Boonshoft School of Medicine students help underserved manage chronic illnesses by promoting healthy behaviors
On a snowy Saturday morning in February, William went to a health screening at the St. Vincent de Paul Gettysburg Gateway for Men homeless shelter. But this wasn’t a typical health clinic.
After Boonshoft School of Medicine students took his blood pressure and checked his glucose levels, William sat down with another group of students who asked him questions about his health and helped him develop ideas to better manage it.
“They’re giving me avenues of how to find a new care provider,” said William, 54, who has hepatitis. “I have a chronic disease. I need to get connected to a clinic.”
Passionate about fighting chronic illness among the poor and the homeless, a group of Wright State University Boonshoft School of Medicine students implemented a community-based, volunteer-powered counseling program in the fall of 2012.
The program, Students Teaching Educational Plans for Success (STEPS), works with vulnerable populations in Dayton to manage chronic illnesses by promoting healthy behaviors.
Paul Blair, a member of the cohort of students who organized the Wright State initiative, garnered the support and active leadership of six other students—Rebecca Beesley, Nikki Craker, Ross Humes, Matias Iberico, T.J. Klein, and Nadia Zaim. Today, the program is comprised of a team of WSU medical, nursing, psychology, social work, and nutrition students, along with Cedarville University School of Pharmacy students.
They were inspired by a similar program run by students at another university.
“I realized it would be a great program for the students at Wright State University and the vulnerable populations of Dayton,” Blair said. “We want the participants to understand that they are the ones in charge of changing their lifestyle.”
Zaim explained that STEPS works to fight the chronic illnesses that are devastating to the poor, the homeless, refugees, and minorities. “We are building an interdisciplinary collaboration of students and faculty to help people make healthy choices,” she said.
The WSU initiative was implemented in September 2012 at the Dakota Center, a Dayton community center. In January 2013, the initiative was moved to the St. Vincent de Paul Gettysburg Gateway for Men, a homeless shelter for single men in Dayton.
On the first Saturday of the month, the students conduct health screenings from 9 to 11 a.m. They check for high blood pressure, obesity, and other risk factors for cardiovascular disease. Through motivational interviewing, a technique of goal-oriented, client-centered counseling, patients are empowered to take the right steps to better health.
“Chronic illness is the major cause of mortality. We are seeing unhealthy habits,” Blair said. “We are trying to help patients change those unhealthy habits.”
As they listen to the participants, the students help guide them toward attainable goals.
Paul Hershberger, Ph.D., ABPP, professor and director of behavioral science for the Boonshoft Family Medicine Residency Program, assists the students with motivational interviewing. At the weekend sessions, he reviews the technique with the group of volunteer students before they meet with the participants. “This is very patient-centered,” said Hershberger, a clinical psychologist. “We want to discuss behavioral issues from the perspective of the patient.”
He encourages the students to find out what is important to the participants by asking open-ended questions, using reflective statements, and being understanding. “Our leading health problems are chronic illnesses,” Hershberger said. “Behavior is a major factor in people’s susceptibility to developing these chronic illnesses.”
“The STEPS initiative is giving students exposure to a certain population of patients they may not meet—the indigent and those without health care,” said faculty volunteer Robert Brandt Jr., M.D., (’80), a clinical professor with Wright State Physicians. “This is a good way for that exposure. It gives them a chance to practice their interviewing skills outside of medical school in a real- world setting.”
David, 48, a participant in a recent session, was grateful for the advice he received. The students helped David, who suffers from asthma, develop a plan on how to better cope with his condition. “I am sleeping in a dorm,” said David, who is staying at the St. Vincent de Paul shelter. “Because of my asthma, I have to get up in the middle of the night.”
The students reviewed how to use his inhaler and gave him leads on how to connect with a primary care physician who can prescribe additional medicine.
T.J. Klein, a second-year medical student, and other students have helped some participants modify their behavior with a regimen of reduced salt intake and increased exercise. “This enables our participants to take their health and well being into their own hands,” Klein said. “We encourage participants to recognize and modify their own behaviors through dialogue and conversation with us.”
Ross Humes, a third-year medical student, and other students met with a participant, who drank four sodas a day. They worked with him to develop a plan to decrease his soda intake to keep his glucose levels down. A month later, he had decreased his soda intake to one per day, sometimes none. Humes and other students also helped him design a plan to decrease the number of cigarettes he smokes.
Humes praised the motivational interviewing aspect of the STEPS initiative. “People can arrive at their own solutions,” he said.
Third-year medical student Rebecca Beesley explained that many of the people the students meet with are on the verge of diabetes.
“The STEPS initiative empowers the patient by encouraging them to figure out why certain habits are bad, why they should quit engaging in certain activities, or why they should be more proactive in a certain area,” Beesley said. “It is extremely rewarding to use motivational interviewing to help someone come up with their own answers to their problems. The solution comes from them, not us. They know their schedule and resources best.”
While Blair and Zaim graduated last year, they made sure that the program included second- and third- year medical students who are committed to continuing the STEPS initiative.
“We feel very passionate about this initiative,” Beesley said. “We are confident that we will be able to continue for years to come.” VS
Photo: Second-year medical student David Solarz checks the blood pressure of a Gettysburg Gateway client.