lifestyle medicine for preventive medicine residents

Lifestyle Medicine

for Preventive Medicine Residents

Shark Tank 2015

Sajida Chaudry MD MPH MBA

Associate Program Director

General Preventive Medicine Residency

Program

Family Physician at JHCP Odenton

Agenda

• Why this is important

• What will we do: LPTL

• How will we prove it worked

• What will we do with the money

What is Lifestyle Medicine?

“Lifestyle Medicine (LM) is the use of lifestyle

interventions in the treatment and management of

disease.

Such interventions include:

Diet (nutrition)

Exercise

Stress Management

Smoking Cessation

A variety of other non-drug modalities”

•Growing burden of chronic disease

•Limited resources

•Growing interest from patients

•Low tech and low cost

•Few side effects

•Patient centered

•Fun for clinicians

•Health promotion and prevention

Why is lifestyle medicine important?

This is what the residents will do

in the lifestyle medicine

curriculum.

• Learn

• Practice

• Teach

• Lead

Learn: Enhance existing curriculum

1. Introduction to Lifestyle Medicine (Eddie Phillips, MD)

2. Introduction to Behavior Change Models (Mellisa Poulsen,

JHSPH)

3. Behavior Health Coaching (Deborah Linehan, RD, LDN, CIC

and Tara McDonald)

4. The Role of the Physician in Health Behavior Change:

Interpersonal Communication (Debra Roter, DrPH, MPH)

5. Stress Management I and II (Delia Chiaramonte, MD)

6. Diet (Dechen Surkhang, RD and Diane Blahut, RD)

7. Motivational Interviewing (Mary Catherine Beach, MD)

8. Using Mindfulness Based Stress Reduction

Learn: What we will add

• Patient Care Curriculum

- Lifestyle medicine interview

- Lifestyle specific assessment and plan

• Self-Awareness Practicum

• Work with co-residents

• Assess themselves (resiliency, well-being

and flourishing scales)

Practice: 2 yr. Clinical Experience

• Weekly 4 hour clinic sessions

– 4-5 patients; 2-3 phone follow-ups

– Referrals from JHCP clinicians (and residents)

• Lifestyle Medicine Interview:• Nutrition, Exercise, Sleep, Mood, Social support,

Substance use

• Care plans & team care

Teach: Patients & Colleagues

• Patient Education:

– Lifestyle medicine

– Resiliency

– Well-being

– Flourishing

• Colleagues

– Model lifestyle medicine

Brief Resilience Scale

1. I tend to bounce back quickly after hard times.

2. I have a hard time making it through stressful

events.

3. It does not take me long to recover from a stressful

event.

4. It is hard for me to snap back when something bad

happens.

5. I usually come through difficult times with little

trouble.

6. I tend to take a long time to get over set-backs in my

life.

Smith, B. W., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J (2008). The brief resilience scale: assessing the

ability to bounce back. International journal of behavioral medicine, 15(3), 194-200.

WHO Wellbeing Index

1. I have felt cheerful in good spirits.

2. I have felt calm and relaxed.

3. I have felt active and vigorous.

4. I woke up feeling fresh and rested.

5. My daily life has been filled with things that interest

me.

Regional Office for Europe WHO. Use of Well-Being Measures in Primary Health Care - The DepCare Project.

Health for All, Target 12, 1998 [http://www.who.dk/document/e60246.pdf]

Bech P. Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newsletter 2004; 32: 15-16.

Short Flourishing Scale

1. I lead a purposeful and meaningful life...

2. My social relationships are supportive and

rewarding...

3. I am engaged and interested in my daily activities...

4. I actively contribute to the happiness and well-being

of others...

5. I am competent and capable in the activities that are

important to me...

6. I am a good person and live a good life...

7. I am optimistic about my future...

8. People respect me...

Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D. W., Oishi, S., & Biswas-Diener, R. (2010). New well-being

measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2),

143-156.

Teach: Precepting and Mentoring

• Provide preceptorship and mentorship from LM experts

– LM rotation core faculty precept weekly clinics

– Bi monthly sessions with Subject Matter Experts and

co- residents to review case and approaches

Linda Lee, Anastasia Rowland-Seymour

and Annie Umbricht

• Bi-monthly resident self reflection on lifestyle changes

• Culminates in 2 year data evaluation and presentation of

findings

– resident and patient lifestyle medicine changes, care plans, scales

Summary

Resident Teaching Assessment

and Plan

Evaluation

of Scales

2 yr Journal

review

Resident A

Resident B

Patient Teaching Assessment

and Plan

Evaluation

of Scales

2 yr chart

and care

plans

Patient A

Patient B

Lead

• Develop Preventive Medicine and

Lifestyle Medicine leaders

• Dissemination

• Residents will share with others

Evaluation

• Resident:

– ACGME competencies (23) and milestones

– Resiliency/self-efficacy/flourishing

– LM knowledge

– Lifestyle medicine changes

• Program: ACGME competencies, milestones,

replication

• Patient

– Self-care plans in EMR meet MU criteria

– Resiliency/self-efficacy/flourishing

– Patient outcomes in terms of lifestyle medicine

changes

Budget

• $10,000

– Curriculum development $2,500

– Faculty support and online meetings

$2,500

– Statistical analysis $2,500

– Dissemination $2,500

Lifestyle Medicine at Hopkins

• Leadership in an emerging field

Thank you