Training Staff in Patient Education: What Dermatologists Need to Know to Improve Patient Understanding
Wednesday, January 03, 2007
Perhaps surprisingly, whether or not your dermatology practice
has a formal staff training program in place for patient education
is not the most crucial piece of this particular puzzle. The one
key factor to keep in mind when training staff: Avoid misinforming
the patient at all costs. "The concern is always on the physician's
part to not just educate the patient," but also employees, says
Kathy Moghadas, RN, a principal of Associated Health Care
Advisors/Topcat in Deer Park, Fla. "So many [physicians] are very
cautious about who's trained and what kind of information is
given." Elaborating on information about which you don't have
adequate knowledge is a definite no-no. "It's better [for staff]
not to teach at all than to teach bad information," she stresses.
However, "the better [staff is] prepared to answer questions the
patient might present, the higher the level at which your practice
will be viewed," notes Moghadas. And crucially, opportunities for
improved patient knowledge and satisfaction will be realized.
Who Should be Trained?
Ninety-nine percent of the staff training done in a
dermatologist's office is delivered by the physician, according to
Moghadas. "Patient care coordinators are usually the ones who are
responsible for educating the patient, and they are trained on the
job directly with the physician," she says.
Joshua L. Fox, MD, is founder and director of Advanced
Dermatology PC and The Center for Laser and Cosmetic Surgery in New
York City. His practice is fairly large, but he personally trains
medical and physician assistants. "For medical assistants [MAs], we
try to limit staff education to things that are repetitive … and
[topics] that are documented on paper so that they can refer to
it," he states. "There's less room for error. The PAs can do
excellent patient education; that's really their role. We think
medical assistants should really not be doing that unless it's
something we have on paper that they're just reiterating or
rephrasing." Fox explains that MAs may summarize some of the things
he has said, but he prefers that they follow the dermatologist's
lead. "That is in contrast to if they're explaining what to do for
a patch test or what the procedural aspects are to a patient. That
is something we like them to get very involved in."
Bev Aldridge, dermatology coordinator at Sutton Ryan Dermatology
in Lincoln, Neb., oversees staff training along with an assistant.
"All new staff goes through a 6- to 8-week training period … to
learn the flow of the clinic," she says. "Front-office staff have a
4-week training period. The staff also have annual safety and OSHA
training." When new equipment or procedures are implemented, she
provides in-services. "There are times when we will initially train
a couple staff members, and then those individuals will train the
staff," she explains. "Educate everybody. Don't keep the front desk
in the dark just because they're answering phones. They are the
first point of contact most of the time, and I think doctors make a
mistake sometimes of not trying to educate [those in] reception,"
Techniques of the Trade
A wide variety of staff training techniques for patient
education can be used, both on and off the job. For one, companies
that sell services and products in dermatology will often send
their representatives into a practice to educate staff. "The reps
will come in and provide educational content when they are bringing
in supplies or samples," notes Moghadas. "Depending on the
procedure or what the product might be - something as simple as
Derma Cleanse, for example - they might even have the staff try it
and see how it works for themselves," she says. "A lot of teaching
material is made available by the drug reps [and] all staff are
encouraged to read."
"The American Academy of Dermatology [AAD] produces a great deal
of literature on topics that are sometimes sponsored by vendors,"
Moghadas says. "They set up practice parameters on how to take care
of certain disorders, which can be very helpful." In addition to
this, AAD and other professional societies offer educational
training conferences, and dermatologists often bring key employees
to breakout sessions at these venues. As far as seminars and
conferences go, Fox says his practice does a little bit of that.
"Mostly, we'll have someone come in. We generally don't send our
staff out." Other training sources may include multimedia materials
such as videos, CDs, and DVDs that can be brought into the
Moghadas recommends that practices have a training logbook. "As
the physician receives information that he feels the employees can
absorb, he'll take a copy of an article and put it in the book so
they have a chance at their leisure to read and initial that
they've read it. It becomes a very effective tool for
Fox has a training manual, too, which includes commonly used
drugs and commonly misspelled medical terms. "We have a training
program the first few weeks when someone first starts. It's not
formal in the sense that we have these 30 topics we're going to
cover. Generally, though, if you go through the course of a day,
you will see these patients. These topics will come up. There will
be a few of the rare cases or unusual scenarios that they may not
According to Moghadas, most of the time training is on the job,
where the dermatologist is instructing staff while actually
performing a procedure. The method is direct, and staff is actively
engaged as the physician uses whatever situations arise as learning
What this Means to Patients: An Example
Let's now put the staff training principles to work, using an
eczema regimen as an example.
- Assess what the patient knows before the teaching session.
Never assume he needs to be taught everything about eczema. Choose
three or four essential concepts and teach those. Once the patient
has a general understanding of the condition, you'll want to
discuss treatment options such as topical medications,
antihistamines, and so on.
- Again, don't overwhelm the patient with information. Keep it
simple so that the patient can readily understand it. Let him know
that some antibiotics are applied to the skin; others come in pill
or liquid form. Phototherapy and stronger systemic medications,
such as corticosteroids and cyclosporine, may be discussed as
- Never present any information that would intimidate or scare
- When teaching a patient a regimen, take the time to watch him
practice these skills and demonstrate on subsequent visits.
- Reinforce the information by asking the patient to restate what
you have taught him so you're sure he understood.
- Use visual aids and/or written materials for teaching and for
patients to take home. Patient instruction sheets and handouts
should be available discussing any lifestyle changes that may help,
such as short, daily baths or showers in warm, not hot, water.
Other topics on which to provide education for eczema patients
might include avoidance of fragranced soaps and detergents, gentle
skin drying and application of a moisture-retaining emollient
cream, and choosing clothes that allow the skin to breathe.
When training staff for patient education, each dermatology
office will have its own protocol - a key point because it allows
less room for error. For some practices, a formal staff training
program might just be what the doctor ordered, as patient education
should be considered one of a dermatologist's most important
Make Sure Patients get the Message
Several repetitions may be needed to impart key information to
dermatology patients. "Educate everybody," advises Kathy Moghadas,
a principal with consulting firm Associated Health Care Advisors.
"Don't keep the front desk in the dark just because they're
answering phones. They are the first point of contact most of the
time, and I think doctors make a mistake sometimes of not trying to
educate [those in] reception." Other tips for educating staff to
provide top-notch education to dermatology patients include
emphasizing demonstration skills, maintaining training logbooks
that include literature and other materials collected by the
physician, and bringing external resources like product
representatives into the practice for staff development.