Hypertension Education to Address and Reduce Disparities (HEARD).

Abstract

Purpose: Hypertension impacts more than half of the United States population, with a disproportionate impact on underrepresented minorities. 1,2 Poorly controlled blood pressure (BP) causes significant morbidity and mortality. 3 Accurate BP measurement in the health care setting is an essential step in improving BP control. 4 While measuring BP is a common procedure, student training in BP measurement is often inadequate and varies widely between schools. To address this, a standardized longitudinal program combining e-learning and hands-on training was integrated into the Patient Centered Care (PCC) Course within the University of North Carolina School of Medicine (UNC SOM) curriculum. The project aims to: (1) implement the American Medical Association (AMA) BP Measurement Essentials Modules 5 for trainees in medicine, pharmacy, dentistry, and nursing; (2) facilitate advanced communication skills through standardized patient encounters to promote accurate at-home self-measured BP; (3) increase awareness of disparities in health care related to hypertension; and (4) pair BP training with training in clinical reasoning and management of chronic diseases through patient cases related to hypertension. Approach: As part of the 3-semester PCC Course during the UNC SOM’s 18-month preclinical phase, first- and second-year medical students completed an online e-learning module followed by an in-person skills session centered around the basics of measuring BP. Two different modules were used, with first-year students completing the AMA BP Essentials Module and second-year students completing the AMA Self-Measured BP Module. A survey was administered after completion of the module and after completion of the in-person session to assess student satisfaction as well as confidence in various skills. To facilitate advanced patient communication and partnering for at-home self-measured BP, students participated in educational sessions focused on self-measured BP, “teach back,” and motivational interviewing. For evaluation, students will complete skills and knowledge postassessments with standardized patient encounters. Outcomes: Seventy-five percent (n = 136) of first-year students and 69.8% (n = 116) of second-year students rated their overall satisfaction with the online module as either extremely satisfied or somewhat satisfied. Overall, student-rated confidence level increased in all measured areas: ability to prepare and position the patient before measuring BP, choose the correct BP cuff, and accurately measure manual and automated BP. 63.1% of first- and second-year students rated the accuracy of the BP measurements they typically take as an 8 to 10 out of 10 after completing the in-person skills session, compared with 32.4% and 37.3% before the session, respectively. Significance: Implementation of a standardized BP measurement module and hands-on skills session was well received by students and clearly improved student-rated accuracy of BP measurements and confidence in various skills required to obtain an accurate BP reading. Future assessment of students’ knowledge and skills will include a hands-on OSCE during which accuracy of student-measured BP will be assessed. Furthermore, to improve interprofessional clinical care, the program will be expanded to the schools of pharmacy, dentistry, and nursing. Additionally, in the upcoming semesters, implementation of a longitudinal lecture series will educate and encourage discussion for solutions to reduce hypertension disparities. Standardized BP education among medical and health professionals is limited and important for obtaining accurate BP measurements and subsequently managing hypertension. Equipping medical students with this skill set as a standardized part of their curriculum will help address the large burden of disease and health care disparities in the United States. Through education in communication and “teach back,” students become better advocates and contribute to improved health outcomes.