Introduction to Self-Management Support: Encouraging Patients to Manage their Health Maureen Gecht-Silver OTR/L, MPH UIC Department of Family Medicine STFM Medical Education Conference Long Beach, California February 4, 2012

Objectives for this Session After this session, peers will be better able to: State effective approaches for teaching self-management support skills Recognize the value of motivational interviewing and action planning Appreciate distinctions between behaviors that promote and deter collaboration

Background: Chronic Health Conditions Affects 45% US population; incidence increasing Modifiable lifestyle behaviors prevent and improve health/disease management Patients benefit from support to self-manage conditions Advice alone is insufficient; approach matters

Statement of the Problem Future physicians receive inadequate training in collaborative approaches to facilitate lifestyle modification Recent M3 curricular interventions Outcome: behavior change skills are teachable Rotations: psychiatry, internal, and family medicine Time Frame: two-hour program to one-month course Content: lecture/discussion and experiential activities Expense: additional expenses, training, coordination Resident training program based on Chronic Care Model White et al. Teaching students behavior change skills: description and assessment of a new MI curriculum (2007); Martino et al Teaching motivational interviewing to year three medical students. (2007); Moser et al. Teaching behavior change concepts and skills during the third-Year medicine clerkship. (2009); Abramowitz et al Linking a MI curriculum to the chronic care model (2010)

Introduction to Self-Management Support Selective (SMS) M3 selective during family medicine clerkship Two 2-hour sessions plus readings & assignment Focus on building self-management support skills to increase collaborative care Key elements Lecture/discussion Modeling: training videotapes and instructor Experiential learning: skills & case-based practice Homework assignment

Aim of Study Evaluate the impact of the program on third year medical student’s: Attitudes: confidence, importance, commitment Knowledge: self-management support Performance skills MI: improve collaboration

Methods Subjects: M3 students assigned to SMS selective; informed consent obtained Evaluation: Pre-test/Post-test design Pre-test at beginning of session 1 Post-test at end of session 2 Data Analysis: Paired t-test

Evaluation Tools Attitudes Assessment Knowledge Test Variables: confidence, importance and commitment 0-10 point Visual Analogue Scale (VAS) Knowledge Test 12 question multiple choice test Video Assessment of Simulated Encounters-Revised (VASE-R) 18-item instrument, 3 video-based vignettes Questions prompt responses scored against MI standards Allows standardized group administration Sensitive to skill improvement Concurrent validity with HRQ and MITI

Confidence

Importance

Commitment

Student Comments Pre-Test “I’m excited to learn new skills and put them into practice” “I am confident I can acquire the skills yet worried I have become too impatient or less understanding” “I don’t feel very confident about talking to patients about behavior changes…; I want to learn how to communicate quickly and in an efficient manner” “I feel I definitely need to improve in my self- management approaches”

Student Comments Post-Test “I learned specific strategies to use to help patients” “ More motivated to use techniques that I have learned and also understand that it’s a long process” “ Since I’ve had the opportunity to better understand SM and how effective it is, I feel my skills level has improved” “Feel more confident about using MI techniques after these two sessions” “I will be more confident and willing to perform these techniques in the future” “Learned new skills”

Knowledge

VASE-R Subtest 1

Summary Topic perceived as important and relevant to M3 students Practical to include in didactic sessions during M3 clerkship in Family Medicine Short, low-budget program Trend toward strong significance in several key variables

Funding Initial development of this program was partially supported by grants from HRSA IDPH

Contact Information Maureen Gecht-Silver UIC Family Medicine 1919 W. Taylor M/C 663 Chicago, IL 60612 312-996-0136 mgecht@uic.edu