Win-Win: Student Health Coaching for Early Workplace Learning February 7 th, 2015 Paul Marcus, MD; Christina Cicoletti, MNA; Jennifer Crawford, MPH; Margaret McNamara, MD; and Margo Vener, MD, MPH The University of California at San Francisco

Disclosures No financial conflicts of interest to disclose UCSF IRB approval obtained

Objectives Upon completion of this session, participants should be able to describe: How health coaching offers potential benefit as an early workplace learning experience for students Two potential roles that first-year students can perform as health coaches in a family health center One benefit and one challenge of having first-year students work as health coaches in a family health center

Given time constraints, the evidence supporting the efficacy of health coaching will not be discussed in this talk Supporting literature is listed at the end of the presentation

Background

Key Aspects of Workplace Learning 1.Preparation 2.Real-time workplace support 3.Reflection and feedback Get buy-in from faculty, residents, support staff and administrators Determine knowledge and skills required Orientation Didactics Simulations Decide number of sessions and if student responsibilities will progress Adapted from: *Billet, Stephen. “Guidelines for practice: Integrating practice-based experiences. ALTC *O’Brien, Bridget; et. al. Clinical Microsystems Experiences. UC San Francisco

Key Aspects of Workplace Learning 1.Preparation 2.Real-time workplace support 3.Reflection and feedback Monitor students’ experiences Designate students’ backup Encourage peer to peer interaction Ensure students’ knowledge base and general support is sufficient

Key Aspects of Workplace Learning 1.Preparation 2.Real-time workplace support 3.Reflection and feedback Employ focus groups, critical reflection exercises and surveys Ensure all site participants are incorporated Link students’ experiences with applicability to their future careers

Methods

Student Health Coaching Goal To help patients gain the knowledge, skills, tools, and confidence to become active participants in their care so that they can reach their self- identified health goals

Methods In , all first year UCSF medical students (n=154) trained as health coaches Students were instructed to apply health coaching activities in their regular clinical preceptorships Training consisted of a four hour workshop and a two hour booster session A subset of students (n=12) chose a selective to work as health coaches in a busy, urban, county Family Medicine resident continuity clinic

Health Coaching Procedure Students paired with a family medicine resident and observed the resident perform the initial patient history and physical exam Students then consulted with the resident to decide on an appropriate health coaching topic Diet, exercise, diabetes education, smoking cessation, etc. While the resident was out of the room presenting to a preceptor, the student discussed the health coaching topic with the patient When the resident and preceptor returned, the student updated them on action plans made and additional history obtained

Curriculum Evaluation Health coaching course (n=154) Surveys for all medical students completing the course Selective (n = 12) Pre and post curriculum surveys and open-ended written questions given to medical students, residents and attendings Formal focus group with the medical students After each clinic, “debriefing” held for the medical students Discussed cases and answered students’ questions Informal and confidential Proctored by a physician

Results

Opinions of Class-Wide Health Coaching Curriculum Students (n= 154) Rated the workshop as valuable to their education 3.90 (0.87) Believed that health coaching is a valuable clinical skill for working with patients 4.43 (0.68) 5-point Likert scales: 1= strongly disagree, 5=strongly agree

Focus group themes - independently coded by two physicians: 1. Medical students learning initiative and confidence “Our knowledge base grows so much from one month to the next … every time you go back you are aware of a new organ system and it is like seeing everything in a new light.” “I learned to push a little harder to see if there is an issue to talk about even though I am usually pretty passive.” 2. Residents as teachers “I was shocked at how much [the residents] make time to talk to us.” “The most positive aspect of the selective has been the residents.” 3. Medical students “adding value” “[This selective] was one of those times you actually got to make a small difference.” “Just having more people there to spend time with patients makes [the patients] feel they are not just on a ‘conveyor belt’ and that I am making a positive contribution.”

Discussion

Challenges and Barriers Finding time and space to perform health coaching Coordinating schedules to create continuity Ensuring all team members know student roles and capabilities Unfamiliarity with translation services Knowledge gaps given structure of first year curriculum Selection bias and small sample size of selective group may limit generalizability

Next Steps Alumni to do peer to peer teaching New system for phone follow-up Using patient health education materials for student education Adjusting student schedules to preserve continuity Obtain the patient perspective Track long-term effects on primary care residency interest for participating students Assess for applicability to inpatient settings

Conclusion

Workplace learning health coaching experiences allow students early direct clinical exposure and the opportunity to “make a difference” for patients Selective offers “hands on” experience, yet students who only did the health coach workshop still found it valuable Selective students felt being a health coach provides meaningful roles in patient care and “adds value” to the healthcare team Attendings and residents felt health coaches help discuss health related behaviors with patients Residents enjoyed their teaching roles Primary barriers to optimal implementation are logistical

References 1.Bennett, Heather; et. al. The effectiveness of health coaching, home blood pressure monitoring, and home-titration in controlling hypertension among low- income patients: protocol for a randomized controlled trial. BMC Public Health 2009, 9:456 doi: / Billett, Stephen. "Guidelines for practice: Integrating practice-based experiences." Australian Learning and Teaching Council Bodenheimer, Tom. Training curriculum for health coaches. UCSF Center for Excellence in Primary Care. May Laing, Brian; et. al. Introducing the “Teamlet”: Initiating a Primary Care Innovation at San Francisco General Hospital. The Permanente Journal. Spring Volume 12 No O’Brien, Bridget; et. al. Clinical Microsystems Experiences. UC San Francisco Wagner, Peggy J; et. al. Medical Students as Health Coaches. Academic Medicine: November Volume 77, Issue 11, p 1164–1165.

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