1. 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

2. 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

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. Confidence

10. Importance

11. Commitment

12. 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”

13. 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”

14. Knowledge

15. VASE-R Subtest 1

16. 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

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

18. Contact Information
Maureen Gecht-Silver UIC Family Medicine 1919 W. Taylor M/C 663 Chicago, IL