- Email: [email protected]
A multidisciplinary patient education workshop to integrate staff training with program development
Patient Education and Counseling, 8 (1986) Elsevier Scientific Publishers Ireland Ltd.
291-298
291
Preparation for Practice A MULTIDISCIPLINARY PATIENT EDUCATION WORKSHOP INTEGRATE STAFF TRAINING WITH PROGRAM DEVELOPMENT
TO
KAREN M. BERMANa, SUSAN MENDOZAb and KATE LORIGC bNursing Service for Education, Veterans Administration Medical Center, Sheridan aMental Hygiene Clinic, Veterans Administration Medical Center, Palo Alto and ‘Stanford Arthritis Center, Stanford University, Stanford, CA (U.S.A.)
WY,
(Received September 23rd, 1985) (Accepted February 2&h, 1986)
ABSTRACT
A four session multidisciplinary workshop was held to teach Veterans Administration (VA) Medical Center staff basic patient education design principles. During the sessions, staff, working in teams, designed patient education programs on a wide variety of health care topics. Guidance to teams was provided at each step of program development so that at the end of the workshop, programs were ready for implementation. Medical Center standards for patient education and documentation were integrated into program designs. Key words: training
Professional
education
-
Veterans
administration
-
Staff
BACKGROUND
The VA Medical Center at Palo Alto, CA, over the past several years, has taken steps to improve the quantity and quality of its patient education activities. The Medical Center consists of two divisions located 7 miles apart. Together, the two divisions contain 1,500 inpatient beds and large outpatient facilities. The medical center has, in addition to general medical and psychiatric care, a kidney dialysis unit, a spinal cord injury unit, a blind rehabilitation center, a geriatric center, a go-bed Vietnam veterans program, five inpatient substance abuse units and a spectrum of programs for medical and psychiatric rehabilitation. 0738-3991/86/$03.50 o 1986 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
292
The Medical Center does not have a Patient Health Education Coordinator. As part of its effort to improve patient education, the Medical Center formed a multidisciplinary Patient Education Committee, administratively responsible to the Chief of Staff through the Associate Chief of Staff for Education. The Committee is charged with developing and coordinating patient health education. Although it has developed a set of standards for patient education programs and maintains incentives for adhering to them, the Committee has no authority to enforce its standards. This authority belongs to the individual services, such as nursing, medicine and social work, which develop their own goals and requirements and oversee their own personnel in patient education programs and activities. The Patient Education Committee concerns itself primarily with formal programs and has an interdisciplinary approach. Over the past several years, the Committee developed program standards, conducted two surveys of ongoing patient education programs and activities, supported staff education in health teaching, coordinated educational activities among professional services, and encouraged new patient education classes in needed areas. Some program gaps were identified by the Patient Education Committee. While more than 100 organized patient education activities were catalogued by the Committee’s surveys, few of these were designed or implemented using generally accepted patient education principles. Most of the teaching activities were informal, lacked a written protocol and were dependent on the good will of their designers for implementation. Problems occurred when staff members left or changed jobs. Since the activities were not institutionalized, they were discontinued when the initiators left or lost interest. A second problem was inconsistent documentation. This created difficulties for clinicians and auditors who tried to assess needs, allocate resources and evaluate ongoing activities. A first attempt to resolve these problems was a multidisciplinary 2-day workshop. This workshop focused on basic patient education skills such as needs assessments, goals and objectives, teaching methods, evaluation and documentation. The 35 participants rated this presentation very highly on post workshop evaluation forms, compared to other staff education programs that have been presented at the Medical Center. Nevertheless, the workshop resulted in few changes in patient education programs within the Medical Center. Participant interviews revealed several problems. First, there was insufficient support in some treatment units for work in the area of patient education. After the workshop, participants frequently were not able to link up with others who would help them accomplish programs. Some participants could not receive permission from supervisors to spend their time on patient education. The most often mentioned obstacle was self imposed. People did not feel justified in taking clinical time to organize new programs. Another problem was limited technical support and feedback. Although, the Patient Education Committee had a mandate to give assistance, staff did not have easy physical access to the Committee.
293
WORKSHOP
RATIONALE
AND DESIGN
Based on surveys and the feedback from previous efforts, the Patient Education Committee sought to sponsor a new staff development workshop, taught by one of the authors (K.L.). Funding was provided by the InterWest Regional Medical Educational Center of the VA. The authors decided to use a traditional community development model [ 1,2]. Patient education skills, when acquired in an academic program, are generally taught by combining didactic and field work. However, few health professionals receive formal patient education training, and most staff at the Palo Alto VA Medical Center had little of this kind of background. In the work setting, patient education skills are usually taught and supervised as part of the job of a trained patient education specialist [4-f3]. However, the majority of health care facilities do not have fulltime trained health education staff. This is the situation at the Palo Alto VA Medical Center. Thus, an adapted community development model seemed the best way to teach patient education skills in the VA Medical Center work setting. An outside expert, helped “community members” (hospital staff) meet their identified needs while learning the skills necessary to continue their development (educational) efforts. Many of the strategies for this type of training are outlined by de Torney and Thompson [ 31. The goals of the workshop were: (1) To train 15-20 VA staff in patient education program design. (2) To develop and implement 5-10 new patient education programs. The 12-h interactive workshop was presented in four 3-h sessions held 4-6 weeks apart. This timing was chosen to give participants time to implement each phase of the training before proceeding to the next phase. The first session focused on needs assessment techniques. Session 2 concentrated on writing behavioral and health status objectives. Sessions three and four dealt with implementation, including basic evaluation and documentation skills. Each team was expected to complete a needs assessment between sessions 1 and 2; to write a protocol between sessions 2 and 3; to begin program implementation between sessions 3 and 4; and to implement an evaluation after session 4. Tables I and II give details of objectives, process and content. Approximately 2 weeks after each session, participants received memos that reviewed important class decisions, reminded participants of the next assignment, and invited them to contact the instructor to discuss problems or concerns. The expanded workshop format was chosen so that participants would have time between sessions to implement their learning. Each session built on the knowledge base of the previous sessions and on the experimental learning between sessions. This helped bridge the gap between abstract learning and real world situations. Finally, the format of the workshop almost insured that upon completion, each participant or team of partici-
294 TABLE I PROGRAM
OBJECTIVES
Participants
will be able to:
Session 1 -Needs Assesement (1) Define patient education (2) Discuse three types of needs assessment (3) Define an area for patient education on their unit (4) Design a needa assessment for their unit Session II-Implementation and Evaluation (1) Define the patient education needs of the patients in their program (2) Write behavioral and health status objectives for their patient education Seseion III-Implementation and Evaluation Discuss the strengths and weaknesses of patient education protocols (1) (2) Discuss administrative and other problems encountered in implementing grams (3) Discuss the differences between process and outcome evaluation (4) Discuss the differences between quantitative and qualitative evaluation (5) Design an evaluation for their patient education program
programs
their pro-
Seesion IV- Evaluation and Documentation (1) Discuss the strengths and weaknesses of their patient education program (2) Discuss and revise evaluation plans (3) Discuss plans for implementation of patient education program on an ongoing basis
pants would have developed
and implemented
a new patient
education
program.
The workshop was structured to assist in overcoming some institutional obstacles. Because they were encouraged to attend in teams, individuals had built-in support on their clinical units. Also, the unit supervisors were made aware of the time commitments and had given formal approval for staff attendance before the workshop began. Before acceptance to the workshop, participants were screened for: (1) General awareness of patient education principles. (2) Having a specific patient education program to be designed and carried out. (3) Having the support of the other care providers in their service areas. (4) Having the support of supervisors. The screening was done through personal interviews by the workshop designers or other members of the Patient Education Committee. RESULTS
Twenty-five people attended the first session. This included eight registered nurses, four social workers, three licensed vocational nurses, one dietitian, six occupational therapists, and three recreational therapists. The group represented 13 teams. The interests of this group ranged from
295 TABLE
II
PROGRAM
CONTENT
AND PROCESS
Session I-Needs Assessment (1) Lecture/discussion on needs assessment (a) stakeholder analysis (b) belief assessment (c) questionnaire (d) modified Delphi (2) Small group discussion to determine patient education project of each group participant (3) Small group discussion to design needs assessment for each group (4) Feedback on needs assessment and planning for implementation HOMEWORK: Conduct a needs assessment and write results Session II - Goals and Objectives (1) Feedback and critique of needs assessment of objectives (2) Lecture/discussion (3) Write behavioral and health status objectives (4) Feedback on objectives on health education process (5) Lecture/discussion HOMEWORK: Write a patient education protocol Session III-Implementation and Evaluation (1) Feedback on protocol and pilot test (2) Discussion of administrative problems (3) Lecture/discussion on evaluation (4) Group work to determine evaluation criteria (5) Feedback on evaluation criteria HOMEWORK: Implement patient education
and pilot part or all of protocol
program
and write an evaluation
plan
Session IV - Evaluation and Documentation (1) Feedback on patient education program (2) Discussion and feedback of evaluation plans (3) Problem solving session
wanting to redesign the entire recreational program of an inpatient psychiatric facility to wanting to develop a high blood pressure program in an outpatient clinic. From the initial comments of the participants, it seemed that some of the projects or participants were not appropriate for the workshop. For example, one group wanted to design a behavior modification program for severely disturbed psychiatric patients. Such an effort seemed out of the realm of traditional patient education programs and beyond the skill range of the instructor. One individual wanted to teach patients how to take care of their trachiotomies at home. Unfortunately, this program was proposed by a person who came without team members and without the support of her service unit. While the program idea was excellent, it lacked support and therefore was unfeasible.
296
Of the original 25 participants, 12 completed all four sessions. These 12 people, along with some non-attending but supportive team members, designed seven programs: (1) Cardiac rehabilitation for post myocardial infarction patients Designed by two registered nurses. (2) Community living skills for psychiatric patients Designed by a registered nurse and a social worker. (3) Hypertension education for an outpatient clinic Designed primarily by a registered nurse practitioner and a dietitian. Two other team members, a psychologist and a pharmacist, did not attend the sessions but assisted in program design. (4) Community resources education for an outpatient arthritis clinic Designed by a social worker as one class given by an interdisciplinary team working in an arthritis clinic. The other team members did not attend. (5) Breast self examination Designed by a licensed vocational nurse. This was the only person who completed the workshop who did not have help from at least one other team member. (6) An information program to motivate smokers to join a stop smoking program Designed by two licensed vocational nurses. (7) Wheelchair repair for spinal cord injured patients Designed by four occupational therapists. All four attended some sessions, but only two completed all of them. One concern was the large attrition rate. Dropouts were all contacted. Reasons for non-completion fell into two major categories. The prescreening discussed above was not entirely successful. In several cases, individuals or programs were inappropriate. Secondly, some people came to the initial session not fully understanding the commitment to complete major assignments between workshop sessions. It became apparent by the second session that more time should have been allowed to teach participants how to apply the results of their needs assessments to their program designs. Several teams conducted excellent assessments, resulting in significant findings, but they ignored their findings when writing their protocols. For example, the breast self examination assessment showed that women did not know how to examine their breasts. However, the participant designing the program initially emphasized the anatomy of the breast and the cancer risk factor rather than examination techniques. EVALUATION
The workshop was evaluated in the following ways: (1) An InterWest Regional Medical Educational Center questionnaire that queried participants about whether their expectations were met, about the quality of the teaching and about the general usefulness of the workshop. (2) An
297
instrument designed by the instructor to test knowledge of the content presented and elicit suggestions for improvement of future workshops. (3) A class discussion at the end of the last session. (4) An assessment of the number and quality of the programs that have emerged from the workshop. According to these evaluation efforts, The Patient Education Committee judged the workshop a success. Six of the seven programs developed in the workshop have met the Patient Education Committee’s standards for programs, as evaluated by the Committee’s Review Section. These programs are now being taught in the following sites at the Medical Center: The cardiac care unit, a milieu therapy psychiatric unit, the medical admitting and evaluation area, the arthritis clinic, gynecology clinic and the spinal cord injury inpatient service. These six programs do not begin to meet the Medical Center’s educational needs. However, progress has been made in training clinic.al staff in the design of formal patient education programs. These programs and the staff that completed the course help provide a base from which to build. Plans are underway to repeat this workshop and to use a similar format for a teaching skills workshop. However, several modifications will be made: (1) Participants will be more carefully screened to ensure their understanding of the work involved and the viability of their program ideas. This task will not be as widely delegated to Committee members but will be done by one or two of the course designers. The large time commitment will be stressed. Preworkshop orientation sessions may assist in giving participants realistic expectations. (2) A second needs assessment session will be added to increase this topic coverage to 6 h. Participants need more feedback on the findings of their assessments. They also need help in transferring the findings from their assessments to an educational protocol. (3) A sixth session will be added after 4-6 months to evaluate the results of implementation and to give participants reinforcement for their efforts. Thus, the entire program, although only 18 h long, will be given over a period of 1 year. In conclusion, it is our hope that our experiences at the Palo Alto Veterans Administration Medical Center will be useful to others. The integration of staff education and program planning has the potential to be a strong force for change. REFERENCES 1 Mica PR. Developing Your Community-Based Organization. Oakland, CA: Third Party Publishing Co., 1981. 2 Ross MG. Community Organization 2nd edn, Harper & Row, 1967. 3 de Torney R, Thompson MA. Strategies for Teaching Nursing, New York: 2nd edn, John Wiley and Sons, 1982. 4 Squyres WD. Patient Education and Health Promotion In Medical Care. Palo Alto, CA: Mayfield Publishing Co., 1985. 5 Prentice ED, Metcalf WK. A Teaching Workshop for Medical Educators. J Med Educ 1974; 49: 1031-1034. 6 Wolle JM. Multidisciplinary teams develop programming for patient education. Health Serv Rep 1974; 89: B-12.
291-298
291
Preparation for Practice A MULTIDISCIPLINARY PATIENT EDUCATION WORKSHOP INTEGRATE STAFF TRAINING WITH PROGRAM DEVELOPMENT
TO
KAREN M. BERMANa, SUSAN MENDOZAb and KATE LORIGC bNursing Service for Education, Veterans Administration Medical Center, Sheridan aMental Hygiene Clinic, Veterans Administration Medical Center, Palo Alto and ‘Stanford Arthritis Center, Stanford University, Stanford, CA (U.S.A.)
WY,
(Received September 23rd, 1985) (Accepted February 2&h, 1986)
ABSTRACT
A four session multidisciplinary workshop was held to teach Veterans Administration (VA) Medical Center staff basic patient education design principles. During the sessions, staff, working in teams, designed patient education programs on a wide variety of health care topics. Guidance to teams was provided at each step of program development so that at the end of the workshop, programs were ready for implementation. Medical Center standards for patient education and documentation were integrated into program designs. Key words: training
Professional
education
-
Veterans
administration
-
Staff
BACKGROUND
The VA Medical Center at Palo Alto, CA, over the past several years, has taken steps to improve the quantity and quality of its patient education activities. The Medical Center consists of two divisions located 7 miles apart. Together, the two divisions contain 1,500 inpatient beds and large outpatient facilities. The medical center has, in addition to general medical and psychiatric care, a kidney dialysis unit, a spinal cord injury unit, a blind rehabilitation center, a geriatric center, a go-bed Vietnam veterans program, five inpatient substance abuse units and a spectrum of programs for medical and psychiatric rehabilitation. 0738-3991/86/$03.50 o 1986 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
292
The Medical Center does not have a Patient Health Education Coordinator. As part of its effort to improve patient education, the Medical Center formed a multidisciplinary Patient Education Committee, administratively responsible to the Chief of Staff through the Associate Chief of Staff for Education. The Committee is charged with developing and coordinating patient health education. Although it has developed a set of standards for patient education programs and maintains incentives for adhering to them, the Committee has no authority to enforce its standards. This authority belongs to the individual services, such as nursing, medicine and social work, which develop their own goals and requirements and oversee their own personnel in patient education programs and activities. The Patient Education Committee concerns itself primarily with formal programs and has an interdisciplinary approach. Over the past several years, the Committee developed program standards, conducted two surveys of ongoing patient education programs and activities, supported staff education in health teaching, coordinated educational activities among professional services, and encouraged new patient education classes in needed areas. Some program gaps were identified by the Patient Education Committee. While more than 100 organized patient education activities were catalogued by the Committee’s surveys, few of these were designed or implemented using generally accepted patient education principles. Most of the teaching activities were informal, lacked a written protocol and were dependent on the good will of their designers for implementation. Problems occurred when staff members left or changed jobs. Since the activities were not institutionalized, they were discontinued when the initiators left or lost interest. A second problem was inconsistent documentation. This created difficulties for clinicians and auditors who tried to assess needs, allocate resources and evaluate ongoing activities. A first attempt to resolve these problems was a multidisciplinary 2-day workshop. This workshop focused on basic patient education skills such as needs assessments, goals and objectives, teaching methods, evaluation and documentation. The 35 participants rated this presentation very highly on post workshop evaluation forms, compared to other staff education programs that have been presented at the Medical Center. Nevertheless, the workshop resulted in few changes in patient education programs within the Medical Center. Participant interviews revealed several problems. First, there was insufficient support in some treatment units for work in the area of patient education. After the workshop, participants frequently were not able to link up with others who would help them accomplish programs. Some participants could not receive permission from supervisors to spend their time on patient education. The most often mentioned obstacle was self imposed. People did not feel justified in taking clinical time to organize new programs. Another problem was limited technical support and feedback. Although, the Patient Education Committee had a mandate to give assistance, staff did not have easy physical access to the Committee.
293
WORKSHOP
RATIONALE
AND DESIGN
Based on surveys and the feedback from previous efforts, the Patient Education Committee sought to sponsor a new staff development workshop, taught by one of the authors (K.L.). Funding was provided by the InterWest Regional Medical Educational Center of the VA. The authors decided to use a traditional community development model [ 1,2]. Patient education skills, when acquired in an academic program, are generally taught by combining didactic and field work. However, few health professionals receive formal patient education training, and most staff at the Palo Alto VA Medical Center had little of this kind of background. In the work setting, patient education skills are usually taught and supervised as part of the job of a trained patient education specialist [4-f3]. However, the majority of health care facilities do not have fulltime trained health education staff. This is the situation at the Palo Alto VA Medical Center. Thus, an adapted community development model seemed the best way to teach patient education skills in the VA Medical Center work setting. An outside expert, helped “community members” (hospital staff) meet their identified needs while learning the skills necessary to continue their development (educational) efforts. Many of the strategies for this type of training are outlined by de Torney and Thompson [ 31. The goals of the workshop were: (1) To train 15-20 VA staff in patient education program design. (2) To develop and implement 5-10 new patient education programs. The 12-h interactive workshop was presented in four 3-h sessions held 4-6 weeks apart. This timing was chosen to give participants time to implement each phase of the training before proceeding to the next phase. The first session focused on needs assessment techniques. Session 2 concentrated on writing behavioral and health status objectives. Sessions three and four dealt with implementation, including basic evaluation and documentation skills. Each team was expected to complete a needs assessment between sessions 1 and 2; to write a protocol between sessions 2 and 3; to begin program implementation between sessions 3 and 4; and to implement an evaluation after session 4. Tables I and II give details of objectives, process and content. Approximately 2 weeks after each session, participants received memos that reviewed important class decisions, reminded participants of the next assignment, and invited them to contact the instructor to discuss problems or concerns. The expanded workshop format was chosen so that participants would have time between sessions to implement their learning. Each session built on the knowledge base of the previous sessions and on the experimental learning between sessions. This helped bridge the gap between abstract learning and real world situations. Finally, the format of the workshop almost insured that upon completion, each participant or team of partici-
294 TABLE I PROGRAM
OBJECTIVES
Participants
will be able to:
Session 1 -Needs Assesement (1) Define patient education (2) Discuse three types of needs assessment (3) Define an area for patient education on their unit (4) Design a needa assessment for their unit Session II-Implementation and Evaluation (1) Define the patient education needs of the patients in their program (2) Write behavioral and health status objectives for their patient education Seseion III-Implementation and Evaluation Discuss the strengths and weaknesses of patient education protocols (1) (2) Discuss administrative and other problems encountered in implementing grams (3) Discuss the differences between process and outcome evaluation (4) Discuss the differences between quantitative and qualitative evaluation (5) Design an evaluation for their patient education program
programs
their pro-
Seesion IV- Evaluation and Documentation (1) Discuss the strengths and weaknesses of their patient education program (2) Discuss and revise evaluation plans (3) Discuss plans for implementation of patient education program on an ongoing basis
pants would have developed
and implemented
a new patient
education
program.
The workshop was structured to assist in overcoming some institutional obstacles. Because they were encouraged to attend in teams, individuals had built-in support on their clinical units. Also, the unit supervisors were made aware of the time commitments and had given formal approval for staff attendance before the workshop began. Before acceptance to the workshop, participants were screened for: (1) General awareness of patient education principles. (2) Having a specific patient education program to be designed and carried out. (3) Having the support of the other care providers in their service areas. (4) Having the support of supervisors. The screening was done through personal interviews by the workshop designers or other members of the Patient Education Committee. RESULTS
Twenty-five people attended the first session. This included eight registered nurses, four social workers, three licensed vocational nurses, one dietitian, six occupational therapists, and three recreational therapists. The group represented 13 teams. The interests of this group ranged from
295 TABLE
II
PROGRAM
CONTENT
AND PROCESS
Session I-Needs Assessment (1) Lecture/discussion on needs assessment (a) stakeholder analysis (b) belief assessment (c) questionnaire (d) modified Delphi (2) Small group discussion to determine patient education project of each group participant (3) Small group discussion to design needs assessment for each group (4) Feedback on needs assessment and planning for implementation HOMEWORK: Conduct a needs assessment and write results Session II - Goals and Objectives (1) Feedback and critique of needs assessment of objectives (2) Lecture/discussion (3) Write behavioral and health status objectives (4) Feedback on objectives on health education process (5) Lecture/discussion HOMEWORK: Write a patient education protocol Session III-Implementation and Evaluation (1) Feedback on protocol and pilot test (2) Discussion of administrative problems (3) Lecture/discussion on evaluation (4) Group work to determine evaluation criteria (5) Feedback on evaluation criteria HOMEWORK: Implement patient education
and pilot part or all of protocol
program
and write an evaluation
plan
Session IV - Evaluation and Documentation (1) Feedback on patient education program (2) Discussion and feedback of evaluation plans (3) Problem solving session
wanting to redesign the entire recreational program of an inpatient psychiatric facility to wanting to develop a high blood pressure program in an outpatient clinic. From the initial comments of the participants, it seemed that some of the projects or participants were not appropriate for the workshop. For example, one group wanted to design a behavior modification program for severely disturbed psychiatric patients. Such an effort seemed out of the realm of traditional patient education programs and beyond the skill range of the instructor. One individual wanted to teach patients how to take care of their trachiotomies at home. Unfortunately, this program was proposed by a person who came without team members and without the support of her service unit. While the program idea was excellent, it lacked support and therefore was unfeasible.
296
Of the original 25 participants, 12 completed all four sessions. These 12 people, along with some non-attending but supportive team members, designed seven programs: (1) Cardiac rehabilitation for post myocardial infarction patients Designed by two registered nurses. (2) Community living skills for psychiatric patients Designed by a registered nurse and a social worker. (3) Hypertension education for an outpatient clinic Designed primarily by a registered nurse practitioner and a dietitian. Two other team members, a psychologist and a pharmacist, did not attend the sessions but assisted in program design. (4) Community resources education for an outpatient arthritis clinic Designed by a social worker as one class given by an interdisciplinary team working in an arthritis clinic. The other team members did not attend. (5) Breast self examination Designed by a licensed vocational nurse. This was the only person who completed the workshop who did not have help from at least one other team member. (6) An information program to motivate smokers to join a stop smoking program Designed by two licensed vocational nurses. (7) Wheelchair repair for spinal cord injured patients Designed by four occupational therapists. All four attended some sessions, but only two completed all of them. One concern was the large attrition rate. Dropouts were all contacted. Reasons for non-completion fell into two major categories. The prescreening discussed above was not entirely successful. In several cases, individuals or programs were inappropriate. Secondly, some people came to the initial session not fully understanding the commitment to complete major assignments between workshop sessions. It became apparent by the second session that more time should have been allowed to teach participants how to apply the results of their needs assessments to their program designs. Several teams conducted excellent assessments, resulting in significant findings, but they ignored their findings when writing their protocols. For example, the breast self examination assessment showed that women did not know how to examine their breasts. However, the participant designing the program initially emphasized the anatomy of the breast and the cancer risk factor rather than examination techniques. EVALUATION
The workshop was evaluated in the following ways: (1) An InterWest Regional Medical Educational Center questionnaire that queried participants about whether their expectations were met, about the quality of the teaching and about the general usefulness of the workshop. (2) An
297
instrument designed by the instructor to test knowledge of the content presented and elicit suggestions for improvement of future workshops. (3) A class discussion at the end of the last session. (4) An assessment of the number and quality of the programs that have emerged from the workshop. According to these evaluation efforts, The Patient Education Committee judged the workshop a success. Six of the seven programs developed in the workshop have met the Patient Education Committee’s standards for programs, as evaluated by the Committee’s Review Section. These programs are now being taught in the following sites at the Medical Center: The cardiac care unit, a milieu therapy psychiatric unit, the medical admitting and evaluation area, the arthritis clinic, gynecology clinic and the spinal cord injury inpatient service. These six programs do not begin to meet the Medical Center’s educational needs. However, progress has been made in training clinic.al staff in the design of formal patient education programs. These programs and the staff that completed the course help provide a base from which to build. Plans are underway to repeat this workshop and to use a similar format for a teaching skills workshop. However, several modifications will be made: (1) Participants will be more carefully screened to ensure their understanding of the work involved and the viability of their program ideas. This task will not be as widely delegated to Committee members but will be done by one or two of the course designers. The large time commitment will be stressed. Preworkshop orientation sessions may assist in giving participants realistic expectations. (2) A second needs assessment session will be added to increase this topic coverage to 6 h. Participants need more feedback on the findings of their assessments. They also need help in transferring the findings from their assessments to an educational protocol. (3) A sixth session will be added after 4-6 months to evaluate the results of implementation and to give participants reinforcement for their efforts. Thus, the entire program, although only 18 h long, will be given over a period of 1 year. In conclusion, it is our hope that our experiences at the Palo Alto Veterans Administration Medical Center will be useful to others. The integration of staff education and program planning has the potential to be a strong force for change. REFERENCES 1 Mica PR. Developing Your Community-Based Organization. Oakland, CA: Third Party Publishing Co., 1981. 2 Ross MG. Community Organization 2nd edn, Harper & Row, 1967. 3 de Torney R, Thompson MA. Strategies for Teaching Nursing, New York: 2nd edn, John Wiley and Sons, 1982. 4 Squyres WD. Patient Education and Health Promotion In Medical Care. Palo Alto, CA: Mayfield Publishing Co., 1985. 5 Prentice ED, Metcalf WK. A Teaching Workshop for Medical Educators. J Med Educ 1974; 49: 1031-1034. 6 Wolle JM. Multidisciplinary teams develop programming for patient education. Health Serv Rep 1974; 89: B-12.