September 27, 2020

Forming One’s Professional Identity

by Alex Craig, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Making the transition from pharmacy student to practicing pharmacist is challenging.1 New pharmacists are tasked with actively applying learned materials in their everyday practice as well as problem-solving when areas of practice are often more gray than black and white. During this transition, a pharmacist’s professional identity plays a crucial role. Professional identity has been defined as “a representation of self, achieved in stages over time during which the characteristics, values, and norms” of the profession are “internalized, resulting in an individual thinking, acting, and feeling” like a health professional.2 Those with strong professional identities tend to be confident, driven, and adaptive when faced with uncertainty.3 I believe professional identity can and must be actively developed through thoughtfully designed student experiences.

Over the last two decades, there has been an explicit effort to teach “professionalism” in health professions education. In recent years this has evolved and helping students form their “professional identity” during their journey to become healthcare professionals has become the educational objective.4 In 2014, the American College of Clinical Pharmacy formed a task force on how to help foster professional identity formation. The task force made recommendations for best practices, created a framework for educational methods to support the formation of professional identity within interprofessional contexts, and generated recommendations to support faculty in helping students develop their professional identities.5


Facilitating professional identity formation requires consideration of many factors: What kind of pharmacist (generalist, specialist, practice setting) does the student pharmacist want to become? What are the hallmark characteristics society needs in a pharmacist now and into the foreseeable future? What processes are in place to support and promote identity formation?1 Forming a professional identity is a dynamic process with many influences.  It is influenced not only by the student’s personal identity, but also factors such as clinical/non-clinical experiences, role models/mentors, formal instruction, self-assessment, reflection, and socialization. Among these, role models/mentors and experiences appear to have the biggest impact. In professional identity formation, a positive mentor/mentee relationship is facilitated by constructive feedback. Feedback serves as a reinforcement of learning and it assists in the confirmation of the learner’s self-perception.4 Preceptors and mentors can aid in identity development by sharing personal experiences and encouraging the student to shift into an independent mindset. For example, when encountering a situation where the best decision is unclear, the preceptor should encourage the student to express their thoughts and suggest potential solutions. Encouraging students to combine foundational knowledge with recent literature and applying that to a patient case or practice management scenario can facilitate this independent thinking.  Indeed, students should be encouraged to be responsible for making choices and this should align with who they want to become as a healthcare professional. Exposure to increasing complex scenarios can also help prepare students for their future practice. There also needs to be opportunities for students to share and reflect on their experiences and what was gained or learned. This may be facilitated through debriefing sessions that are student-led.4

A 2019 scoping review investigated pharmacy student professional identity formation.1 The paper pointed out important aspects to be considered when developing curricula to foster professional identity formation. First, it's important to examine how pharmacy students see themselves. Pharmacy students often lack an understanding of their professional selves and are unable to articulate what it means to be a pharmacist. Pharmacy students tended to focus on traditional pharmacist roles (dispensing and counseling) and this understanding was reinforced by experiential learning and part-time work experiences. Pharmacy students also found it challenging when engaging with patients when they were met with disinterest or anger. Experiences gained within the pharmacy curriculum often led to unresolved identity dissonance because students’ practice experiences did not align with the idealist view taught in the classroom about the pharmacist role.1 This includes ambiguity about the definition of “clinical” pharmacy. For example, the definition of “clinical” often vary by practice setting, and students perceive big differences in the role and responsibilities of pharmacists in community, ambulatory care, and hospital settings. Some educators suggest that role-play activities can help encourage students to merge the gap between the “ideal” professional role and their lived experiences. Students should be given opportunities to discuss their experiences with a trust role model and re-enact how they responded to the experience.  This enables students to envision their professional identity but also critically examine their personal identity.6

To facilitate professional identity formation, faculty will likely need to be educated about the construct. It is important that faculty understand that students must participate in developing their own professional identities and maintaining a welcoming environment for open dialog is critical.  The curriculum should address known factors that affect identity formation and there should be a mechanism to assess student progress. Some schools engage students in the development of professional identity by using reflective strategies.3 This strategy can consist of some foundational instruction about professional identity formation and periodically asking student pharmacists to reflect on their stage of development. These reflections can help gauge the student’s understanding, track their progress, and identify gaps. A tiered approach is needed and activities should be appropriate for the learner’s stage of development.

I challenge you to think about your own transition into practice and your understanding of your role. What experiences did you have that fostered the development of your professional identity? What experiences or role models do you wish you could have had during your training?

The aim is not to homogenize all personal identities into a standard; rather, the student maintains his or her ‘self-identity’ while building a professional identity through exposure to diverse experiences while upholding the key virtues of a … professional including competence, kindness, honesty, and integrity.7

References:

  1. Noble C, McKauge L, Clavarino A. Pharmacy student professional identity formation: a scoping review. Integr Pharm Res Pract. 2019; 8: 15-34.
  2. Cruess R, Cruess S, Boudreau J, et al. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446–1451.
  3. Scanlon L. “Becoming” a professional. Dordrecht: Springer; 2011. 
  4. Cruess S, Cruess R, Steinhert Y. Supporting the development of a professional identity: General principles. Medical Teacher. 2019; 41(6): 641-649.
  5. American Association of Colleges of Pharmacy. Taskforce on professional identity formation – final report. 
  6. Monrouxe LV, Rees CE, Endacott R, et al. “Even now it makes me angry”: health care students’ professionalism dilemma narratives. Med Educ. 2014; 48(5): 502–517.
  7. Forouzadeh M, Kiani M, Bazmi S. Professionalism and its role in the formation of medical professional identity. Med J Islam Repub Iran. 2018; 32: 130.

Using Twitter to Augment Student Learning

by Emily Ware, PharmD, PGY1 Pharmacy Practice Resident, St. Dominic Hospital 

The use of social media across the educational landscape has considerably increased over the past few years and especially in the past few months during the COVID-19 pandemic. Social media was not designed for the purpose of education and other learning activities; however, the ease of networking and sharing content has allowed social media platforms to gain popularity in higher education.1 Twitter has been used as a communication tool for formal and informal learning by allowing students and scholars to engage with their peers and discuss emerging information.1

In one study that investigated the use of Twitter as part of a face-to-face class, undergraduate students taking a teacher education course reported that Twitter enabled communication and interaction between classmates as well as with the broader educational community.2 Students stated that Twitter also facilitated connectedness and resource sharing. This encouraged a more collaborative approach to learning.2 Another study looked at the perceptions of first-year biomedical students who completed a course in which Twitter-related activities were incorporated into the course design.3 The study found that the students who most actively engaging in the Twitter activities had higher end-of-semester grades compared with those who did not.3 The authors also reported that the use of Twitter was a useful method of promoting public health, along with facilitating collaboration among peers.3

While there are potential benefits using Twitter for educational purposes, there are some drawbacks that should be mentioned.  One study that explored the perceptions of high school students found that students were overwhelmed with the volume of information on Twitter.4 Moreover, first-time users had difficulty using the platform and questioned the appropriateness of using Twitter in the educational setting.4 In another study conducted at a school of pharmacy, students who completed an optional survey about the use of Twitter in a management course, 71% stated Twitter was distracting and 69% believed it prevented note-taking.5 Although these are valid points, these are issues that could be solved if students are taught how to use Twitter effectively as a tool to support their educational endeavors.

There are many ways to use Twitter as an instructional tool. Since some students will not be familiar with Twitter, it’s important to start out small with a brief activity that intended to get students accustomed to the platform.  For example, an instructor could tweet a poll for students to respond to during class. Next, teachers could create an assignment requiring students to formulate a tweet. As students become more comfortable with the tool, the instructor could ask students to create concise writing exercises (like a tweetorial), take Twitter quizzes, use it to research a topic, and engage “backchannel” discussions.  Backchannel discussions are digital conversations that run concurrently with a face-to-face activity and they enable more students to participate and ask questions.  Twitter can also be used for professional development. For example, there are many health professionals across the world who regularly use Twitter to discuss interesting cases they have seen, analyze recently published research manuscripts, or share experiences during their day-to-day work.  Students may find it beneficial to follow a few people on Twitter who work in a potential career path to get a glimpse of what that field or specialty might be like.  Students could then be asked to complete an assignment summarizing their findings and opinions about their potential career choice.

During my third year of my doctor of pharmacy curriculum, we had days in which we completed a “Twitter consult” and were “on call”. During these simulated on call activities (similar to being on call in real life), it was imperative to be readily available and not engage in any activities during the day that required us to be away from our phone.  The consult request was delivered in the form of a tweet, and we never knew when the consult request was going to arrive.  It was the student’s responsibility to respond to the consult within an hour and formulate a verbal response. Typically, the verbal response could not be longer than two minutes. The concept of Twitter consults was to provide a very interactive way for us to glimpse what our future careers may look like – concisely answering difficult questions from health professionals (and patients) in a timely manner. 

Now, as a pharmacy resident, Twitter has helped me to stay current on the latest research and therapeutic recommendations. I have found it to be a great networking tool. I “follow” other pharmacy residents and practitioners who are located all around the US. It is insightful to learn from other pharmacists about their ideas and perspectives on pharmacy and medication-related issues.

I believe that there are many benefits to using Twitter as a teaching tool and I hope it is used more frequently in the classroom and experiential learning settings.  Students need to develop the skills to collaborate and network with their peers and Twitter (and similar social media platforms) go beyond what could be achieved in face-to-face settings.  Twitter can also help build a student’s confidence by encouraging them to formulate their own ideas and opinions. I believe Twitter can augment learning and can be used by teachers and students to facilitate collaboration, networking, and interaction.

References:

  1. Malik A, Heyman-Schrum C, Johri A. Use of Twitter Across Educational Settings: A Review of the Literature. Int J Educ Technol High Educ. 2019;16:1-22.
  2. Carpenter JP. Twitter’s Capacity to Support Collaborative Learning. Int. J. of Social Media and Interactive Learning Environments. 2014;2:103
  3. Diug B, Kendal E, Ilic D. Evaluating the Use of Twitter as a Tool to Increase Engagement in Medical Education. Educ Health (Abingdon). 2016;29(3):223-230.
  4. Bull P, Adams S, et al. Learning Technologies: Tweeting in a High School Social Studies Class. Journal of Educational Technology. 2012;8:26–33.
  5. Fox BI, Varadarajan R. Use of Twitter to Encourage Interaction in a Multi-Campus Pharmacy Management Course. Am J Pharm Educ. 2011;75:Article 88.

May 25, 2020

The Role of Education in Increasing Social Justice

By Bianca Lascano, PharmD, PGY2 Ambulatory Care Pharmacy Practice Resident, University of Mississippi School of Pharmacy

As healthcare professionals, we understand that social determinants of health have profound effects on health outcomes. Awareness of the health disparities they generate underscores the significance of emphasizing social justice principles in health professions education. It is important that educators help students develop the critical thinking, collaboration, and self-reflection skills necessary to foster a better society.1 There are several courses embedded in the curriculum that must be taught as students matriculate through the didactic portion of their professional degree program. There are many opportunities to discuss social determinants of health throughout the curriculum and help students understand their implications through the lens of social justice.

Image from: https://www.promotionswest.com/health---social-equity.html

In A Practical Strategy for Infusing Multicultural Content into Any Lesson posted on the Faculty Focus website, Dr. St Germain discusses a method to integrate multicultural content into each lesson he teaches in a business communications course. Dr. St. Germain gives specific directions to guide his students to think about marginalized groups. For example, if students are developing a website for the city’s recreation department, the directions would state, “evaluate how well the website ensures people of color and how welcoming the content may be to the LGBTQ community.” Having students work at the evaluation level of Bloom’s taxonomy, greatly increases the chances that the activity will allow the students to construct new knowledge as it pertains to cultural competence and social justice.2

Professors in the health professions can emulate Dr. St. Germain by including diverse patient populations when designing patient cases within each clinical module. Including social aspects of a patient’s life that might impact health outcomes and having students explore how that could affect treatment and healthcare delivery will prompt students to create individualized plans through the lens that is different than their own. Thus social justice issues can be woven into course material that, on the surface, appears unrelated to social justice.

It is surprising that even though issues related to social justice are central to healthcare services provided to patients, they have received inadequate scholarly attention. A lot of the course material taught within the health professions curriculum can be viewed from a social justice perspective. For example, we understand the treatment of hypertension can adversely affect certain patient populations more than others. Access to treatment and follow up care is more difficult for some populations. Food insecurity and lack of transportation can be significant barriers. It is important that students begin to recognize their assumptions and implicit biases as they explore and discuss case studies.

Unfortunately, implicit bias, by definition, influences health professionals without their knowledge and despite their best intentions.4 A process described as implicit bias recognition and management (IBRM) is required to mitigate the negative impact of bias. Research on IBRM suggests that as health professionals begin to accept that they can never eliminate all their biases, they also confront that they are learning within an environment that reinforces and contributes to these biases.5  Even well-intentioned learners may find the process of discussing and reflecting on biases challenging.  Moreover, faculty may be reticent to facilitate such discussions.4

Sukhera, Watling, and Gonzalez propose transformative learning theory (TLT) as a guide for implementing implicit bias training in health professions education. TLT suggests that learning is a process triggered by disruption, followed by a revised interpretation of experiences that guide an individual’s actions.4 The process requires critical reflection, dialogue, and action. An illustrative example would be placing a health professional learner in a challenging rural or remote setting for service learning. This would facilitate cross-cultural interactions that produce dissonance, promote skill development, and require dialogue.4 This most certainly would be more transformative than a lecture about diabetes. Professors can assess engagement in these activities by inviting students to reflect on how their actions perpetuate the status quo. The goals of transformative learning are to increase awareness of how to construct reality and to break free of limiting structures that shape our understanding.4

In a recent article posted on The Edvocate website entitled Teaching Social Justice in Your Classroom, Mathew Lynch provides some activities that can be used to develop the skills necessary to advance social justice.3

These skills include:
·       Differentiating between fact and opinion to determine what is true
·       Examining diverse points of view to look at an issue from all sides
·       Developing a personal perspective based on accurate comprehension

Given that the majority of health professions students come from diverse backgrounds, these skills are not only relevant when treating patients, but also when interacting and working with classmates. Even more reason to explore social justice! Students should be able to have a healthy dialogue with persons of different ethnicities, gender, age, and religious beliefs.

In a recent article posted on the Resilient Educator website entitled Teaching Social Justice in Theory and Practice by Caitrin Blake, the author suggests using these questions  to explore potential systemic inequality in public policy … or healthcare delivery:1

·       Who makes decisions and who is left out?
·       Who benefits and who suffers?
·       Why is a given practice fair or unfair?
·       What is required to create change?
·       What alternatives can we imagine?

Blake suggests, in order to foster social justice in the classroom, educators must first build a safe, encouraging place where students can speak about their experiences and beliefs.1 Thought-provoking conversations can be created by encouraging students to share their ideas and respectfully respond to others without shutting the discussion down.

Social justice cannot be taught and fully understood overnight. Starting the dialogue in the classroom affords students the opportunity to engage in an authentic examination of their world and to work toward positive changes that make healthcare delivery more equitable. Providing a safe environment for students to share personal stories and opinions on different aspects of social justice is just the start. Consider how you might discuss social justice topics with your colleagues and introduce these concepts to your students.

References
  1. Blake C. Teaching social justice in theory and practice. Resilient Educator [Internet]. 2015 May 13. Available from https://education.cu-portland.edu/blog/classroom-resources/teaching-social-justice/
  2. Germain D St. Practical Strategy for Infusing Multicultural Content into Any Lesson. Faculty Focus [Internet]. 2019 Nov 11. Available from:  https://www.facultyfocus.com/articles/effective-teaching-strategies/infusing-multicultural-content-into-any-lesson/
  3. Lynch M. Teaching Social Justice in Your Classroom. The Edvocate [Internet]. 2019 Jan 9. Available from: https://www.theedadvocate.org/teaching-social-justice-in-your-classroom/ 
  4. Sukhera J, Watling CJ, Gonzalez CM. Implicit Bias in Health Professions: From Recognition to Transformation. Acad Med. 2020;95:717723. 
  5. Van Ryn M, Hardeman R, Phelan SM, et al. Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student CHANGES study report. J Gen Intern Med. 2015; 30:17

May 22, 2020

Teaching Stress Management and Coping Strategies to Students in the Health Professions

by Ganiat Animashawun, PharmD, PGY1 Pharmacy Resident G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS

Stress can be perceived in different ways. Stress is a complex bio-behavioral, psycho-social response to a stressor.1 Stress can be both negative and positive.2 Negative stress is labeled as distress, whereas positive stress is called eustress.3 People may assume that all stress is bad, but stress can actually be a positive thing. A stressor can be real or perceived prompted by something in the external environment or internally generated.1 A “real” stressor is produced from an actual event. For example, if a student fails an exam that is a real stressor. A perceived stressor would be when the student thinks “I did horrible. I failed my exam.”  It hasn’t actually happened (yet). External or environmental stressors are things that are out of one’s control. For example, “there are tornado warnings so I will not be able to drive to the school to take my exam.” Internal stressors are based on the way you evaluate yourself or based on your beliefs.  A panic attack before an exam due to negative self-talk is an example of an internal stressor.2 Seeking an advanced degree can stressful – and these stressors are both real and perceived, external and internal. Wanting to be successful in school and making sure that one has a job post-graduation adds more pressure. While some stress can positively drive performance, excessive stress can negatively impact a student’s learning.4 Therefore, stress management and coping strategies should routinely be taught in health professions educational programs.

The correlation between stress and learning is multifaceted. There are different factors that influence or cause a person to be more susceptible to feelings of stress. Coping style, personality type, genetic vulnerability, and social support are all factors.2 When a student is confronted with a problem, the first step is to identify the source of the problem and then determine what resources are available to address the problem.2 If a student is unable to find the resources necessary to cope with the problem, it often results in stress.3

A cohort study entitled Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students: A Five Year Cohort Study focused on evaluating perceived stress, coping strategies, and health-related quality of life (HRQOL) in pharmacy students. One hundred forty-five pharmacy students at the University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) participated in the study. The researchers measured stress and HRQOL using 3 tools: the Perceived Stress Scale (PSS), Brief COPE, and Short Form-36. Surveys were administered to the students three times a year over five years. The study found that there was a significant increase (worsening) PSS scores and an increase in students’ maladaptive coping behaviors over time. This corresponded, not surprisingly, with worsening scores on the mental health domain of the health-related quality of life instrument. Thus, the research found a significant increase in perceived stress, increased maladaptive coping, and worsening in mental health across the three pre-clinical curriculum years.4  To address this problem, the school implemented strategies for reducing stress and provided coping skills training sessions for the students as well as a peer-to-peer tutoring program.  Moreover, they initiated a curricular review.4


To better cope with stress, a student must learn how to take control of the triggers that may cause stress. At the University of Massachusetts Medical School, they have a Mindfulness-Based Stress Reduction (MBSR) curriculum that has been extensively studied and replicated around the world. MBSR guides the students on how to practice, integrate, and apply mindfulness every day.6 The primary purpose of the MBSR is to create a structured pathway to increase well-being and alleviate stressors. MBSR can be added and incorporated during early course work in the first year of the curriculum. MBSR is typically taught over 8-weeks with 10 sessions training students to engage in mindfulness meditation and mindful yoga. Even if MBSR course isn’t practical, all students should be introduced to mindfulness. It seems simple but developing mindful habits is actually very difficult. To be truly mindful, students must be able to reflect on all of their actions and be aware of how everything internally and externally can affect their minds and lead to stress.

In a MBSR program, students learn about stress, habitual, automatic behavioral, physical, emotional, and cognitive patterns. In addition the students learn to analyze how they approach and tackle the demands in their everyday life.6  Students learn how to recognize their perceptions of a potentially stressful event and then how to creatively respond. Students learn how they can control the way they react or respond. Once the students learn how to condition and focus on the way they respond to stress then they can use the strategies they’ve learned to address future stressful events and thoughts. The MBSR program provides many examples of how to complete each task.6 Studies have shown that participants who have completed a MBSR program experience a 35% reduction in the number of somatic symptoms and a 40% reduction in psychological symptoms.7 Furthermore, MBSR has been shown to significantly improve health-related quality of life7.

Mindfulness-Based Stress Reduction (MBSR) should be routinely taught to first-year health professions students. The earlier the students are exposed to mindfulness practices, the sooner they will able to use those tools to manage stress. Teaching students how to productively managing stressors might vary well lead to improved learning outcomes and reduce drop-out rates.

References
  1. Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants Ann Rev Clin Psych 2005; 1: 607-28.
  2. Salleh MR. Life event, stress and illness. Malays J Med Sci 2008; 15: 9-18.
  3. Votta J and Benau E. Predictors of stress in Doctor of Pharmacy students: Results from a nationwide survey. Curr Pharm Teach Learn 2013; 5: 365-72.
  4. Hirsch JD, Nemlekar P, Phuong P, Hollenbach KA, Lee KC, Adler DS, and Morello CM. Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students: A Five Year Cohort Study. Am J Pharm Educ [Internet]. (2019).
  5. Silvester JA, Cosme S, Brigham TP. Adverse impact of pharmacy resident stress during trainingAm J Health-Syst Pharm 2017; 74: 553–554.
  6. Kabat-Zinn J, Saki F. Santorelli, Florence Meleo-Meyer, Lynn Koerbel, Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. [Internet]. (2007).
  7. Kabat-Zinn J. Mindfulness-Based Stress Reduction Research Summary.[Internet]. Waterloo, Ontario, Canada; 1992 Dec.

May 15, 2020

Atypical Awareness - Responding to the Educational Needs of Patients with Autism Spectrum Disorder

by Elizabeth Yett, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident, University of Mississippi School of Pharmacy

In 2018, 1 in 59 children had a diagnosis of autism spectrum disorder (ASD) by the age of 8 in the United States, based on the DSM-5 criteria.1 However, we are unable to determine a reliable estimate of the prevalence of ASD among adults. Given that there is a spectrum of characteristics that a patient with autism might display, healthcare practitioners have an obligation to identify patients who may have ASD and adapt patient education strategies to meet their needs. As a resident, I have had the pleasure of interacting with 2 pediatric patients (to my knowledge) with autism. They are quite different in their ability to receive information and respond to questions. One patient is completely non-verbal, while the other prefers to play games on his phone rather than engage in a conversation — just like a typical teenager. Reflecting on my own experiences, it is no wonder that people with disabilities, including patients with autism, face significant health challenges and health care inequities. Patients with disabilities report lower satisfaction with health care, lower health self-efficacy when navigating the healthcare system, and lower use of recommended preventative care services.2

Effective patient-provider communication is essential in improving health outcomes. Yet if we do not know (or understand) the patient’s specific educational needs, how can we be certain we are meeting them? Luckily, the Academic-Autistic Spectrum Partnership in Research and Education (AASPIRE) has created the Autism Healthcare Accommodations Tool (AHAT) to assist us in understanding the needs and preferences of people with ASD.3 Reflecting on the ADDIE model of instructional design assists with the analysis of each patient’s individual needs and how best to communicate and interact with the patient. Patients and/or their caregivers can create a personalized accommodations report that includes information to assist with the patient’s preferred communication style, tips to help patients answer questions, and how to approach physical exams. The AASPIRE website also includes great information for healthcare providers regarding the diagnosis of ASD as well as legal and ethical considerations in caring for patients on the autism spectrum.



Finding the most effective communication mode for a patient with ASD can be challenging, especially if it involves changing your usual communication style. Although patients with autism have unique educational needs – indeed, all patients do for that matter – it can be beneficial to understand a few ASD-related characteristics that often impact communication and learning. This recognition, along with a few recommended strategies to accommodate the patient with ASD, can facilitate a more effective patient interaction (Table 1). Along the same lines, this can help you implement ADDIE with an effective design and development of instructional materials that are most appropriate for the patient.

Table 1

ASD-Related Characteristic

Instructional strategies/tips

  • Tendency to take language literally and a need for precise language
  • Tendency to be visual thinkers
  • Avoid figures of speech, broad questions, and vague statements
  • Be concrete and specific with questions
  • Show patients lists of symptoms or visual scales to assist with the assessment
  • Create a visual schedule for the patient for when to take his or her medications
  • Difficulty understanding and carrying out nonverbal communication
  • Recognize that patients may struggle to understand your body language or tone of voice
  • Respect a patient’s methods of nonverbal communication
  • Repetitive behaviors (self-stimulatory behaviors or “stimming”) - including hand-flapping, rocking, jumping, squealing, pacing, echoing, and obsessing
  • Recognize these behaviors as outlets for anxiety and energy
  • Aim to thoughtfully provide an environment to minimize potential stressors
  • Play soothing music during encounters, teach mindful breathing, reinforce appropriate behavior
  • Need for consistency
  • Limited awareness of time
  • Difficulties organizing
  • Help patients set up an alarm for when to take medication
  • Link the act of taking medications to specific parts of their daily routine
  • Help patient or caregiver set up pillbox or organize medications
  • Provide worksheets or handouts that can be used to keep track of symptoms or concerns between visits

Adapted from: AASPIRE Healthcare Toolkit. Available at: http://autismandhealth.org/.

 

It is important to evaluate current practices in place in order to make positive improvements. In England, the perspectives of 40 families of children with ASD were gathered through a survey to gain a better understanding of their healthcare experiences.4 Families noted the need for healthcare providers to be more knowledgeable and trained about the heterogeneity of ASD, and to view families as allies in facilitating during patient encounters. Earlier this year, Children’s Hospital and Medical Center of Omaha launched a new program called PATCH (Patient Assistance Team at Children’s Hospital & Medical Center) that intends to do just that. PATCH creates a pathway that facilitates communication between parents of ASD-impacted patients and hospital staff. This helps ensure patient needs are clearly and efficiently identified and necessary modifications can be made to the care plan. Wouldn’t it be amazing if a similar program could be implemented at all medical centers!

When working with an unfamiliar patient population, we have an obligation to educate ourselves to best serve their needs. This can include finding appropriate resources (listed below), seeking opportunities to work with or volunteer with patients with ASD, and demonstrating an interest in developing the diversity of our patient care skills. In this way, we can take steps to minimize disparities experienced by patients with autism by improving their satisfaction with healthcare and increasing their self-efficacy.

The main character in the television program The Good Doctor is a physician with autism. One of the other characters on the show, fighting to save the main character’s job, wisely states, “Aren’t we judged by how we treat people? I don’t mean as doctors, I mean as people. Especially those who don’t have the same advantages that we have.” I think we can all agree that it is impossible for us to always understand how to best interact with patients, especially those with ASD. There are always opportunities for improving communication with the patient, family, and other providers to create environments that address their needs. While we shouldn’t treat patients differently based on their disease states or disabilities, we should adjust to their needs. It might not always be easy to interact with patients with autism, but as educators, we need to do our part to achieve the most positive experiences for our patients.

Select readings and resources about Autism Spectrum Disorder:

References:

  1. Autism spectrum disorder (ASD) Surveillance Summaries. Centers for Disease Control and Prevention. 2018; 67(6):1–23.
  2. Nicolaidis C, Kripke CC, Raymaker D. Primary care for adults on the autism spectrum. Med Clin North Am 2014; 98(5): 1169–1191.
  3. AASPIRE Healthcare Toolkit. AASPIRE. Accessed 23 March 2020. https://autismandhealth.org/
  4. Kouo J. Seeking Patient-and Family-Centered Care: The Experiences of Families of Children with an Autism Spectrum Disorder. Autism Open Access 2020; 10: Article 247.