By Michael A. Gisondi (@MikeGisondi)
In February 2023, the Journal of Graduate Medical Education published an article entitled, “The Role of Graduate Medical Education in the Fight Against Health Misinformation.” (Sheng et al.) It summarizes the challenges associated with misinformation training and offers practical recommendations for incorporating such training in your program.
Full disclosure, I am a co-author of said paper. But I am also committed to learning and sharing the best ways to address misinformation in our professional lives. I hope that you take the time to read the manuscript, however, I recognize that you are a busy clinician educator. So, I’m using the ICE Blog forum to offer some quick take-aways from the paper.
The Training Gap
- In 2021, the US Surgeon General called misinformation a public health threat. His advisory described the need for a “whole of society” response to address misinformation. Health professionals are especially important to such efforts.
- We have a mandate to train our residents and fellows to address health misinformation, yet most programs do not teach common misinformation debunking strategies.
- Less than ⅕ of US physicians have received misinformation training, and therefore faculty expertise is likely lacking in this domain.
Techniques for the Clinical Learning Environment
- Debunking misinformation with patients in the clinical environment is an example of a ‘difficult conversation’ that trainees must learn, much like breaking bad news or death disclosure. Trainees need guidance to navigate these challenging conversations.
- Failing to learn how to correctly manage misinformation with patients is a missed training opportunity.
- Teach the following 5 communication approaches for addressing misinformation with patients during clinical encounters:
- Motivational Interviewing: “a nonjudgmental, active listening framework in which the interviewer displays empathy for the patient, validates their beliefs, develops trust, and provides correct information in a respectful manner”
- Conversational Receptiveness: “the use of concrete words and phrases that parties in conflict can incorporate into any conversation to demonstrate active engagement with their counterpart’s perspectives”
- Elicit-Share-Elicit: “an active listening approach in which resident physicians can elicit patients’ knowledge, share information, debunk misinformation, and seek understanding”
- The ‘Three Cs’ Approach: “emphasizes compassionate understanding, connection, and collaboration when addressing misinformation”
- Learner-centered Approaches: “ensuring a psychologically safe learning environment for the patient, employing scaffolding by building upon prior experiences when providing patient education, and respecting the social context in which patients learn and make health decisions”
Techniques for Social Media Platforms
- Health misinformation spreads rapidly on social media.
- Patients are more likely to choose healthy behaviors if online misinformation is corrected with factual information.
- There is a growing call for physicians to address misinformation online by providing users with facts.
- Barriers to physician engagement online include a lack of training, perceived lack of institutional support, and concern for harassment or bullying.
- Physicians are more likely to address health misinformation online if they have received social media or misinformation training, or if they believe their institution is supportive of their efforts.
- Teach residents how to identify misinformation on social media and how to professionally debunk these misconceptions when posting online.
- Teach a 5-step approach for debunking health misinformation online:
- Step 1: Respond immediately when encountering misinformation
- Step 2: Identify and label misinformation
- Step 3: Provide correct information
- Step 4: Provide a reference
- Step 5: State the correct information twice in the response to reinforce
Supporting our Trainees
- Identify effective strategies to teach physicians and trainees how to debunk misinformation. Research is needed in this space.
- Allot the faculty effort and time required to develop new misinformation curricula, teach that content to trainees, and role model best practices.
- Provide social media and misinformation training to residents and faculty members alike.
- Directly support the efforts of trainees and faculty to address misinformation online.
- Role model communication techniques for trainees with patients and online.
- Revise institutional social media policies to support physician engagement.
- Contact potential employers and advocate for residents who professionally debunk health misinformation. Such efforts should be viewed as strengths not liabilities.
- Misinformation is a public health threat that physicians must address.
- Communication frameworks can help residents effectively debunk misinformation.
- Misinformation and social media training are needed to better prepare future graduates.
- Research about the effectiveness of misinformation training and specific debunking strategies is needed.
About the Author: Michael A. Gisondi, MD is a medical education researcher and emergency physician living in Palo Alto, California. He is currently Associate Professor and Vice Chair of Education in the Department of Emergency Medicine at Stanford School of Medicine. Twitter: @MikeGisondi
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