Clinical Conversations Training Program

Clinical Conversations is a program from the Network of the National Library of Medicine (NNLM) for training clinicians and other clinical staff who interact with patients about health literacy and related concepts. This program allows clinical trainers or managers to offer brief trainings embedded into regular staff meetings or trainings that they already facilitate as a way to offer continuing education that does not take time out of already busy schedules.

The primary goal of Clinical Conversations is to increase knowledge and awareness of health literacy and associated skills and tools. Clinical Conversations has built in discussion points intended to encourage conversation so participants can learn from one another. The intent of offering Clinical Conversations as part of regular meetings is to convey the importance of these skills and concepts at the institution. To become an expert in the skills presented, there may be a need for further training and practice, so each subject includes a list of additional trainings on that topic. Clinical Conversations provides information for clinical settings but is not intended to provide specific medical advice or to take the place of either the written law or regulations.

Clinical Conversations Topics

Clinical Conversations is comprised of 7 topics. Each topic contains 3-12 modules. Each module includes PowerPoint slides, printable handouts and e-mail follow ups. All of these materials can be downloaded by selecting the subject from the tabs above. The speaker notes and discussion questions are formatted as though someone is using the Clinical Conversations subjects in the following order:

Health Literacy
Cultural Humility
LGBTQ+ Affirming Care
Social Determinants of Health
Motivational Interviewing
Evidence-Based Practice
Shared Decision Making

Facilitators may choose to deliver only certain topic or deliver them in a different order. In these instances, a facilitator will likely need to adjust the speaker notes and discussion questions. Areas for potential adjustments are indicated in the speaker notes included in the PowerPoint slides.

Clinical Conversations Discussions

To fit into busy clinical schedules, the informational component of each module should take approximately 10-15 minutes to deliver. To encourage interaction between participants, each module contains discussion points. Discussion can occur in different ways depending on the institution implementing this program.

With only 10-15 minutes for a module, the discussion questions can be presented as takeaways on which participants reflect between meetings, with a few people sharing their thoughts or experiences at the beginning of the next conversation. [The slides are formatted for this option. Recommendations for adjusting to another option are described in the speaker notes].
With more than 15 minutes available for a module, discussion questions can be used at the end of the informational content for facilitated group discussion.
For institutions with an internal LMS system, discussion questions can be loaded into an online discussion board on which participants post their thoughts between meetings.

For institutions with more training time, the modules can be combined into longer trainings. For example, three modules could be combined for a 30 minute informational training by adjusting the placement of the discussion questions and introductory slides. In these instances, the facilitator can decide how they would like to use discussion questions.

Clinical Conversations Evaluation

Clinical Conversations contains three evaluations.

The Clinical Conversations program evaluation is a pre/post tool to evaluate the program as a whole. This can be administered before the first module and after the final module, regardless of which subjects are used.
The subject specific evaluations (linked on each subject page) are pre/post tools to evaluate knowledge gain related module learning objectives. This can be administered before the first module in a certain subject and after the last module in that subject.
The trainer post evaluation looks at outcomes from the individual who taught the Clinical Conversations content. The trainer can complete this after they teach the final module.

If a facilitator chooses not to deliver all the Clinical Conversations subjects, they will likely need to adjust the Clinical Conversations Program Evaluation.

Clinical Conversations Program Options

Clinical Conversations includes several points of flexibility depending on institution needs. A Clinical Conversations facilitator can choose how to deliver the following:

E-mail follow-ups. There are pre-developed e-mails for a facilitator to send to participants between meetings. The e-mails reinforce module content or provide additional resources. These can be used at the discretion of the facilitator based on what follow up information they think is valuable for their audience.
Fillable notes pages. These are intended to be printed handouts that participants can refer to during in-person training and fill in key points throughout the session. They also include all references used in the modules if participants are interested in the sources of information. If participants want a handout, but do not want to fill in the blanks, a facilitator can pass out the handout answer key instead.
Evaluations. Clinical Conversations has a pre and post evaluation for each subject and evaluations for the program as a whole. The evaluations are designed to be printed and completed on paper. A facilitator is welcome to distribute these evaluations to participants electronically if it is preferred.
Trusted Resources. All of the subjects include reference to at least one resource from the National Library of Medicine. The Health Literacy subject contains two full modules on the NLM resources MedlinePlus and HealthReach. If an institution wishes to offer the Clinical Conversations topics in an order different from the one recommended above, a facilitator can teach the resource modules from the Health Literacy topic with other topics to familiarize participants with the resources referenced. Suggestions about this are provided on the subject pages of this guide.
Facilitator Preparation. Each set of PowerPoint slides contains speaker notes for the trainer/facilitator delivering the Clinical Conversations program. Depending on the background and experience of the trainer, they may need additional preparation before offering Clinical Conversations. Each subject page links to additional resources and suggests NNLM courses that align with Clinical Conversations topics. Facilitators are encouraged to use these resources to prepare for subjects with which they are less familiar.

Questions?

This training program was originally developed by Erin Seger, MPH, MCHES, with funding from the NNLM Middle Atlantic Region (now Region 1) in the 2016-2021 contract period.

All materials provided here are public domain, and freely available for re-use. Please acknowledge NLM as the source of the information by including the phrase “Courtesy of the U.S. National Library of Medicine” or “Source: U.S. National Library of Medicine.”

For questions contact nto@utah.edu.

Health Literacy

Seven modules that cover the impact of health literacy on physical health and communication skills to address health literacy in a clinical setting. Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This topic also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

Suggested NNLM Courses for Facilitator Preparation

Effective Health Communication and Health Literacy: Understanding the Connection: This introductory class to health literacy and health communication will help you understand and raise your awareness of the complexity of these concepts. We will define health literacy today, identify various types of literacy, explore how communication and health literacy affects how a person manages and makes health care decisions.

Making Sense of Numbers: Understanding Risks and Benefits. Communicating Numerical Health Information: This class is a basic introduction for anyone who wants to understand how to communicate health information that involves numbers. The purpose of this class is to understand risk and benefits from an individual's perspective and to understand that the communication of numbers must be clear and easy to understand.

MedlinePlus Tutorial for Librarians and Health Educators: Discover the history, selection criteria and sources of MedlinePlus through this on-demand, hands-on tutorial. Designed to take about an hour to complete, the narrated tutorial explains how to locate information on health topics, drugs, and supplements in MedlinePlus.gov, highlighting additional tools and the authoritative sources from which MedlinePlus.gov draws its health information.

More Information

The goal of Clinical Conversations is to increase awareness of and discussion around clinical topics related to health information and health literacy. While they are valuable tools for busy clinical settings, there are additional resources for someone who wants to dive deeper into one of the module topics. Additional education and training on the concepts in the Health Literacy module include:

The CAHPS Ambulatory Care Improvement Guide (Agency for Healthcare Research and Quality)
Resource guide for providers seeking to improve their performance in patient experience measured by CAHPS surveys of ambulatory care. Includes information about shared decision making, behavior change, communication and cultural competence.

Health Literacy Universal Precautions Toolkit, 2nd edition (Agency for Healthcare Research and Quality)
Toolkit to help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.

Health Literacy Training in CDC TRAIN (Centers for Disease Control and Prevention)
7 online health literacy courses for health professionals from the Centers for Disease Control and Prevention.

Always Use Teach Back!
Toolkit is to help health care providers use teach-back. The toolkit combines health literacy principles of plain language and using teach-back to confirm understanding, with behavior change principles of coaching.

Cultural Humility

5 modules cover the importance of cultural humility in healthcare, the difference between traditional cultural competence modules and how providers can go about the process of lifelong learning emphasized within cultural humility. Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

Suggested NNLM Courses for Facilitator Preparation

Providing Multilingual and Multicultural Health Information: This class is designed to assist librarians and others who work with diverse populations in locating health information. The resources presented are selected for their emphasis on providing culturally relevant information in the preferred language of the population. Background information on refugees and immigrants in the U.S. and their unique health issues are also presented.

More Information

Think Cultural Health (Department of Health and Human Services)
Free, continuing education e-learning programs, counselors, administrators and healthcare providers provide culturally and linguistically appropriate services (CLAS). CE is available for many categories of health professionals who complete these courses.

Effective Communication for Healthcare Teams in CDC TRAIN (Centers for Disease Control and Prevention)
3 online communication courses for healthcare teams from the Centers for Disease Control and Prevention. Module 2 is about cultural competence and Module 3 is about working with those with limited English proficiency. These are located on the TRAIN Learning Network.

LGBTQ+ Affirming Care

4 modules discuss sexual orientation, gender and the importance of this information in healthcare. Module four discusses how healthcare providers can be affirming to their LGBTQ+ patients. Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

More Information

National LGBT Health Education Center (Fenway Institute)
The Center provides educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for lesbian, gay, bisexual, and transgender (LGBT) people.

LGBT Training Curricula for Behavioral Health and Primary Care Practitioners (SAMHSA) (link is external)
A list of available trainings focused on improving the health of LGBT individuals compiled by the Substance Abuse and Mental Health Administration and the Health Resources and Services Administration.

Social Determinants of Health

5 modules that cover how the social determinants of health affect a patient's ability to engage in their care, how providers can support these patients and how shared decision making applies in this context. Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

More Information

Social Determinants of Health (Agency for Healthcare Research and Quality)
Resource page that links to research, data and tools related to the social determinants of health for clinicians. The links focus on SDOH as they relate to healthcare.

Social Determinants of Health (SDOH) Training Plan (Public Health Foundation)
This training plan provides an overview of the Social Determinants of Health (SDOH). Upon completion of this training plan, learners will be able to: (1) describe fundamental aspects of SDOH, (2) explain social contexts and effects of SDOH on specific populations; and (3) apply SDOH knowledge to design targeted interventions for improving public health.

Motivational Interviewing

8 modules that cover the basics of motivational interviewing and how it can be used in the context of the transtheoretical model (stages of change). Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

More Information

Blending Initiative Motivational Interviewing CME/CE and Patient Simulation (National Institute on Drug Abuse)
Training that offers practical guidance for physicians and other clinicians in effective Motivational Interviewing techniques that will facilitate conversations with patients to address Health Risk Behaviors. Includes and course and a patient simulation.

Integrating Primary Care Practices and Community-based Resources to Manage Obesity (Agency for Healthcare Research and Quality)
AHRQ resources and case study on motivational interviewing to support patient engagement in chronic disease management.

Books:

Gold, M., Kelly, T. & Douihy, A. (2015). Motivational Interviewing: A Guide for Medical Trainees. New York: Oxford University Press.
Rollnick, S., Miller, W. & Butler, C. (2008). Motivational Interviewing in Healthcare. New York: Guilford Press.

Evidence-based Practice

12 modules that teach the benefits of evidence-based practice and the process of developing a research question, acquiring, appraising and applying evidence in practice. Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Depending on the needs of an institution, a facilitator can implement only part of the evidence-based practice topic. Modules 5, 6, 10, 11 and 12 are optional and cover more advanced concepts. These optional modules can be removed with small adjustments as indicated in the speaker notes of the PowerPoint slides. Removing these optional modules will make the evidence-based practice section of Clinical Conversations will save time, and also keep the topic more introductory than it would be if all 12 modules were taught.

Evaluation & Planning

Suggested NNLM Courses for Facilitator Preparation

PubMed Essentials (on-demand)
PubMed Essentials is made up of 10 very short video-modules (2-3 minutes each) with interactive exercises built into each video-module so you can explore PubMed at your own pace. PubMed Essentials is an on-demand, online class that is available via Moodle 24/7 (upon registration).

How PubMed® Works
How PubMed Works is a series of four 90-minute classes presented via WebEx. The individual classes are:

How PubMed Works: Introduction
How PubMed Works: Selection
How PubMed Works: MeSH (Medical Subject Headings)
How PubMed Works: ATM (Automatic Term Mapping

Shared Decision Making

3 modules that cover the basics of shared decision making. The emphasis of these modules is how shared decision making is linked to the other Clinical Conversations topics. This section would be best implemented after other Clinical Conversations topics or adapted with content from previous modules if this would be a standalone training. This set of modules is intentionally shorter than the other Clinical Conversations topics because the Agency for Healthcare Research and Quality offers a 6-hour training on shared decision making (see the additional information section). Each module is made up of a PowerPoint presentation with speaker notes, handout, and e-mail follow ups that a facilitator can send to trainees between modules. This subject also includes a pre and post evaluation to assess participants' change in knowledge and a planning guide for a facilitator to organize when they will teach these modules and use the follow up content. Select the links below to download these training materials.

Evaluation & Planning

More Information

SHARE Approach Workshop Curriculum (Agency for Healthcare Research and Quality)
Training program for clinical organizations that teaches more in-depth information about the five step shared decision making process developed by AHRQ. This includes exploring and comparing the benefits, harms, and risks of each option through meaningful dialogue about what matters most to the patient.

Recommended Tools & Training from the MGH Health Decision Sciences Center
Links to additional SDM training for clinicians, Decision Quality Instruments, and more SDM educational videos.

Clinical Conversations Training Program