Shak Emma B, Berry Lyn, Chow Bryant, Abramowitz Sharone, Mehta Kala M
Department of Medicine, UC San Francisco, Division of General Internal Medicine, San Francisco Department of Medical Affairs, 401 3rd Street, San Francisco, CA, 94107, USA.
Department of Medicine, Highland Hospital, Alameda Health System, (emeritus) 1411 E. 31st Street, Oakland, CA, 94602, USA.
BMC Med Educ. 2025 Feb 27;25(1):322. doi: 10.1186/s12909-024-06524-6.
The volunteer Pre-Medical Health Coach (PHC) program engages student volunteers, in team-based primary care providing self-management support to patients with chronic conditions. Both the PHCs and the patients they serve are diverse. The aims of this study are to assess the impact of the PHC program on student outcomes and patient biomarkers.
All PHCs were students recruited from local universities, interviewed, then trained in motivational interviewing and evidence-based chronic disease self-management support. The 22 PHCs were diverse - 8 (36.3%) were underrepresented in medicine and 2 (9%) were first generation in college. The study setting was a public safety-net adult medicine outpatient clinic in Oakland, California. PHCs spent 5 h weekly, for 1-3 years, volunteering alongside primary care residents and faculty. Duties included: (1) observing the doctor-patient interview, (2) on-site health coaching, and (3) telephone follow-up. An internal medicine physician and a licensed clinical social worker supervised the program. Surveys were implemented to understand program impacts and career trajectories of the 22 PHCs and health action plans were reviewed over 4 years. In addition, a focus group was conducted with the PHCs using a deductive approach.
Two years after completing the program, 90.9% of the PHCs were still on the path to health professions programs, 50% had applied to medical school, and 18.2% started medical training. Qualitative impacts on coaches included significant clinical exposure, meaningful connection with patients, 'bridging' between the community and health care system and having a more holistic view on health. Patient biomarkers included a decrease in hemoglobin A1c level by 1% point in diabetic patients with diabetes-focused action plans, and smoking-focused action plans led to decreased smoking or cessation.
The Pre-Medical Health Coach (PHC) program may benefit both PHCs and patients. PHCs were diverse and providing chronic disease self-management support to patients in a safety-net health care system. This program could be readily adapted in health care systems nationwide to increase diverse entrants to the healthcare workforce.
志愿者医前健康教练（PHC）项目让学生志愿者参与基于团队的初级医疗，为慢性病患者提供自我管理支持。PHC及其服务的患者都具有多样性。本研究的目的是评估PHC项目对学生成果和患者生物标志物的影响。
所有PHC均为从当地大学招募的学生，接受面试后，接受动机性访谈和循证慢性病自我管理支持方面的培训。22名PHC具有多样性——8名（36.3%）在医学领域代表性不足，2名（9%）是大学第一代学生。研究地点是加利福尼亚州奥克兰的一家公共安全网成人内科门诊诊所。PHC每周花费5小时，持续1至3年，与初级医疗住院医师和教员一起志愿服务。职责包括：（1）观察医患面谈，（2）现场健康指导，以及（3）电话随访。一名内科医生和一名持牌临床社会工作者监督该项目。实施了调查以了解该项目对22名PHC的影响和职业轨迹，并在4年时间里审查了健康行动计划。此外，采用演绎法与PHC进行了焦点小组讨论。
完成项目两年后，90.9%的PHC仍在通往健康专业项目的道路上，50%已申请医学院，18.2%已开始医学培训。对教练的定性影响包括大量的临床接触、与患者有意义的联系、社区与医疗系统之间的“桥梁作用”以及对健康有更全面的看法。患者生物标志物方面，针对糖尿病的行动计划使糖尿病患者的糖化血红蛋白水平降低了1个百分点；针对吸烟的行动计划导致吸烟减少或戒烟。
医前健康教练（PHC）项目可能使PHC和患者都受益。PHC具有多样性，并在安全网医疗系统中为患者提供慢性病自我管理支持。该项目可在全国医疗系统中轻松推广，以增加医疗劳动力队伍中的多元化参与者。
