Health Catalyst Program Development of Health Coaching Skills in First Year Medical Students University of California, Irvine School of Medicine David Kilgore, M.D., FAAFP, Clinical Professor Family Medicine Julie Youm, Ph.D. Instructional Technologies Group Kirti Malhotra 2 nd Year Medical Student

Disclosures Nothing to disclose

UCI Health Catalyst Program Summer Internship “Healthy Living” Health Coaching Program MS 1 Academic Year –Nutrition –Exercise –MBSR (Mindfulness Based Stress Reduction Course) –Motivational Interviewing and Health Coaching

Polonsky KS. N Engl J Med 2012;367: Epidemic of Diabetes

Going Up Stream "It's not enough to pull drowning victims out of the river; we need to walk back upstream and find out who's throwing them in." Bishop V. Gene Robinson

Health and Lifestyle Behaviors

Traditional Approach

Innovations in Supporting Healthy Lifestyle Change Motivational Interviewing Health Coaching Employee Wellness Programs –RAND Study –Cost effective

Impact of Physician Lifestyle Habits on Likelihood of Patient Counseling “Compelling data exists that physicians who have healthy personal habits are more likely to encourage patients to adopt related habits” 7

Nutrition Activity Motivational Interviewing Mind-Body

Nutrition and Healthy Diet Basics macro/micro nutrients, estimating energy needs EBM info whole food diets: Mediterranean, DASH, Vegetarian Taking dietary histories Motivational Interviewing Mindful Eating Community Survey project Co-taught MD / RD

Exercise and Activity Types of exercise, EBM outcome info on exercise and health AHA/ACC recs on targets for types, duration, freq Exercise in special populations: CVD, DM, pregnancy, Elderly, Asthma Formulating Exercise Rx Experiential: stretching, strengthening, Tai Chi Co-taught MD / exercise Ph.D

Mindfulness Based Stress Reduction 8 week MBSR class Review simple breath relaxation techniques Evidence impact meditation / mindfulness on health Taught by MBSR trained MD

Motivational Interviewing Stages of Change Basic communication principles and philosophy of MI Lots of small group and paired role plays Conclude with OSCE session: lifestyle change issue Co-taught MD / Ph.D

Healthy Living (Health Coaching) Program Supplement manufacturing business near med school Each Student paired with employees to function as health coaches, focus on healthy lifestyle changes. 6 week summer program – followed by bimonthly 1:1 meetings during MS2 year until March. Summer: Weekly meetings – Alternate between –Small group interactive educational sessions –1:1 meeting: focus individual goals –Each 2 weeks had theme topic: Nutrition, Exercise, Stress mgt Faculty present for group sessions and paired 1:1 mtgs

Healthy Living Program Program continued after summer: bimonthly meetings through fall, winter to sustain healthy lifestyle changes. Information tracked on tablet computers via secure IRB approved process –Baseline / Final healthy lifestyle habits –Baseline / Final Biometrics: BP, Weight, Waist/Hip circumference –Individual Employee health goals and action plans

Health Catalyst Elective 2012 – 2013 –17 First Year Medical Students 2013 – 2014 –19 First Year Medical Students Vitatech Healthy Living Program –44 Employees –4 Health Catalysts –5 Faculty –3 Translators

Participating Employees

Number of Employees

Employee Needs Healthy ExerciseNo = 73% Healthy DietNo = 54% Manageable StressNo = 41% Alcohol6 > 2x per Week 1-5 per Day Soda7 > 5 per Week Fast Food11 > 3x per Week

Outcomes Employees –Majority embarked on sustained lifestyle changes –Formed strong connections with Health Catalyst Students supported by non-traditional communication style (Motivational Interviewing) –Employees comfortable opening up with Health Catalysts –Sustainable Lifestyle change long term process, strongly influenced by intrapersonal, family, cultural, environmental context.

Employee Outcomes

Student Impact Early exposure to practical information on nutrition, exercise, stress management skills (MBSR). Early Development of Patient-Centered (Motivational Interviewing) communication skills. Students leading related efforts –Nutrition Elective –FIT Elective –APAMSA Elective to support Asian community

Student’s Perspective

Challenges Scheduling: Students, Faculty, Employees Translation needs Funding –Initially “Dean’s special project fund” –Currently reviewing sustainable business plan, “workstudy community partnership” as employer(s) see benefit to program

Program Evolution (Fall 2014) Integrate content of elective course into core medical school curriculum over 1 st and 2 nd years. (Under discussion) Expand “workstudy” health coaching opportunities to more students during academic year.

Highlights and Caveats Positive impact on employee healthy lifestyle changes –Formed strong relationship students Effective use MI skills and wellness knowledge by students (Our opinion): this set of skills and knowledge essential to MD training for future Don’t underestimate logistical support needs Affirm at least 6-9 months coaching support to sustain lifestyle changes Importance of employer leadership support

Questions?

Contact Information David Kilgore, M.D. (714) Julie Youm, Ph.D (949)