Learning basics on hypertension, exercise and healthy diet
“This project goes beyond providing students with broader educational opportunities,” said Christine Matson, MD, a family physician who serves as the chair of generalist medicine and recent past chair of the Department of Family and Community Medicine at EVMS.
With money left over in a grant, the Virginia Department of Health (VDH) offered funding for hypertension coaches to EVMS. Dr. Matson worked closely with a team of students to develop training modules for the hypertension coaches based on a community health worker’s monograph previously used by the VDH.
The program expanded based on their experience with the clinical skills curriculum and five modules were created, including the basics of hypertension, exercise and healthy diet, motivational interviewing and how to use medications. Students have remained engaged throughout the hypertension coach project, said Dr. Matson.
“We expanded beyond training our two hypertension coaches and we embraced the entire nursing staff in multiple practices,” she added.
Students worked with the nursing staff to present the modules and explain concepts from the AMA’s BP Improvement Program, embracing protocols such as those that help ensure accurate measurement of blood pressure.
“Our major intervention as a practice was to acknowledge the importance of achieving hypertension control by bringing the patients back within two to four weeks rather than three or six months from now,” Dr. Matson said.
Seven years ago, EVMS faculty member Richard M. Bikowski, MD, started an innovative fourth-year quality improvement elective, through which hypertension was identified as the major focus for students’ engagement as change agents. The students’ active involvement in identifying opportunities to improve blood pressure management grew into the opportunity for experiential learning. Eventually, the BP Improvement Program process and the hypertension coach project merged into one multifaceted, robust collaborative project.
“We have more students who want to take the elective than can be accommodated,” Dr. Matson said. “Using hypertension coaches to effectively identify barriers to success with behavioral change and link to available resources for patients has been replicated for patients with diabetes as well.”
“What doctors should be doing”
The hypertension coaches are just one of several innovative efforts at EVMS that aim to incorporate lifestyle changes into medical education. Another is the use of “virtual families” to help students experience an integrated approach to diagnosis in M1-2 years. Each storyline in this curriculum contains an expanded social history that conveys the multiple factors that influence patients’ health decisions and capabilities. Most portray virtual patients who try to cope with multiple, inter-related complex conditions, with hypertension as a comorbidity that occurs frequently.
“We’re using those cases on a weekly basis with the students,” Dr. Mazzurco said. “The idea is that the patient and the diagnoses are set in the context of their family and community, providing that foundation for discussion.”
EVMS students also have created nutrition modules that equip their classmates to employ dietary discussions to improve health within their communities. Service learning initiatives are part of the curriculum at EVMS that include a focus on choosing healthy lifestyles. Their project develops classes for the community.
“It sets the basis for what doctors should be doing,” said second-year med student Kimberly Ha. “It is good for us to know for our own personal health, but ultimately it is good to know for our ability to educate our patients in the future.”