Learning to Motivate Patients Toward Healthier Lifestyles

Eat healthy and exercise: It’s the most common New Year’s resolution people make and often fail to achieve. But this year, University at Buffalo students have acquired new skills they are putting to use in local clinics in an effort to motivate their patients — and themselves — to make better lifestyle choices.

Earlier this month, 170 third-year medical students in the Jacobs School and 30 dietetics students in the School of Public Health and Health Professions participated in a two-week intersession with a “Food as Medicine” focus.

Marla Guarino, associate director of health and well-being at the BNMC, kicked off the event by discussing the National Food As Medicine Movement, and BNMC’s conference on the topic last fall. Beth Machnica, director of health and well-being, joined the session’s final day to describe how Jacobs School students can participate in the Food as Medicine research study that BNMC has launched with its recent Blue Fund award.

“In 2022, BNMC will conduct a Food as Medicine research study, supported by HighMark Blue Cross Blue Shield, that aims to contribute to the existing body of research while continuing to foster clinical-community partnerships — including with the Jacobs School,” said Guarino. “The UB/Jacobs School/BNMC partnership will help ensure future health care practitioners acquire an in-depth understanding of the link between food and health to use in their continuum of care.”

The advantages of this interprofessional session will prove to be far more than academic, according to Jacobs School faculty organizers. This semester, armed with their new ”Food as Medicine” knowledge and skills, Jacobs School students will be incorporating into third-year clerkship and clinic rotations in the community new ways to motivate patients to eat healthier.

Daniel Sheehan, MD, PhD, associate director of medical curriculum and professor of pediatrics, who has directed the annual intersession for third-year students for the past seven years, noted: “Our students are not just vessels to be filled with knowledge. They are a great value to our health care system and they can be co-agents of change with us.”

“This is the whole point of an academic medical center,” he continued. “In a world where doctors and medical residents are busier than ever, our students provide such great value.”

The intersession “Food as Medicine Friday” on Jan. 7 was designed as an interprofessional activity to get UB’s aspiring physicians and aspiring dietitians to appreciate how the health care team of the future is better equipped to meet the needs of patients and clients.

The two weeks culminated with a final day devoted to the discussion of findings in scientific papers that have demonstrated, for example, how dietary interventions with patients with diabetes can result in better outcomes than pharmacological interventions.

“Having an event where medical and dietetic students come together to share their knowledge can help learners develop an attitude of appreciation for other health care professionals and reinforce the need to seek interdisciplinary solutions for their patients’ problems,” said Alison Vargovich, PhD, assistant professor of medicine in the Division of Behavioral Medicine in the Jacobs School.

“Interprofessional opportunities are not generally built into the traditional curricula of the health sciences, so these sessions are extremely valuable,” said Jill Tirabassi, MD, clinical assistant professor of family medicine.

“The sooner that students see the integration between the different facets of the health care team and gain an understanding of what their colleagues do, the better they can utilize their expertise when they enter their profession,” she explained. “Our educational systems have not been designed to do this naturally, so being able to make this happen now is wonderful and will foster future collaboration.”

Under the direction of Nicole Klem, director of the Clinical Nutrition MS/dietetic internship in the School of Public Health and Health Professions, second-year dietetics students developed a presentation for medical students about specific aisles in the supermarket that pose unique challenges for consumers.

Medical students learned that contrary to what some people have heard, low-fat dairy products don’t necessarily have a higher sugar content. They discussed alternatives to dairy milk centered on soy, oat, almond, pea and other non-dairy milks; it was noted that while cow’s milk contains about 8 grams of protein, soy and pea milk might be comparable, but almond and oat milk provide less protein per serving.

Cereals, notorious for their high sugar content, were also discussed, and it was recommended that patients should choose cereals with 5 grams of sugar or less. Canned goods were singled out as being convenient and affordable, but they can contain excessive amounts of sodium, which can often be significantly reduced simply by rinsing the contents before cooking.

After a lively discussion of healthy eating tips, the medical students began to tackle the much harder question of how to motivate patients to make healthier lifestyle choices. It’s an issue, faculty stressed, that lies at the very essence of the practice of medicine.

“I posit to each of you that no matter what house of medicine you go into, 90 percent of the job is convincing your patients to get a little unstuck, to get off the fence, to take new action to improve their health,” said Sourav Sengupta, MD, assistant professor of psychiatry and pediatrics. He sees patients through UBMD Psychiatry.

He noted that Jacobs School students have been hearing about behavioral change in medicine since year one of their training and that a key skill is the technique called motivational interviewing, or MI.

“Motivational interviewing is a way to be centered on where the patient is, how they may be stuck and how we can help them take that next step,” he said.

It’s a technique that has been described less as a way of pushing someone to do something and more as a way to cultivate the conditions where change is more likely.

“Motivational interviewing is a style of communication that should feel like ‘dancing’ rather than ‘wrestling’ with a patient,” explained Vargovich. “This creates a patient-centered focus, giving the patient autonomy over their health choices and fostering rapport between the doctor and patient. The aim is never to force a change, but it makes it easier to understand a patient’s perspective and concerns, plant seeds related to making important health changes and provide education as needed.”

Starting Jan. 10, the third-year Jacobs School students headed back out to local clinics to start sharing what they had learned. “Our students have gained a great understanding of food as medicine,” said Sheehan. “They will be going out into the community as messengers to talk to patients and other health care providers about healthy diets and brainstorm how to improve nutrition when patients are living in ‘food deserts.’ With training like this, we are empowering them to help us transform health care in Buffalo,” Sheehan said.

Other faculty involved in the intersession included Michael Morales, PhD, research associate professor of physiology and biophysics; A. John Ryan, MD, clinical associate professor of medicine; Helen Cappuccino, MD, clinical assistant professor of surgery at UB and assistant professor of oncology at Roswell Park Comprehensive Cancer Center; and Gary Giovino, PhD, SUNY Distinguished Professor Emeritus in the School of Public Health and Health Professions.

Funding for the four-module, online nutrition course “What Every Clinician Needs to Know” (from the Gaples Institute, a physician-led, educational, nonprofit organization) that was completed by all third-year medical students was provided by the Gerald Friedman, MD ’57 and Roberta Friedman Medical School Curriculum Research and Education Fund.