An Innovative Medical School Curriculum to Address Human Papillomavirus Vaccine Hesitancy

"Educating all future physicians to recommend vaccination and respond compassionately to vaccine hesitant parents is a core responsibility of medical training."

In a country where vaccination rates against human papillomavirus (HPV) remain low, results from a United States (US) national immunisation survey found that female adolescents who received a provider recommendation for the HPV) vaccine were almost 5 times more likely to initiate the HPV vaccine series compared to adolescents who did not receive this recommendation. However, many providers report inadequate training and low comfort levels responding to questions from vaccine-hesitant parents. This study examined whether a multi-modal curriculum (including evidence-based lecture, communication methodology, and simulation training) would improve medical student confidence in addressing the concerns of vaccine-hesitant parents.

The researchers created a curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of:

• A presentation by a board-certified gynaecologic-oncology physician on the epidemiology, biology, and disease morbidity associated with HPV
• A video on implementing:
  • The presumptive method, which teaches students to use a direct statement when discussing vaccination, such as "Today you will be receiving your HPV vaccine" (vs. a participatory question, such as "Would you like to receive your vaccine today?"
  • The C.A.S.E. method, which is to be used if the presumptive approach is unsuccessful. First, the clinician asks for the parent's specific concern regarding vaccination. He or she then proceeds through the following steps: (C) Corroborate - acknowledging and validating the patient's concern, (A) About Me - explaining how the physician became an expert on the issue, (S) Science - relaying the scientific facts addressing the parent's concern, and (E) Explain/Advise - summarising the recommendation, emphasising the health risks of HPV infection, and urging the parent to agree to the vaccine.
• Role-playing simulations, in which students role-played 3 separate scenarios using the presumptive and C.A.S.E. methods. For each scenario, students played the role of either a provider, patient, or observer.

Pre- and post-intervention surveys were completed by 101 of the 132 participants. After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1-5, p < 0.01), and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Greater than 90% of students found the C.A.S.E approach useful not only to talk about vaccine hesitancy but also to discuss other medical concerns.

In discussing the results, the researchers cite studies indicative of a body of research on effective methods for communication with HPV vaccine-hesitant parents indicating that a multi-faceted approach is best, beginning with a presumptive statement, followed by a statement of scientific fact regarding the risk of disease pertaining to the individual patient, and concluding with a strong recommendation to vaccinate. Their HPV vaccine training curriculum for medical school students incorporates all these elements. Furthermore, the intervention is "easy to implement, scalable, and requires minimal resources."

The researchers note that vaccine communication training is not currently a standard component of medical education. A 2014 study found that of 92 paediatric residency programmes in the US, only 41% of programmes had formal training in vaccine safety and communication strategies for vaccine-hesitant patients. They contend that, "by initiating an intervention at the medical school level we have a potential to fill this training gap, target all medical specialties, and make future physicians more comfortable conversing with vaccine hesitant parents before practice patterns are established."

Future studies could randomise students to various interventions to determine specifically the most effective intervention. In addition, according to the researchers, future studies might incorporate longitudinal follow-up of student attitudes to ensure that student comfort talking to vaccine-hesitant parents remains high months to years following this type of intervention.