MEDU-4091 - Evidence-based Programs for Lifestyle Change

MEDU-4091 - Evidence-based Programs for Lifestyle Change

Elective Title: Evidence-based Programs for Lifestyle Change
Course Number: MEDU-4091
Elective Type: career Duration/Weeks: 2 Max Enrollment: 10
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Hanaa Sallam, MD, PhD Periods Offered: 10A & 10B excluding holiday period 8 
Coordinator: Other Faculty: Hani Serag MD, MPH Wentong Pan, MD Monique Ferguson, PhD Rizwana Sultana, MD Kevin McKinney, MD
Location to Report on First Day:
Virtual on Zoom

Goals
1) To strengthen the knowledge and skills of medical students in the areas of shared decision-making in prediabetes and diabetes
2) To become a certified lifestyle coach for the CDC's National Diabetes Prevention Program (NDPP)

Objectives
1. Describe the pathophysiological basis of prediabetes, metabolic syndrome, and type 2 diabetes.
2. Compare the incidence of Type 2 diabetes in various ethnic groups and discuss the determinants of such disparities.
3. Role-play the role of a lifestyle coach to implement a module of the CDC-accredited lifestyle change program for people with prediabetes (NDPP) or the intensive Diabetes Self-Management Education and Support Program (iDSMES) for people with Type 2 diabetes.
4. Obtain a certificate as a lifestyle coach for the NDPP.
5. Demonstrate facilitation and motivational interviewing skills, as well as shared decision-making when delivering the NDPP.

Description of course activities
Students will be trained and certified as lifestyle coaches for the National Diabetes Prevention Program (NDPP) and observe how to work with people with prediabetes or diabetes to instill lifestyle modifications to self-manage their conditions. The course is offered over 32 hours per week divided into applying various pedagogical methods. This approach is to ensure better student engagement and understanding.
1. Interactive training: Over the course of the 16-hour training, students will engage in the lifestyle coach training. They will be equipped with the knowledge and understanding needed to effectively deliver the NDPP lifestyle change program. They will work with the course director, an experienced DTTAC Master Trainer SelectTM, and engage with other to-be coaches in hands-on activities and interactive discussions.
2. Thematic sessions (Open webinars): The webinars are designed to introduce definitions and concepts, targeting specific themes. These include but are not limited to:
a. Standard of care for type 2 diabetes
b. Diabetes Technology
c. Addressing Social Determinants of Health in Diabetes
d. Sleep, obesity and diabetes
3. Community Engagement: During the course, students will be required to shadow and assist senior lifestyle coaches delivering classes at Osher Lifelong Learning Institute (OLLI), St. Vincent Clinic, Rosenberg Library, or Virtual.
4. Reading material: Mandatory and elective readings will include book chapters, publications, and videos to enhance student understanding of the subject matter.
The students will have 20 hours of faculty time, 6 hours of self-directed time, and 6 hours of community engagement per week.

Type of students who would benefit from the course
Medical Students who are interested to know more about preventative and lifestyle medicine.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

 Average number of patients seen per week:
 Call Schedule:

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
   
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Elective peers - Program Director - Faculty
  B. Frequency / Duration of Presentation(s)?
    1) First assessment: At the end of the Lifestyle Coach Training Course / 7 minutes 2) Final Assessment: At the end of the course / 15 minutes
  C. Format - What guidelines are set for the student's presentation?
    1) First assessment 7-minute role-play as a lifestyle coach for a selected NDPP module with fellow peers as pretend-program participants. Students are expected to use the facilitation skills approaches learned in the training. 2) Final Assessment 10-minute presentation + 5 minute Discussion. Presentation guidelines include: 1. Introduction to provide background to the topic and discuss its importance 2. Use a systematic way while answering the selected questions; organize your arguments in a logical sequence, support these arguments with demonstrative examples from available literature, and provide a list of references. 3. Provide a concise conclusion.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Once at the end of the elective, students will be asked to cite at least five recent references in their essay. They can use references from the readings that the faculty will offer them during the elective. In addition, the course director will have a one-to-one discussion to guide students in selecting the references.
  B. Format - What guidelines are set for the student's written work?
    Short essay of no more 750 words
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Students will be asked to cite at least five recent references in their essays. They can use references from the readings that the faculty will offer them during the elective. In addition, the course director will have one-to-one discussions to guide students in selecting the references. Listed references will be in AMA style.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    The student chooses one of the proposed essay topics to write on: 1) What are the risk factors of type 2 diabetes and how to address them? Focus on 3 major risk factors. 2) "Let food be thy medicine and medicine be thy food". Discuss how food choices are key for the management of patients with pre-diabetes or diabetes. 3) Walk with Ease is an evidence-based program that encourages physical activity in adults with arthritis. There are initiatives to combine with NDPP. Discuss the importance of guidelines for physical activity in patients with pre-diabetes or diabetes. 4) Based on the Diabetes Prevention Group research, lifestyle was more effective in reducing diabetes risk than Metformin. Yet, metformin remains used as a treatment for patients with pre-diabetes. Do you believe that there is still a benefit to using metformin in this patient population? Use evidence-based research to support your opinion.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The course will consist of four general components: 1) Interactive training: Over the course of 4 days, students will engage in the lifestyle coach training. They will be equipped with the knowledge and understanding needed to effectively deliver the NDPP lifestyle change program. They will work with the course director, an experienced DTTAC Master Trainer SelectTM and engage with other to-be coaches in hands-on activities and interactive discussions. 2) Thematic sessions (Open webinars): The webinars are designed to introduce definitions and concepts, targeting specific themes. These include but are not limited to: a) Standard of care for type 2 diabetes b) Diabetes Technology c) Addressing Social Determinants of Health in Diabetes d) Sleep, obesity and diabetes 3) Community Engagement: During the course, students will be required to shadow and assist senior lifestyle coaches delivering classes at Osher Lifelong Learning Institute (OLLI), St. Vincent Clinic, Rosenberg Library, or Virtual. 4) Reading material: mandatory and elective readings will include book chapters, publications, and videos to enhance student understanding of the subject matter

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Students will interact and meet with faculty from Endocrinology, Stark Diabetes Center, and Sleep Medicine.
They will meet the course director every day during the course who will provide hands-on training and one-on-one mentoring, interaction and feedback.
Students will be evaluated with respect to the following items:
- Knowledge acquisition,
- Knowledge application / problem-solving skills,
- Group interaction, and
- Professional behavior
Students will be also given the chance to evaluate their benefits from the course. This will be through an evaluation form to help students to document the usefulness of the course in terms of specific knowledge and skills.
In order to pass this course (expected performance) students will have to complete the following:
- Attend all required in-class sessions.
- Complete at least one community organization site visit.
- Complete writing assignments.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
   
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
   
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
   
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
   
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
   
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
   
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.