Teaching undergraduate medical students how to communicate with vaccine-hesitant patients: A scoping review



vaccine hesitancy, undergraduate medical education, curriculum, teaching


Introduction: Vaccine hesitancy poses a challenge to healthcare professionals. Prior to graduation, medical students may not be fully equipped with the knowledge or skills to manage interactions with vaccine-hesitant patients. The aim of this scoping review was to identify and evaluate the characteristics of educational interventions that improve medical students’ skills in communicating with vaccine-hesitant patients.

Methods: EMBASE, OVID Medline, CINAHL, and ERIC databases were searched with keywords related to “vaccine hesitancy” and “undergraduate medical education”. One hundred and fourteen primary studies were identified, and seven articles were included for review. Data extraction included the characteristics of educational interventions, such as the modality, duration, frequency and assessment methods.

Results: There is limited literature describing educational interventions that help medical students develop skills to effectively with vaccine-hesitant patients. This makes it difficult to draw conclusions on the effectiveness of different pedagogical approaches. Although the included studies generally reported an increase in student self-reported confidence to communicate with vaccine-hesitant patients, none assessed whether the interventions led to changes in student clinical practice or improvements in patient outcomes.

Conclusion: Additional research into the identification of educational interventions that establish persistent changes in students’ knowledge, attitudes and skills to communicate with vaccine-hesitant patients is required. An evidence-based medicine component of an education program, which can adapt to evolving contributors to vaccine hesitancy and the variety of concerns across different vaccines, may present a potential solution. Educators would be better directed with further research that aligns health outcomes with teaching, assessment and evaluation of a proposed vaccine-hesitancy curriculum.


Afonso, N., Kavanagh, M., & Swanberg, S. (2014). Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention. Vaccine, 32(4), 502–506. https://doi.org/10.1016/j.vaccine.2013.11.043

Afonso, N. M., Kavanagh, M. J., Swanberg, S. M., Schulte, J. M., Wunderlich, T., & Lucia, V. C. (2017). Will they lead by example? Assessment of vaccination rates and attitudes to human papilloma virus in millennial medical students. BMC Public Health, 17(1), Article 35. https://doi.org/10.1186/s12889-016-3969-x

Baessler, F., Zafar, A., Mengler, K., Natus, R. N., Dutt, A. J., Kuhlmann, M., Çinkaya, E., & Hennes, S. (2022). A needs-based analysis of teaching on vaccinations and COVID-19 in German medical schools. Vaccines, 10(6), Article 975. https://doi.org/10.3390/vaccines10060975

Bahethi, R. R., Liu, B. Y., Asriel, B., Blum, J. R., Huxley-Reicher, Z., Agathis, A. Z., Pathak, S., Sainte Willis, M., & Muller, D. (2021). The COVID-19 student workforce at the Icahn School of Medicine at Mount Sinai: A model for rapid response in emergency preparedness. Academic Medicine, 96(6), 859–863. https://doi.org/10.1097/ACM.0000000000003863

Bates, R. (2004). A critical analysis of evaluation practice: The Kirkpatrick model and the principle of beneficence. Evaluation and Program Planning, 27(3), 341–347. https://doi.org/10.1016/j.evalprogplan.2004.04.011

Bechini, A., Moscadelli, A., Sartor, G., Shtylla, J., Guelfi, M. R., Bonanni, P., & Boccalini, S. (2019). Impact assessment of an educational course on vaccinations in a population of medical students. Journal of Preventive Medicine and Hygiene, 60(3), E171–E177. https://doi.org/10.15167/2421-4248/jpmh2019.60.3.1201

Bolsen, T., & Palm, R. (2022). Chapter five: Politicization and COVID-19 vaccine resistance in the U.S. In T. Bolsen & R. Palm (Eds.), Progress in molecular biology and translational science (Vol. 188, pp. 81–100). Academic Press. https://doi.org/10.1016/bs.pmbts.2021.10.002

Bralic, I., & Pivalica, K. (2019). The undergraduate education about vaccination and vaccine hesitancy. Archives of Disease in Childhood, 104(Suppl. 3), A301–A302. https://doi.org/10.1136/archdischild-2019-epa.709

Burki, T. (2020). The online anti-vaccine movement in the age of COVID-19. The Lancet Digital Health, 2(10), e504–e505. https://doi.org/10.1016/S2589-7500(20)30227-2

Caruso Brown, A. E., Suryadevara, M., Welch, T. R., & Botash, A. S. (2017). "Being persistent without being pushy": Student reflections on vaccine hesitancy. Narrative Inquiry in Bioethics, 7(1), 59–70. https://doi.org/10.1353/nib.2017.0018

Coleman, A., & Lehman, D. (2017). A flipped classroom and case-based curriculum to prepare medical students for vaccine-related conversations with parents. MedEdPORTAL, 13, Article 10582. https://doi.org/10.15766/mep_2374-8265.10582

D’Urzo, K. A., Flood, S. M., Baillie, C., Skelding, S., Dobrowolski, S., Houlden, R. L., & Tomasone, J. R. (2020). Evaluating the implementation and impact of a motivational interviewing workshop on medical student knowledge and social cognitions towards counseling patients on lifestyle behaviors. Teaching and Learning in Medicine, 32(2), 218–230. https://doi.org/10.1080/10401334.2019.1681273

de Albuquerque Veloso Machado, M., Roberts, B., Wong, B. L. H., van Kessel, R., & Mossialos, E. (2021). The relationship between the COVID-19 pandemic and vaccine hesitancy: A scoping review of literature until August 2021. Frontiers in Public Health, 9, Article 747787. https://www.frontiersin.org/articles/10.3389/fpubh.2021.747787

Dempsey, A. F., Pyrznawoski, J., Lockhart, S., Barnard, J., Campagna, E. J., Garrett, K., Fisher, A., Dickinson, L. M., & O’Leary, S. T. (2018). Effect of a health care professional communication training intervention on adolescent human papillomavirus vaccination: A cluster randomized clinical trial. JAMA Pediatrics, 172(5), Article e180016. https://doi.org/10.1001/jamapediatrics.2018.0016

Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., & Bettinger, J. A. (2013). Vaccine hesitancy. Human Vaccines & Immunotherapeutics, 9(8), 1763–1773. https://doi.org/10.4161/hv.24657

Dybsand, L. L., Hall, K. J., & Carson, P. J. (2019). Immunization attitudes, opinions, and knowledge of healthcare professional students at two Midwestern universities in the United States. BMC Medical Education, 19(1), Article 242. https://doi.org/10.1186/s12909-019-1678-8

Edwards, E. J., Arora, B., Green, P., Bannatyne, A. J., & Nielson, T. (2022). Teaching brief motivational interviewing to medical students using a pedagogical framework. Patient Education and Counseling, 105(7), 2315–2319. https://doi.org/10.1016/j.pec.2022.01.012

Haldane, V., De Foo, C., Abdalla, S. M., Jung, A.-S., Tan, M., Wu, S., Chua, A., Verma, M., Shrestha, P., Singh, S., Perez, T., Tan, S. M., Bartos, M., Mabuchi, S., Bonk, M., McNab, C., Werner, G. K., Panjabi, R., Nordström, A., & Legido-Quigley, H. (2021). Health systems resilience in managing the COVID-19 pandemic: Lessons from 28 countries. Nature Medicine, 27(6), 964–980. https://doi.org/10.1038/s41591-021-01381-y

Jacobs, N. N., Calvo, L., Dieringer, A., Hall, A., & Danko, R. (2021). Motivational interviewing training: A case-based curriculum for preclinical medical students. MedEdPORTAL, 17, Article 11104. https://doi.org/10.15766/mep_2374-8265.11104

Kaye, A. D., Okeagu, C. N., Pham, A. D., Silva, R. A., Hurley, J. J., Arron, B. L., Sarfraz, N., Lee, H. N., Ghali, G. E., Gamble, J. W., Liu, H., Urman, R. D., & Cornett, E. M. (2021). Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Practice & Research Clinical Anaesthesiology, 35(3), 293–306. https://doi.org/10.1016/j.bpa.2020.11.009

Kelekar, A., Rubino, I., Kavanagh, M., Lewis-Bedz, R., LeClerc, G., Pedell, L., & Afonso, N. (2022). Vaccine hesitancy counseling: An educational intervention to teach a critical skill to preclinical medical students. Medical Science Educator, 32(1), 141–147. https://doi.org/10.1007/s40670-021-01495-5

Kernéis, S., Jacquet, C., Bannay, A., May, T., Launay, O., Verger, P., Pulcini, C., Abgueguen, P., Ansart, S., Bani-Sadr, F., Bannay, A., Bernard, L., Botelho-Nevers, E., Boutoille, D., Cassir, N., Cazanave, C., Demonchy, E., Epaulard, O., Etienne, M., . . . Wyplosz, B. (2017). Vaccine education of medical students: A nationwide cross-sectional survey. American Journal of Preventive Medicine, 53(3), e97–e104. https://doi.org/10.1016/j.amepre.2017.01.014

Khamees, D., Brown, C. A., Arribas, M., Murphey, A. C., Haas, M. R. C., & House, J. B. (2020). In crisis: Medical students in the COVID-19 pandemic. AEM Education and Training, 4(3), 284–290. https://doi.org/10.1002/aet2.10450

Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick's four levels of training evaluation. Association for Talent Development.

Koski, K., Lehto, J. T., & Hakkarainen, K. (2018). Simulated encounters with vaccine-hesitant parents: Arts-based video scenario and a writing exercise. Journal of Medical Education and Curricular Development, 5. https://doi.org/10.1177/2382120518790257

Kumar, D., Chandra, R., Mathur, M., Samdariya, S., & Kapoor, N. (2016). Vaccine hesitancy: Understanding better to address better. Israel Journal of Health Policy Research, 5(1), Article 2. https://doi.org/10.1186/s13584-016-0062-y

Lambert, P. H., & Podda, A. (2018). Education in vaccinology: An important tool for strengthening global health. Frontiers in Immunology, 9, Article 1134. https://doi.org/10.3389/fimmu.2018.01134

Lau, M., Lin, H., & Flores, G. (2012). Factors associated with human papillomavirus vaccine-series initiation and healthcare provider recommendation in US adolescent females: 2007 national survey of children's health. Vaccine, 30(20), 3112–3118. https://doi.org/10.1016/j.vaccine.2012.02.034

Lepiller, Q., Bouiller, K., Slekovec, C., Millot, D., Mazué, N., Pourchet, V., Balice, R., Garrien-Maire, F., Simon, E., Wintenberger, V., Guillaume, A., Monaton, M.-F., Van Eis, B., Bertrand, X., Bennabi, D., Moulin, T., Anxionnat, R., & Nerich, V. (2020). Perceptions of French healthcare students of vaccines and the impact of conducting an intervention in health promotion. Vaccine, 38(43), 6794–6799. https://doi.org/10.1016/j.vaccine.2020.08.036

MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036

Marotta, C., Raia, D. D., Ventura, G., Casuccio, N., Dieli, F., D'Angelo, C., Restivo, V., Costantino, C., Vitale, F., & Casuccio, A. (2017). Improvement in vaccination knowledge among health students following an integrated extra curricular intervention: An explorative study in the University of Palermo. Journal of Preventive Medicine and Hygiene, 58(2), E93–E98.

Miller, D. G., Pierson, L., & Doernberg, S. (2020). The role of medical students during the COVID-19 pandemic. Annals of Internal Medicine, 173(2), 145–146. https://doi.org/10.7326/M20-1281

Morhardt, T., McCormack, K., Cardenas, V., Zank, J., Wolff, M., & Burrows, H. (2016). Vaccine curriculum to engage vaccine-hesitant families: Didactics and communication techniques with simulated patient encounter. MedEdPORTAL, 12, Article 10400. https://doi.org/10.15766/mep_2374-8265.10400

Moss, J. L., Reiter, P. L., Rimer, B. K., & Brewer, N. T. (2016). Collaborative patient–provider communication and uptake of adolescent vaccines. Social Science & Medicine, 159, 100–107. https://doi.org/10.1016/j.socscimed.2016.04.030

Onello, E., Friedrichsen, S., Krafts, K., Simmons, G., & Diebel, K. (2020). First year allopathic medical student attitudes about vaccination and vaccine hesitancy. Vaccine, 38(4), 808–814. https://doi.org/10.1016/j.vaccine.2019.10.094

Pahud, B., Elizabeth Williams, S., Lee, B. R., Lewis, K. O., Middleton, D. B., Clark, S., & Humiston, S. G. (2020). A randomized controlled trial of an online immunization curriculum. Vaccine, 38(46), 7299–7307. https://doi.org/10.1016/j.vaccine.2020.09.043

Pelly, L. P., Pierrynowski MacDougall, D. M., Halperin, B. A., Strang, R. A., Bowles, S. K., Baxendale, D. M., & McNeil, S. A. (2010). The Vaxed project: An assessment of immunization education in Canadian health professional programs. BMC Medical Education, 10(1), Article 86. https://doi.org/10.1186/1472-6920-10-86

Phiri, P., Ramakrishnan, R., Rathod, S., Elliot, K., Thayanandan, T., Sandle, N., Haque, N., Chau, S. W. H., Wong, O. W. H., Chan, S. S. M., Wong, E. K. Y., Raymont, V., Au-Yeung, S. K., Kingdon, D., & Delanerolle, G. (2021). An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. eClinicalMedicine, 34, Article 100806. https://doi.org/10.1016/j.eclinm.2021.100806

Purkabiri, K., Steppacher, V., Bernardy, K., Karl, N., Vedder, V., Borgmann, M., Rogausch, A., Stammberger, U., Bals, R., Raupach, T., Koellner, V., & Hamacher, J. (2016). Outcome of a four-hour smoking cessation counselling workshop for medical students. Tobacco Induced Diseases, 14(1), Article 37. https://doi.org/10.1186/s12971-016-0103-x

Ragsdale, J., Berry, A., Gibson, J., Herber-Valdez, C., Germain, L., & Engle, D. (2020). Evaluating the effectiveness of undergraduate clinical education programs. Medical Education Online, 25(1), Article 1757883. https://doi.org/10.1080/10872981.2020.1757883

Rasmussen, S., Sperling, P., Poulsen, M. S., Emmersen, J., & Andersen, S. (2020). Medical students for health-care staff shortages during the COVID-19 pandemic. The Lancet, 395(10234), e79–e80. https://doi.org/10.1016/S0140-6736(20)30923-5

Real, F. J., DeBlasio, D., Beck, A. F., Ollberding, N. J., Davis, D., Cruse, B., Samaan, Z., McLinden, D., & Klein, M. D. (2017). A virtual reality curriculum for pediatric residents decreases rates of influenza vaccine refusal. Academic Pediatrics, 17(4), 431–435. https://doi.org/10.1016/j.acap.2017.01.010

Riedel, S. (2005). Edward Jenner and the history of smallpox and vaccination. Baylor University Medical Center Proceedings, 18(1), 21–25. https://doi.org/10.1080/08998280.2005.11928028

Rosenthal, S. L., Weiss, T. W., Zimet, G. D., Ma, L., Good, M. B., & Vichnin, M. D. (2011). Predictors of HPV vaccine uptake among women aged 19–26: Importance of a physician's recommendation. Vaccine, 29(5), 890–895. https://doi.org/10.1016/j.vaccine.2009.12.063

Schnaith, A. M., Evans, E. M., Vogt, C., Tinsay, A. M., Schmidt, T. E., Tessier, K. M., & Erickson, B. K. (2018). An innovative medical school curriculum to address human papillomavirus vaccine hesitancy. Vaccine, 36(26), 3830–3835. https://doi.org/10.1016/j.vaccine.2018.05.014

Smith, P. J., Kennedy, A. M., Wooten, K., Gust, D. A., & Pickering, L. K. (2006). Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics, 118(5), e1287–e1292. https://doi.org/10.1542/peds.2006-0923

Soled, D., Goel, S., Barry, D., Erfani, P., Joseph, N., Kochis, M., Uppal, N., Velasquez, D., Vora, K., & Scott, K. W. (2020). Medical student mobilization during a crisis: Lessons from a COVID-19 medical student response team. Academic Medicine, 95(9), 1384–1387. https://doi.org/10.1097/ACM.0000000000003401

Stachteas, P., Vlachopoulos, N., & Smyrnakis, E. (2021). Deploying medical students during the COVID-19 pandemic. Medical Science Educator, 31(6), 2049–2053. https://doi.org/10.1007/s40670-021-01393-w

Tessema, G. A., Kinfu, Y., Dachew, B. A., Tesema, A. G., Assefa, Y., Alene, K. A., Aregay, A. F., Ayalew, M. B., Bezabhe, W. M., Bali, A. G., Dadi, A. F., Duko, B., Erku, D., Gebrekidan, K., Gebremariam, K. T., Gebremichael, L. G., Gebreyohannes, E. A., Gelaw, Y. A., Gesesew, H. A., . . . Tesfay, F. H. (2021). The COVID-19 pandemic and healthcare systems in Africa: A scoping review of preparedness, impact and response. BMJ Global Health, 6(12), Article e007179. https://doi.org/10.1136/bmjgh-2021-007179

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., . . . Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850

Vorsters, A., Bonanni, P., Maltezou, H. C., Yarwood, J., Brewer, N. T., Bosch, F. X., Hanley, S., Cameron, R., Franco, E. L., Arbyn, M., Munoz, N., Kojouharova, M., Pattyn, J., Baay, M., Karafillakis, E., & Van Damme, P. (2019). The role of healthcare providers in HPV vaccination programs: A meeting report. Papillomavirus Research, 8, Article 100183. https://doi.org/10.1016/j.pvr.2019.100183

Vorsters, A., Tack, S., Hendrickx, G., Vladimirova, N., Bonanni, P., Pistol, A., Metličar, T., Pasquin, M. J. A., Mayer, M. A., Aronsson, B., Heijbel, H., & Van Damme, P. (2010). A summer school on vaccinology: Responding to identified gaps in pre-service immunisation training of future health care workers. Vaccine, 28(9), 2053–2059. https://doi.org/10.1016/j.vaccine.2009.12.033

White, L. L., Gazewood, J. D., & Mounsey, A. L. (2007). Teaching students behavior change skills: Description and assessment of a new motivational interviewing curriculum. Medical Teacher, 29(4), e67–e71. https://doi.org/10.1080/01421590601032443

Ylitalo, K. R., Lee, H., & Mehta, N. K. (2012). Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US national immunization survey. American Journal of Public Health, 103(1), 164–169. https://doi.org/10.2105/AJPH.2011.300600




How to Cite

Bilszta, J., & Nguyen, E. (2023). Teaching undergraduate medical students how to communicate with vaccine-hesitant patients: A scoping review. Focus on Health Professional Education: A Multi-Professional Journal, 24(4), 1–23. Retrieved from https://fohpe.org/FoHPE/article/view/694