maximize its effectiveness.2 These events are the “why” behind the
“how” of ASHP’s four steps to patient interaction. Examining them more
closely will help us develop a more complete understanding of what needs to
happen during a patient counseling session. After all, at its core, effective
patient counseling is a form of instruction.
Here are AHSP’s four
step of patient counseling and how Gagne’s nine events of instruction related
to each:1,2
Step 1. Establish
caring relationship, explain pharmacist role, and ask for permission to
counsel. Gagne’s first and second event of instruction are to gain the
learner’s attention and inform them of the objectives.
Step 2. Assess the
patient’s knowledge and capabilities. Gagne’s third event is to stimulate
recall of prior learning.
Step 3. Provide
information to fill in the gaps in the patient’s knowledge. Gagne’s fourth and
fifth events are to present content and provide learning guidance.
Step 4. Verify
patient’s knowledge and understanding. Here Gagne’s sixth through ninth events
are to elicit performance, provide feedback, assess performance, and enhance
retention and transfer.
Notice how efficiently
ASHP’s four steps contain all of Gagne’s nine events of instruction?
Let’s consider the
Indian Health Services Three-Prime Questions:3
- What did the doctor tell you this medication was for?
- How did the doctor tell you to take this medication?
- What did the doctor tell you to expect?
Gagne’s nine events
show that these questions are an integral part of the learning process.2 Here the use of opened questions serve
to grab learners’ attention and engage them in conversation. Now that you’ve got their brain
running and you’re stimulating prior learning through the three questions, it’s
your turn to assess their “knowledge and capabilities” as Gagne suggests and
then to present the content and provide guidance. You have already elicited the
patient’s understanding, so now the holes can be filled in based on their level
of health literacy. While the Indian Health Service’s Three-Prime questions lay
the groundwork for an effective counseling session, they do not offer guidance
from start to finish the way ASHP’s Four-Steps do. Understanding Gagne’s nine events of
instruction allows for an effective closer to the counseling session by
utilizing the sixth through ninth steps: eliciting performance, providing
feedback, assess performance, and enhance retention, and finally transfer to
future situations. Without
these final steps, the patient will have endured a deluge of information but
you won’t know if they really understood. While your intentions were good and
the information thorough, the “teach back” technique is the only way to ensure
the patient is truly ready to use their medication in an appropriate manner.
As the demands on our
time increase, we must seek ways to be more efficient. By reminding ourselves
that patient counseling sessions are a form of instruction, we can use Gagne’s
nine events of instruction to master these techniques. Effective patient
counseling leads to better outcomes and may decrease the amount of time spent
re-answering the same questions at a later encounter. So before your
next patient encounter, take a few minutes to reflect on how you would approach
it and remember Gagne’s nine events of instruction.
References:
1. American Society of Health Systems
Pharmacists. ASHP
Guidelines on pharmacist-conducted patient education and counseling. Am J Health-Sys Pharm. 1997; 54:431-434. [accessed 2013 Sept
22].
2. Buscombe, C. Using Gagne’s theory to teach procedural skills. The Clinical Teacher. 2013; 10: 302-307. [Accessed 2013 Nov 16th].
2. Buscombe, C. Using Gagne’s theory to teach procedural skills. The Clinical Teacher. 2013; 10: 302-307. [Accessed 2013 Nov 16th].
3. Indian Health
Services: The Federal Program for American Indians and Alaska Natives
[Internet]. Patient-Provider
Communication Toolkit. Tool 9. Pharmacist Consultation.
Rockville: Indian Health Services. [accessed 2013 Nov 16th].
No comments:
Post a Comment
Thank you for your comment to the Educational Theory and Practice blog. It will be submitted for review and approval. Only those comments that substantially enhance the value of the blog site will be released and posted.