Putting the Patient-Provider Interaction On Stage

Background:  In 2011, the St. Louis STD/HIV Prevention Training Center approached Act3 to develop a new approach to their training program for health professionals in the areas of sexual and reproductive health. Objectives included reframing how health care professionals think about and interact with clinic patients who may have symptoms of or exhibit risk factors for HIV or STDs, increasing the effectiveness and frequency of sexual history taking, and reducing the spread of HIV and STDs.

Program background:  The center is a member of the National Network of STD/HIV Prevention Training Centers, a CDC-funded group of regional centers created in partnership with health departments and universities to provide health care professionals with the latest research and clinical information in the field of sexually transmitted diseases (STDs).

Evaluation Methods and Results:  Act3 conducted interviews from late-2011 through mid-2012 to fully understand all facets of the story. Interview subjects included:

• Lisa Biagiotti, Director, deepsouth, a film about HIV in the rural American South
• Don Conner, PA-C, Research Patient Coordinator, Washington University School of Medicine
• Emily Corcoran, Medical Student, University of Missouri School of Medicine
• Parker Gregg, Medical Student, Vanderbilt University School of Medicine
• Mark Levine, MD, Emergency Medicine, Barnes-Jewish Hospital
• Gene Lincoln, Manager for Clinical Education for Corizon Correctional Healthcare
• Katherine J. Mathews, MD, Director of Clinical Services, Casa de Salud
• Sarika Talve-Goodman, PhD student in Narrative Medicine 

After gathering all the information, Act3 recommended reframing the story being told in the current provider training, and suggested several strategies that could be used to communicate differently with providers. A key recommendation was to address these topics via a scripted performance -- a short, three-act play, presented by actors – that would replace the traditional opening lecture. The play addressed three key issues:

• Treating patients as a collection of stories, not symptoms
• There is no “right answer” to the questions in a sexual history
• Considering a new normal, and withholding judgment on difference

The performance featured interactions between patient and provider acting out a story, with the patient or provider “breaking the fourth wall” and interacting with the audience to reveal their thoughts. This direct audience interaction serves as a teaching tool, and sets up discussion topics for the session facilitator. Demonstrating this patient/provider dynamic in story form rather than reviewing it or discussing it in lecture form has enabled participants to absorb and retain information presented more effectively.

Conclusions:  The reaction to the play as part of the training illustrates the educational benefits found in breaking from traditional communication strategies around health communication, and the potential impact that storytelling can have in provider education, which can lead to better community health outcomes.

Implications for research and/or practice:  The enthusiasm from the St. Louis STD/HIV Prevention Training Center for the project suggests the potential to replicate this model in other STD/HIV centers, thus impacting STD/HIV education for providers nationwide. Improved training may lead to more effective taking of sexual histories, which has the potential to decrease the spread of disease and improve treatment for those with STDs.