Putting it all together

Dr Evie Kemp MBBS MSc FFOM

Occupational Health Physician

Director of Medical Student Wellbeing and Lecturer

Technion American Medical School, Israel
 Overview

Motivational interviewing
• Dietary habits screening tool
• Starting the conversation
exercise

Community for support

• Finding Meaning in Medicine
groups

Review of the elective

• Party!

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 Motivational Interviewing

A client centered, goal

oriented method for
enhancing (intrinsic)
motivation and resolving
ambivalence

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 Motivational Interviewing: 4 guiding
principles RULE

U: understanding your L: listening to your E: empower your

R: resist righting reflex
patient’s motivations patient patient
• Can have the • It is the patient’s • Active listening skills
paradoxial effect reasons for change • Seek to understand • Work with your
• Avoid telling, not yours that will their values, needs, patient to set
directing or trigger behaviour abilities, motivations achievable goals and
convincing them change and potential barriers identify techniques
about the right path • Seek to understand to changing to overcome barriers
to good health their values, needs, behaviour • Helping the patient
abilities, motivations explore how they can
and potential barriers make a difference to
for changing their own health
behaviours

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SMART Goals
Specific
Measurable
Attainable
Relevant
Time bound
 Motivational Interviewing: 6As

Assess: What is the situation now?

What does the patient understand?
Ask: Is it ok to have the discussion now?
Advise: Some information to consider
Agree: Agree making change is not easy,
ambivalence and resistance to change is normal
Assist: Offer help to make changes e.g. SMART goals
Arrange: Follow up

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 Motivational Interviewing in action

https://www.youtube.com/watch?v=Egh2mHhrUTM 7
Your eating pattern
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Dietary Habits
Screening Tool:
Starting the
Conversation

• Easy to administer
• Validated
• Quick for patient to
complete
• Feedback on areas that
would benefit from
improvement
• Non dieticians can use
 STARTING THE CONVERSATION
DIETARY COMPONENT FREQUENCY AND SCORE

SCORE 0 EACH SCORE 1 EACH SCORE 2 EACH

Fast food meals or snacks < 1 ×/week 1–3 ×/week ≥ 4 ×/week
Fruit servings ≥ 5/day 3–4/day ≤ 2/day
Vegetable servings ≥ 5/day 3–4/day ≤ 2/day
Sugar-sweetened beverages < 1/day 1–2/day ≥ 3/day
Legumes, chicken, fish ≥ 3 ×/week 1–2 ×/week < 1 ×/week
Regular (not low fat) snack (chips or
≤ 1/week 2–3 ×/week ≥ 4 ×/week
crackers)
Desserts and sweets ≤ 1/week 2–3 ×/week ≥ 4 ×/week
Margarine, butter, meat fats little some lots

Subtotal:
 • Eating patterns (not diet)
• How many eating episodes in a typical day?
More information • Where food is purchased, prepared and consumed?
 BEHAVIOUR CHANGE GOALS

BEHAVIORAL CHANGE
PROBLEM AREA SAMPLE SMALL STEP
GOAL

Choose a prepared supermarket meal in place of a fast food meal to

Fast food ↓ by 1 visit/week replace 1 fast food meal/week.

Fruit ↑ by 1 serving/day Add fresh, frozen, or canned fruit to breakfast meal.

Add fresh, frozen, or canned vegetables to frozen entrée usually

Vegetables ↑ by 1 serving/day consumed at lunchjme.

Sugar-sweetened beverages ↓ by 1 serving/day Replace one sugary drink with flavored water once each day.

Increase legume intake by planning a “Meatless Monday” meal each

Legumes, chicken, fish ↑ by 1 serving/week week.

Choose air-popped popcorn or small handful of nuts as a snack

Snack chips or crackers ↓ by 1 serving/week instead.

Desserts and sweets ↓ by 1 serving/week Replace a sugary dessert with a piece of fruit.

Margarine, butter, meat fats ↓ Use olive oil and garlic to season vegetables instead of butter.
 • Pairs
Starting the • Doctor and Student (yourself)
Conversation • Doctor, please introduce yourself
Exercise • 6As Motivational Interviewing
• Swop over
 Starting the Conversation: 6As
Assess: I would really like us to have a look at your current
eating patterns together
Ask: Would it be ok if we fill in a quick and easy questionnaire
about that together now?
Advise: Some information to consider (1-2 points from Misrad
Habriut guidelines)
Agree: Agree making change is not easy, and ambivalence and
resistance to change is normal
Assist: Offer help to make changes: show them the list of
behaviour change goals and see if they can choose
one or two
Arrange: Follow up- agree to check in in a weeks time to see
how they are progressing
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Community for support
 Aim: students feel less alone, less stressed and more
able to bring their values and perspectives to the world
of medicine

Finding • 4-6 students agree to meet monthly for an hour

/hour and a half to create a supportive conversation
Meaning in group
• Find a quiet spot and put do not disturb sign on
Medicine door
• Agree standard guidelines e.g. generous listening,
confidentiality
conversation • Agree topic for discussion at the meeting before
hand
group for • Everyone brings a personal story or poem or object
• Group listens and reflects, agrees topic and date for
Medical next meeting
• Ends with closing circle
Students
FMM resource guide for medical students
www.rishiprograms.org
 Standard Guidelines
• Confidentiality
• Generous listening (without
judgment/trying to fix)
• No interruptions when someone
is speaking
• Allow for all differences
respectfully (no need to agree)
• Share from personal experience;
own what you are sharing by
using “I”
• Give advice only when directly
asked for it
• Allow silence when it occurs
naturally
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 Trial conversation
group
• Groups of 4-5
• Agree confidentiality rules
• Choose facilitator (role rotates)
• Topic ”Why do I want to be a
doctor? ….”
• Go round and everyone shares a
story
• Rest of the group actively listen
• End with closing circle led by
facilitator
• Agree topic and facilitator for
next time

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 Closing circle
• Everyone shuts their eyes
• Facilitator makes a sound (bell) or says a word
• Person on their left says their name
• In silence, everyone focuses their attention on
that person, on what they have shared and
wishes them well
• After 20 seconds the facilitator makes the sound
again or says a word or claps hands
• The next person round says their name
• The group focuses their attention on that person
in the same supportive way
• Facilitator ends the exercise by saying their own
name, and after 20 seconds finishes with the
sound

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Topic
examples

• How I cope with stress?

• A difficult patient
• My most challenging day
in medical school so far
• What is compassion?
• What does a life of
healing look like?

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Building &
Maintaining
Confidence
Resilience
Recognise your strengths
Physical well-being

Practical tips Social Support

Purposefulness and
Building networks
techniques
Personal moral compass to build
resilience

Adaptability
Resilient thinking
Thinking errors

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 Building and Maintaining Resilience

Workshops:

1. Health and wellbeing medical students Purposefulness

2. Myers Briggs Type Indicator Confidence, recognising strengths
3. Cogntive Behaviour Therapy Adaptability, resilient thinking
4. Mindfulness Adaptability, resilient thinking
5. Behaviour Change Confidence, physical well being
6. Putting it all together Social support, building networks

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 Elective Written Paper

Written paper reflecting on your current health and wellbeing

with reference to the topics covered in this course, plus a bullet
point personal self-care and lifestyle plan for the duration of
medical school and beyond.
Please note I am not asking for details of any confidential
personal medical information.
Around 2-3 pages (50% grade)
Hand in deadline: Wednesday 15th June 2022
Via email: evie@technion.ac.il
60% pass mark. Pass/Fail grade

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 Written paper grading: demonstration of
learning and reflection on the following topics
TOPIC TO BE COVERED Percentage grade

Challenges of medical student wellbeing-why is this so 10%

important?
Your MBTI profile in general & in relation to managing 10%
stress
CBT skills -especially challenging negative thoughts 10%
Stress management including mindfulness 10%
Ergonomic set up of your computer/workstation 10%

Physical activity (stages of change, SMART goals) 10%

Eating patterns (stages of change, SMART goals) 10%
Social support/creating community 10%
Conclusion: your personal bullet point health and 20%
wellbeing plan
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 Conclusion: my personal bullet point health and
wellbeing plan

• Jog 15 minutes a day 6 times a week and implement a few stretches beforehand.
• Try getting at least 6.5 hours of sleep, this can mainly be done if I am simply more
productive during my day without procrastinating until the evening.
• Study with my grandfather 15 minutes a day to not lose those precious 15 minutes I
have spent over a decade cultivating, being lost to my career training.
• Purchase a chair that has decent back support.
• Try having oatmeal for breakfast 4 times a week with fruit
• Have a carrot or cucumber for a snack at least 3 times a week instead of a bag of
chips.
• Drink 1.3 liters of water a day at least.
• Jog for 15 minutes when a feeling of stress builds up, in addition for taking a
moment of self-awareness with a few deep breaths.

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 ANY QUESTIONS?
Contact details: evie@technion.ac.il
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