Using Blackboard Discussion
Board in a Health Care
Communication Course
Teresa Cheng
Julie Crosson
Suzy Sarfaty
Thomas Barber
Health Care Communications
Course



Course begun in 2010
Series of workshops on advanced
physician patient communications skills in
the Ambulatory Medicine Clerkship for 3rd
and 4th year medical students
Led by internal medicine attending
physicians, each with more than 15 years
of clinical experience
Health Behavior Change





Common part of most medical encounters in ambulatory
medicine
Motivational interviewing (MI) has been developed as
one way of encouraging behavioral change
MI activates patients’ own motivation for change and
adherence to treatment
Medical students usually taught to counsel with advice
giving
Often difficult to appreciate the challenges of behavior
change, especially in the context of difficult
socioeconomic situations
Teaching Motivational Interviewing




Pre work posted on Blackboard
Review Motivational Interviewing (MI) concepts
Demo MI with a volunteer student “patient”
Small group sessions with role play practice


Each student will pick a behavior change from their
own lives to discuss and work through
Assign health behavior change and posts on
Blackboard Discussion Board
Role Play


Patient: You will be playing yourself, visiting
your primary care provider.
Provider: Overall your patient is pretty healthy
and you have a little extra time today to discuss
lifestyle changes. You ask about and discuss
any change the patient wants to work on.
The patient will decide to take on some change
or component of the change for the following
week and you agree to meet again next week to
see how it went.
Motivational Interviewing
Summary




R: Resist the
Righting Reflex
U: Understand You
Patient’s
Motivations
L: Listen to Your
Patient
E: Empower Your
Patient




Reflective
Listening
Asking open
ended questions
Affirming
Summarizing
Behavior Change Assignment




Pick a behavior change to try for this week
(either the one you worked on in your small
group or one of the others on the list)
Please post two reflections of your experiences
on your behavior change on Blackboard 8.
Ideally, this would be before the weekend.
Read, respond and reflect on two posts from
your small group.
Next week, before session, we will briefly
discuss your experiences.
Post-Eating habits



To be honest, I have not made much progress in terms of the behavior change I
chose to adopt after Wednesday’s MI session. After reflecting on some of the things
discussed during my motivational interview, I realized that I probably wasn’t
completely honest about the extent to which I actually believe my poor eating habits
over the past few years have had an impact on my health. I know that , in theory,
not eating enough fruits, vegetables and whole grains, etc does have an impact on
my underlying health. However, as I think my metabolism is still pretty good, I feel
like I have managed to avoid putting on excessive weight which is the most concrete
evidence, in my mind, of poor eating and insufficient exercise. Thus I feel like I have
managed to stay distanced from the impact of unhealthy eating. I know, however,
that as one ages and one’s metabolism slows, that weight is harder to avoid if you’re
not eating well.
A second aspect that I have realized over this past week is that if I don’t schedule
time to make healthy eating happen, it won’t happen. For instance, during my MI
session, we explored the fact that if I can get to the grocery store, I will buy healthy
food and during that following week or so, I will eat healthy. The problem arises
when I am unable to make time to get to the grocery store and thus end up eating at
local cafes or skipping meals (which I know can often be just as detrimental as not
eating healthy).
Overall, I feel confident that as long as I begin to make healthy grocery shopping a
part of my weekly schedule (no matter what comes up), I will be able to make
improvements in the quality of my diet. In terms of resolving the first point, I am at a
bit of a loss in terms of changing my mentality about the effect my unhealthy eating
is having on my underlying health. Suggestions are welcome!
Response – Eating Habits



I totally understand how you feel about not seeing any bad effects of eating
unhealthy foods. I think that is probably very similar to how patients with
Diabetes of hypertension feel when we tell them that they have a chronic
disease that puts them at risk for heart attack and strokes. They often say,
"But I feel just fine." It's hard to really make something like good eating
habits a priority when the consequences seem so distant and unreal.
I have to admit that I struggle with the same problem and it did not really
get any better during third year. That being said, one thing I did was to
allow myself to spend the extra money on healthy foods when I had to eat
out. It is virtually guaranteed that you will feel zapped of energy during
third year and I told myself that eating fried, greasy foods may satisfy my
hunger, but they wouldn't give me the energy I needed to be motivated to
work and learn for 14 hours a day. Also, eating 3 meals a day from the fried
food line in the cafeteria for 8 weeks of surgery will definitely cure you of
your craving for unhealthy food!
It's definitely a mind game, and like we talked about in class, maybe it
really does only take 21 days to make a habit. But it is definitely a difficult
21 days.
Second Post – eating habits



Well, it has almost been a week since the MI session and I still have not
made it to the grocery store. I think I did not anticipate some of the
barriers I would face when I originally discussed this issue. For example,
this past week has been a busy one for me and I don't think I sufficiently
explored how to approach making time for healthy grocery shopping during
busier weeks. I realize also that the longer I procrastinate, the greater
sense of failure I feel and the less motivated I feel to make this goal
happen - it is certainly a vicious circle. Furthermore, I am realizing also the
importance of a support system to effectively implementing a behavior
change.
A behavior change such as this one might not need an emotional support
system but perhaps a logistical one - i.e. committing to grocery shopping
with a friend on a given day every week or two. I am usually more likely to
carry through on something when I feel that I am accountable to someone
for it. Going forward, I think I need to be more realistic about my ability to
make it to the store during busier weeks and perhaps just aim to eat
healthy wherever I find myself eating.
During less busy weeks, I should aim to make a grocery date with someone
to ensure that I will follow through with it. I think making a zipcar
reservation to get to the store will also hold me accountable and that adds
financial incentive to follow through. Thanks also M.. for the reassurance
that this is a challenge that a great deal of people face during their third
year.
Discussion Board Posts




Most common posts are on healthy eating and
exercise but also areas of time management,
family/ friend relationships were addressed.
Student reflections on MI and challenges of
behavior change are common
Student innovations on posts include attachment
of pictures, links to other articles and info they
have researched
Responses to posts were in the spirit of MI,
more collaborative and less advice giving/
lecturing.
Post- Saving Money

So my behavior change was to decrease my shopping in
an attempt to save money for more important things. I
think I have been doing better with this. Instead of
going shopping, I went to Barnes and Nobles and
purchased a book off of the clearance rack to read. This
enabled me to do something I enjoyed for a cheaper
price and is even more time consuming so that I don't
have extra time to shop. J also suggested that I read
outside by the water at my apartment complex as a filler
for the relaxation that shopping provided which I have
not attempted yet but will try. I also made a budget to
reflect how much money I have to spend on things that
make me happy. All in all I am happy with my attempts
but for me the key is perserverence and longevity.
Anyone have any clues on that?
Post –Response

Congrats!!! I am so proud that you bought a book off the clearance rack!! What a
smart idea! It's a purchase (your shopping fix) + a leisure way to spend time! Go
you.
Saving money is hard. We all need to do it. No one wants to do it. Budgeting is even
harder. You feel constrained and like you have big brother on your back. Trying to
save without feeling deprived is a big factor in this.
I had a couple thoughts--maybe you needed this time to go cold turkey from
shopping, but when and if you do start again...maybe you could set a weekly resolve
to spend x less dollars. Or make a game out of it, to see how much you can get/what
a steal you can get for x dollars.
Another method I've adopted in times of money droughts is "desiring less". I try not
to look at fashion mags etc. Ask myself is it really necessary? Ask myself why I think
this will enhance my life? If it's a superficial reason (which it usually is...ie I want Billy
Bob to think I'm cute) then I don't buy it. If it's something that will make me
consistently happy, without getting tired of it (ie 4 months from now, I will still love
wearing this shirt), then I'll buy it.
I think you've been doing a great job, and you're not alone in this mula struggle, or
the bigger behavior change struggle. Good luck!
Limitations


Unknown if sessions make a difference
long term in attitudes or skills
Discussion posts require additional faculty
time to organize and to provide feedback
Summary



Blackboard can be used in clinical
medicine rotations to enhance educational
experience
Drawing on students own experiences on
challenges of behavior change may
enhance medical student understanding
and empathy
Discussion Board can be effective as a
vehicle for group learning and sharing
reflections
Thank you.
Questions?