45-minute talks with med students improve patient management of chronic conditions

Just 45 minutes of chatting with a second-year medical student could improve disease management among patients with chronic conditions like hypertension, diabetes and chronic obstructive pulmonary disease (COPD), according to research published in the November issue of the Journal of the American Osteopathic Association.

“The Other 45” study, led by Alexis Stoner, PhD, MPH, the director for preventive medicine and public health at the Edward Via College of Osteopathic Medicine (VCOM), enrolled 47 hypertension, diabetes or COPD patients and paired them with a total of 69 medical students. Stoner and her team said the trial, which focused on underserved patients in Virginia, looked to promote appropriate self-management of chronic diseases while honing students’ communication and teaching skills.

“As medical students train to be physicians, developing their skills to effectively communicate and provide patient-centered care will be essential in helping them improve their patients’ chronic disease self-management,” Stoner et al. wrote. “Developing a student’s ability to teach has been shown to be an effective strategy to help them better acquire and apply knowledge. However, medical school curricula do not typically include training on formal education and teaching principles, and often medical students enter residency without confidence in their teaching abilities."

Participants in Stoner and colleagues’ trial met with medical students three times: initially following a scheduled physician’s visit, again three weeks later and once more at the three-month mark. At each visit, patients completed the Health Education Impact Questionnaire (HeiQ), a 40-item patient-reported outcomes measurement tool.

HeiQ was designed to evaluate a patient’s level of engagement with their healthcare, their technical capabilities, their social and emotional well-being and their level of self-monitoring, among other constructs. In the case of COPD, patients instead filled out the Clinical COPD Questionnaire.

Stoner et al. said students facilitated these visits, ideally helping to educate patients where they saw knowledge gaps. Before and after the process, all participants completed a survey that measured patient-centered care, clinical confidence and medical or teaching knowledge.

As measured by HeiQ, at three weeks patients showed significant improvement in skill and technique acquisition, constructive attitudes and approaches, health services navigation and positive and active engagement in life. In addition, patients’ self-monitoring and insight began to significantly improve at the three-month mark.

“Self-monitoring and insight was the only construct that only showed significant improvements at the three-month visit, indicating that improving patients’ abilities to monitor their own subclinical indicators of their disease may take longer involvement with a program and multiple educational sessions,” Stoner et al. wrote. “These findings suggest that multiple educational sessions can help improve patients’ motivation to improve their life circumstances, provide skills to achieve symptomatic relief from their chronic disease and reduce negative health-related affect, improving feelings such as stress, anger, depression and anxiety.”

The authors said the exercise was also greatly beneficial to students, who were better able to understand the value of listening to their patients and articulating medical knowledge while fueling their own mental, physical and spiritual needs.

“An osteopathic approach to training medical students and delivering healthcare encompasses viewing the patient as a whole and addressing the patient’s body, mind and spirit,” Stoner and coauthors said. “The Other 45 provides an opportunity for medical students to look beyond the biomedical condition and understand the barriers to health that these medically underserved patients faced, allowing students to help each patient address the individual variables that influenced their mind and spirit, which can have a large impact on chronic disease outcomes.”