Vaccine Hesitancy Counseling-an Educational Intervention to Teach a Critical Skill to Preclinical Medical Students

Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries

Physician recommendations can reduce vaccine hesitancy (VH) and improve uptake yet are often done poorly and can be improved by early-career training. We examined educational interventions for medical students in Western countries to explore what is being taught, identify effective elements, and review the quality of evidence. A mixed methods systematic narrative review, guided by the JBI framework, assessed the study quality using MERSQI and Cote & Turgeon frameworks. Data were extracted to analyze content and framing, with effectiveness graded using value-based judgment. Among the 33 studies with 30 unique interventions, effective studies used multiple methods grounded in educational theory to teach knowledge, skills, and attitudes. Most interventions reinforced a deficit-based approach (assuming VH stems from misinformation) which can be counterproductive. Effective interventions used hands-on, interactive methods emulating real practice, with short- and long-term follow-ups. Evidence-based approaches like motivational interviewing should frame interventions instead of the deficit model.

Mitigating Misinformation Toolkit: Online Simulation and Standardized Patient Cases for Interprofessional Students to Address Vaccine Hesitancy and Misinformation

Introduction

Medical misinformation, which contributes to vaccine hesitancy, poses challenges to health professionals. Health professions students, while capable of addressing and advocating for vaccination, may lack the confidence to engage with vaccine-hesitant individuals influenced by medical misinformation.

Methods

An interprofessional in-person simulation activity (90 minutes) using standardized patients was developed and instituted for students in medicine, nursing, pharmacy, and public health programs. Student volunteers were recruited from classes approximately halfway through their respective degree programs (i.e., second or third year of a 4-year program). Online simulation was used as a method to prepare for in-person simulation. Impact on students was assessed primarily through a postprogram student self-assessment.

Results

A total of 220 students participated in the program; 206 (94%) had paired data available to analyze. Following program participation, self-assessed abilities increased from pre to post, from 2.8 out of 5 (good) to 3.9 out of 5 (very good; p < .001). Ninety-eight percent of students felt that their ability to address medical misinformation was somewhat/much better after the activity, compared to before, and that their ability to address vaccine hesitancy was somewhat/much better. The overall program was rated highly, with mean scores for each program evaluation item >4 out of 5 (very good).

Discussion

An interprofessional cohort of students demonstrated improvement in self-assessed skills to participate in a conversation with an individual with hesitancy to receive vaccines and/or beliefs informed by misinformation. Students felt that this program was relevant and important to their professional development.

Mitigating Misinformation Toolkit: A Medical Student Role-Play Curriculum on Communication Techniques to Facilitate Vaccine Misinformation Conversations

Introduction

The COVID pandemic and affiliated infodemic led to widespread health misinformation, generating confusion and distrust. Physicians must identify and address misinformation, with attention to cultural/health literacy, equity, and autonomy. Most medical students receive training in core communication techniques but are rarely taught how to combat misinformation with patients and lack opportunities for practice in diverse settings.

Methods

We used mixed methods to evaluate the impact of a role-play-based training curriculum on 44 third- and fourth-year medical students' comfort and confidence applying ask-respond-tell-seek solutions (ARTS) and motivational interviewing (MI) to discuss vaccine hesitancy, using COVID-19 as an example. There were three training iterations: prior to volunteering at a community health fair, during a medicine clinical rotation, and during a pediatrics rotation. Pre- and postsession questionnaires were administered. Likert-scale questions assessed comfort and confidence using ARTS and MI. Narrative responses focused on previous experiences with vaccine hesitancy, challenges faced, and session takeaways.

Results

Students' comfort, confidence with ARTS/MI, and self-reported ability to discuss COVID-19 vaccinations improved as measured by pre- and postsession surveys (p < .05). Qualitatively, students reported increased confidence delivering recommendations in plain language and exploring patients' thought processes behind choices.

Discussion

Reinforcement of core communications strategies in medical school can positively impact trainees' ability and ease addressing misinformation. We recommend this 45-minute training session to effectively increase medical students' comfort and confidence in discussing COVID-19 vaccines with patients. It can be adapted to any health professions school with an existing communications thread.

Ten Actions to Counteract Vaccine Hesitancy Suggested by the Italian Society of Hygiene, Preventive Medicine, and Public Health

Vaccine hesitancy (VH) is one of the main causes of the widespread decline in vaccination coverage and has become the subject of ongoing debate among public health professionals. The present commentary is a “decalogue” of strategic actions to counteract vaccine hesitancy for public health professionals that comes from the cognitive and formative path put in place by the “Communication in Public Health” working group (WG) of the Italian Society of Hygiene, Preventive Medicine, and Public Health. From the establishment of a national, multidisciplinary WG on VH to the activation of a national monitoring/surveillance system on vaccine hesitancy, several proposals are discussed. The identification and dissemination of good practices and tools to counteract and understand vaccine hesitancy, interdisciplinary training on vaccine hesitancy and on risk communication, community engagement and infodemiology, the inclusion of effective interventions to counteract vaccine hesitancy within the National Immunization Plan (NIP), the promotion and growth of a community of practice and research in the field of vaccine hesitancy, collaborations between scientific societies, and knowledge from the behavioral sciences represent other actions recommended in the present commentary. The present document suggests ten undeferrable strategies that could be implemented at the national and local levels in Italy, and that could be borrowed by other European countries in order to counteract vaccines hesitancy with a systematic and organic approach.