Welcome to the simulation titled Gender Affirming Care. This is a transcript of the simulation designed for screenreaders.
This virtual simulation was designed to help healthcare providers to use motivational interviewing and culturally sensitive engagement techniques in chronic disease management conversations with patients and clients. Providers learn to provide gender affirming care using best practices that help all patients and clients feel supported.
Pic 0: A woman appears in an abstract background.
DANIELLE: Hi, I’m Danielle, a health professions educator, specialized in patient engagement strategies. I want to share a way to talk with patients about healthy lifestyle changes, a communication style called Motivational Interviewing, or MI.
Pic 1: The words “Motivational Interviewing” show up next to Danielle, with the letters “M” and “I” highlighted.
Using MI, any healthcare professional, from doctors and nurses to dietitians, therapists, and other staff members, can guide patients to recognize their own reasons for change, which can motivate them to make plans to commit to change.
Pic 2: The words change to “MI Techniques”.
Today, we’ll go over some MI techniques and prepare you to use them when speaking with patients.
Pic 3: The words “Conversation NOT Prescription” appear below “MI Techniques”. Conversation bubble icons appear next to “Conversation” while an Rx icon appears next to “Prescription”.
While there are many MI techniques you can master, the overall approach is simple: MI is a way of being with patients and treats decisions about change as a conversation, not a prescription.
Pic 4: A person silhouette appears with a text box and words “Reasons” within.
We listen to patients with empathy and partner with them to work through their reasons both for and against change.
Pic 5: Background splits into a blue half on the left and a gray half on the right. A title, “Ambivalence”, appears along with the person silhouette appearing to display two text boxes, one on either side. The first text box on the left says “Make changes” while the second says “Don’t change” on the right.
What we find is that most patients don’t resist change because of lack of information, but because of genuine ambivalence. Using MI, we can guide them to address both sides of their thinking and ultimately come up with a plan about change that they’re motivated to follow.
Pic 6: On the left, the words “Pro Change” appears with an arrow pointed up to the word “Change Talk”. On the right, the words “Counter Change” is displayed.
In any conversation about change, you’ll hear some statements that are pro change and some that are counter change.
Pic 7: Screen changes to a green background with the title “Change Talk”. Two seated people silhouettes are shown talking to each other. Icons of speech bubbles are displayed on top and are colored in to represent a Change Talk meter increasing.
Pro change statements are called change talk and indicate that, even in some small way, the patient is contemplating change. Research shows that the more patients talk about changing, the more they do change.
Pic 8: Screen returns to the blue and gray backgrounds. On the right, the word “Counter Change” appears with an arrow pointing downwards to the words “Sustain Talk”.
Counter change statements are called sustain talk because they indicate a desire to sustain the status quo.
Sustain talk comes in the form of statements like…
Pic 9: Screen changes to a red background with the title “Sustain Talk”. Two quotations are listed:
“That first smoke in the morning helps me wake up.”
“I need to have a soda every day.”
Pic 10: Red exe’s appear next to both quotes.
DANIELLE: To guide people towards change, you should reframe or deemphasize sustain talk while eliciting and building upon change talk.
Pic 11: Screen changes to a green background with the title “Change Talk”. The words “Listen for desire, ability, reason, or need for change” appears at the center.
Listen for change talk that expresses an explicit or implied desire, ability, reason, or need for change.
Listen for some examples:
Pic 12: Under the “Change Talk” title, three quotations emerge:
“I don’t like feeling out of breath when I walk.”
“I know drinking soda’s not good for me.”
“I probably could quit with my husband’s support.”
DANIELLE: You want to explore these kinds of statements with a goal of eliciting even stronger change talk like this:
Pic 13: The quotes are replaced with three more:
“I will exercise with our class.”
“I’m going to drink diet instead of regular soda.”
“I’m ready to quit.”
DANIELLE: This is commitment language that signals likely change.
Pic 14: The speech bubble icons representing a Change Talk meter reappear below the “Change Talk” title. Then Danielle reappears on an abstract background.
Guiding patients towards change requires collaboration: listening to what they see as important and what changes they want to make in their lives.
There are some simple tactics you can use to support and invite collaboration:
Pic 15: Screen changes to a gray blue background with the title “OARS”. Underneath, the first letters of the acronym are highlighted and say:
Open ended questions
Affirmations
Reflections
Summaries
DANIELLE: Open ended questions, affirmations, reflections, and summaries, collectively known as the “OARS” techniques.
Pic 16: The title “Elicit Provide Elicit” appears. An icon of three speech bubbles is displayed, the first speech bubble pointing left, the second pointing right, and the third pointing left again.
We’ll also talk about a technique for sharing information called “Elicit Provide Elicit.”
Click on each tactic to learn more and see some examples.