1. Instituting A Required Health Promotion Rotation In A Family Medicine Residency Janeen Drazdik, David Eberlein, Stephen Flynn, Eileen Garven, Fred Jorgensen, Robert Kelly, Sandra Olsen, Virginia Simons, and Carl Tyler Fairview Hospital / Cleveland Clinic Family Medicine Residency Program

2. Why? Outcome of strategic planning
FFM - FP’s seen as expected to be “good at” health promotion
Faculty saw need to improve resident skills
Focus on key health risk areas for Healthy People 2010 goals

3. How? One-month required rotation in the second year of training
Curriculum jointly planned by resident / faculty committee
Key features:
Entire class does rotation together
Entire faculty involved in teaching
Outside “experts” recruited to help

4. What? Key lifestyle health risks
USPSTF and other evidence-based recommendations
Behavior change theory
Skills for motivating change
Practical office implementation

5. Topics & Activities Behavior change theory / models USPSTF review
Alcohol abuse
Smoking
Obesity
Nutrition
Exercise
Stress reduction
STEP UP results
Office time management
Self-assessment
Group project

6. Experience It For Yourself

7. “Fieldtrip”

10. USPSTF Overview Time: 2 half days
Faculty: CT (Key concepts), FJ (USPSTF Review)
Topics- Key concepts of prevention,distilled version of USPSTF current guidelines, familiarize with key websites

11. Behavior Change Theories & Models
Time: 1 half day
Faculty: Frank
Topics- Generic overview of behavior change theory /psychology, overview of major models and key concepts of each

12. Obesity Time: 2 half days Faculty: Drazdik (adult), Olsen (peds)
Topics- Overview of problem, evidence for risk/interventions, motivational tools, application of skills/practice, site visit(s), community resources.

13. Nutrition Time: 2 half days Faculty: Kelly, Garven
Topics- Current guidelines, evidence review, pyramids, basic nutritional counseling, how to make referrals, practical quick tools (e.g. label reading), food shopping trip, websites

14. Exercise Time: 2 half days Faculty: Flynn, Tyler
Topics: Current guideline overview, evidence review, physical activity assessment tools, motivational tools, toys (e.g. pedometer)

15. Smoking Cessation Time: 1 half day Faculty: Frank
Topics: Overview of problem, avoidance strategies, cessation strategies, community outreach (e.g. Tar Wars).

16. Alcohol Misuse Time: 1 half day plus 1 hr.
Faculty: Eberlein, Flynn, alcoholism counselor
Topics- Overview, screening, intervention strategies, community resources, site visits (e.g. AA, rehab facility)

17. Sexual Health Time: 1 half day Faculty: Drazdik
Topics- Overview of problem and risks, screening, intervention strategies, community outreach (“teen chat room”, school talks)

18. Stress Management Time: 1.5 half days Faculty: Simons
Topics: Overview of problem, evidence review, screening and assessment tools, intervention strategies

19. Time Management Time: 1 half day Faculty: Jorgensen; Kelly
Topics- Brief intervention toolbox, PPIP review, strategies for integration into office practice, skill practice, videos

20. Sub Topics Time: 2 half days Faculty : Various
Topics: Group Visits (Kratche), CFM Practice/self assessment and Practice Improvement project (Jorgensen, Garven), STEP UP (Stange)

21. Evaluation Mechanisms
Residents evaluate all sessions
Pre / post test on USPSTF
Self-evaluation of health promotion practice by audit
Focus group following rotation

22. The Evaluations New info: “About 25%”
basic science re exercise; nutrition science; weight loss strategies; relaxation techniques
75% was solidifying /reframing/learning to apply existing knowledge

23. Effects on behaviors
Changes in practice: Trying to include HP in every visit; less time on pre-contemplatives; increased counseling re seatbelts, immunizations, diet specifics, exercise

24. Evaluations, cont.
Most useful sessions: Nutrition I (evidence base of nutrition) and II (esp. practical diet calcs); Time Mngmt.; Basic exercise; Stress mngmt; JD/DE personal narratives, USPSTF review, Stages of Change concepts – “right tool at right time”

25. Evaluations, cont.
Least useful: STEP UP; Group Visits; ETOH counselor (idea valuable but wasn’t prepared w/ resources, etc.); Sexual health (good info, but need sexual health promo across all spectrums)

26. Focus Group Comments
“This rotation really changed my practice. I try to spend time during every visit on health promotion”
“I’m much better now in identifying stages of change, and wasting less time on pre-contemplative patients”
“I’m definitely more aware of the importance of cancer screening and why we do (or don’t) do it”

27. Focus Group Comments
“Seeing the evidence behind exercise and nutrition recommendations makes me much more confident in my discussions with patients”
“Learning tricks for fitting this into my visits was very helpful”
“It was useful seeing how to apply different weight management techniques to different people”

28. Other Benefits
Faculty development of content knowledge and team building
Resident class bonding
Stimulation of scholarly activity
Improved patient care
Practice improvement and involvement of entire staff

29. Future Plans Continue, refine, improve Implement practice changes
Share information with other resident classes and staff
Research opportunities