1. Group Medical Visits: Training Medical Students to Become Part of the Group Visit Team Maureen Gecht-Silver, OTR/L, MPH Susan Buchanan, MD, MPH Department of Family Medicine University of Illinois at Chicago

2. Objectives Increase participants’ understanding of how to integrate students into medical groups visits Increase participants’ ability to teach students patient-physician collaboration and patient self-management approaches Increase participants’ ability to teach students to follow-up with patients after group visits

3. Why Include Medical Students in Group Visits ? Learn about patient-physician collaboration and self-management approaches Opportunity to experience new care delivery model

4. Medical Student Training Program--Objectives Participate interactively Formulate a personal action plan Use a non-judgmental, non-blaming approach Be a team member Coach patients over the phone Learn skills to support patient self- management in 1:1 encounters

5. Medical Student Training Program--Process M3 clerkship students at our clinic (OCC) 2 to 4 Students per Block 2 hour meeting one week prior to visit ½ hour meeting before group visit ½ hour debrief one week after group visit

6. Orienting Students to Group Medical Visits

7. What Is a Group Medical Visit? CHCC – Cooperative Health Care Clinics Same group of participants at each visit Focus on one disease or health topic DIGMA – Drop-In Group Medical Appointments For non-infectious acute conditions Follow-up of chronic conditions UIC Group Medical Visit combines elements of both

8. Group Visits at UIC Started one year ago Hypertension Once-a-month One doctor, one health educator, medical students Still working to improve the system

9. Chronic Conditions Appropriate to Group Visit Care Obesity Diabetes Hypertension Cardiac disease Asthma Depression

10. Why Do Group Medical Visits?

11. Benefits to Physicians Less repetition Increase productivity Increase satisfaction

12. Benefits for Patients Increase access to care Increase satisfaction Increase adherence to treatment plan More time with the physician Support from other patients Help from the entire health care team

13. Efficacy of Group Visits 321 patients with chronic illness (Kaiser Permanente) Fewer ED visits Fewer subspecialty visits Fewer repeat admissions Fewer phone calls Greater satisfaction Beck A, Scott J,William P, et al. Randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic. J AM Geri Soc. 1997;45: 543-549

14. Group Visits for Diabetes 32% reduction in total chol/HDL ratio 30% drop in HgbA1c 7% reduction in health care expenses Masley S, Sokoloff J, Hawes C. Planning group visit for high-risk patients. Fam Pract Manage. June 2000: 33-37.

15. Self-management: Background Lorig 6-week CDSMP with lay leaders Action planning and problem-solving key elements Bodenheimer Advocates physicians use self-management approach over traditional Wagner Chronic Disease Model Advocates planned system approach to Chronic Illness Care One key component is self-management support

16. What Does a Collaborative Self-Management Approach Look Like… Patient-centered, whole person care Partnership between patients and health care team Focus on healthy lifestyles Action planning Problem-solving Resource utilization Follow-up

17. A Collaborative Self-Management Approach Fosters Self-Efficacy

18. Strategies to Engage Medical Students in Using A Self- Management Approach

19. Introducing Students to Action Planning

20. Planning for the Group Visit Walk Through the “Road Map” Preparation Take vitals 1:1 encounter Questions and discussion Inquire about past action plans Activity Set new action plans Role play follow-up

21. Summary of Students’ Role Greet patients and take vitals Participate with MD in 1:1 Work with patients along with health educator Actively participate in answering patients’ questions Discuss progress with action plan from 1 week ago (if desired) Set new action plan Role play follow-up phone call

22. Preparing the Students for Follow-Up with Patients After the Group Visit

23. Training Materials Provided to Students JNC 7 express guidelines Exercise and hypertension Dash diet Getting it right: why bother with patient-centered care? Making group visits work Living a healthy life with chronic conditions Pedometers (optional) Relaxation tapes (optional)

24. Debriefing Session One week after the group visit Review experiences with follow-up phone calls Discuss impressions of group visits

25. Future Directions Increase opportunities for medical students to practice self-management skills Integrate the group visit into usual care Formal evaluation Quantitative investigation of health outcomes Expand to include more medical students

26. Patient Comments About Students in Our Group Visits “They are nice and seem to know what they were doing” “Followed up on my action plan to not eat potato chips….., this helped me stay with my plan” “It’s important for students to listen to patients who are proactive in their own care” “I like having them in the group visit—they’re cute” “They’re great! It adds more life to the group, we see doctors as individuals too.”

27. Student Comments About The Group Visit Experience “This program was a great experience” “ I liked the peer pressure incentive” “I liked the action plans” “Shouldn’t replace 1:1 visits with the doctor” “Gives a different view of family medicine” “The group visit gives patients more opportunities to have their questions answered.” “This interaction creates a warm environment…”

28. Student Surprises… “I didn’t think participating in the group visits was something I wanted to do, but I saw it was helpful to patients and doctors.” “I was surprised that the patients were so cooperative—everyone was supportive to each other.” “The patients opened up more than they would have with an attending.”

29. Evidence of Impact on Students’ Attitudes and Behavior “Now I am asking patients to keep a log.” “[I enjoyed the group sessions], for the past few weeks I’ve been exercising fairly regularly— motivated largely by my 6 weeks spent in Family Medicine” “After calling the patient I was assigned to, I realized that the patient was more comfortable adhering to the goal since it was self-created.” “I am going to teach my brother to use action plans” “I am using action planning with my patients and finding it very helpful”

30. Contact Information UIC Family Medicine, 1919 W. Taylor M/C 663 Chicago, IL 60612 Maureen Gecht-Silver 312-996-0136 e-mail: mgecht@uic.edumgecht@uic.edu Dr. Susan Buchanan 312-996-0806 e-mail: sbucha3@uic.edu

31. Questions?