Behaviour change counselling in obesity & chronic disease management with Dr. Michael Vallis & Tiffany Shepherd

– Welcome back to “Scale Up Your Practice,” the podcast from Obesity Canada. I’m Dr. Roshan Abraham, family physician and associate professor at the University of Alberta.

– And I’m Michelle McMillan, a lived experience advocate and a member of Obesity Canada’s community. This podcast is where we have honest conversations about how we can improve obesity care that’s grounded in both evidence and empathy.

– Today, we’re talking about something that shows up in nearly every clinic, every specialty, every patient interaction, whether we realize it or not, and that’s behavior change.

– So many of us, whether we’re patients, caregivers, or someone’s support system, know what should help. We set goals, we try to make changes, we want to do the right thing, but actually, changing behavior and sustaining that behavioral change, that’s often the hardest part, and it’s something most healthcare professionals were never formally trained to support.

– Joining us today is Dr. Michael Vallis and Dr. Tiffany Shepherd, health psychologists based in Halifax, who study, teach, and support behavior change in healthcare. Dr. Vallis, welcome back to the podcast. And Dr. Shepherd, welcome. And thanks so much for being here. So I’d like to start with something we often hear from colleagues. I know what the guidelines say, but I don’t always know how to help my patients get there. That gap between clinical knowledge and real-world behavior change is something many of us feel in practice, and it’s one of the many reasons why the Canadian Adult Obesity Clinical Practice Guidelines introduced a psychological pillar dedicated to this exact part of practice. Why is this pillar such an important and often overlooked part of care?

– If it’s okay, I’ll start with that, because I think that’s a really critically important question. And I think the key is that there is a tendency in the way that we’ve all been trained as healthcare professionals to be transactional. And so that means that our job is to be the expert. And of course, the expert then knows best and would guide themselves on their ability to stick to the rules. This is where guidelines actually come from. So the clinician would naturally be trained to say, “If the guidelines say this is what I should do, if the guidelines say this is what should work, then my job is to let the patient know that, let the person know that.” And the challenge is, obesity management is not transactional. Obesity management is relational. All chronic disease management requires the relationship between the provider and the person with the problem. The reason is because the solutions require the person with the disease, with the condition to do the work to make the change happen. And this is true of all intervention. So any lifestyle-related intervention, any medical-related intervention, any surgical intervention requires a significant component of behavior on the part of the person. So the question really becomes, for us as clinicians, why should anybody ever listen to us? Because they will make their choices based on what their life is like outside of the clinic, not inside the clinic. If the outcomes that we’re trying to achieve were controlled by what we clinicians do inside the clinic, now, think of the anesthesiologist, think of the surgeon, you’re good to go. So this transactional model may work in acute medicine, which is really the foundational perspective that all of us have been trained in. And the reality is, we work in a relational dynamic. And so this is so important, because many clinicians kind of say, “I’m going to lead, and the patient’s going to follow.” And some of us are really good at leading. And, you know, I think of this metaphor, that we’re sort of, we’re on the journey, but we stop. You know, we’re 30 steps down the road, we stop, we look back, the poor person is like at step one, step one and a half, because they’ve run into barriers. So the essence really is, and I think this is what I’m so happy about in our guidelines, is that we sort of really emphasize the behavioral, medical, and surgical pillars, because we believe that all of the interventions for obesity management, be them lifestyle-related, be them medical-related, or surgical-related, are in essence on the basis of the relationship that’s established. And people will follow advice if they feel respected, if they feel understood, if they feel supported, and importantly, if they feel that the message that’s delivered is actually suited to where the person is in the moment, not where the clinician wants the person to be, but where the person is. So in essence, we feel that there’s a fundamental challenge between this transactional approach, that we would all kind of be very comfortable with, with the relational approach. And I think what you’ve kind of identified, Roshan, is what happens to us when we go, “Uh-oh, the transactional approach isn’t working. What do I do next?” And I think that describes some of this tension that we experience.

– Yeah, and speaking from, you know, the opposite side of that conversation, you know, the patient side of that conversation, I know that I’ve been in many situations with medical professionals where they’ve been struggling with that shift from transactional to relational. And I truly believe that most professionals really want to do 100% the best for their patients. But I guess my question would be, Dr. Vallis, is, from a practical point of view, what does that look like when you’re interacting with a patient, that shift from transactional to relationship-based? What are the actual practicalities of dealing with that in your clinic with the person?

– I love that question. The actual practicalities is that you have to look at yourself, not the person, because the main barrier is the emotional reaction that the clinician has to letting go of control, to recognizing, “I’m going to ask a question. I have no idea what I’m going to do after that,” because I have to wait, listen to the answer, and then somehow I have to base my next response on what the patient says. That requires some trust, it requires some comfort with a distress of saying, “I don’t know what I’m going to do today in this interaction, because I’m not sure where the person is and where they are.” I have to be honest, most of us would feel we’re comfortable if we said, “I got this down, I know exactly what I’m going to do. I do this every day. It’s sort of bang, bang, bang.” So what we often find is, just like human behavior change, we find that it’s hard to make a change because most of our behavior is rooted in the subcortical, fast-thinking system, which we understand when we start to think a bit about, you know, food choices and behavior choices. We sort of introduce these as part of our interventions, but what we understand is that this also applies equally to us as clinicians. So I think one of the things that’s really important, and this is something that Tiffany and I have really spent a lot of our time kind of focusing on, is how do we help the clinicians kind of get comfortable with, you know, letting go of control and recognizing that it’s not my job to make the person change, if the person is struggling, that doesn’t mean that I’m failing, so we can recognize that it’s really about, my job is to meet you where you are, and then together, let’s go forward. But I’m not going to go too far beyond you. I’ll take a step, and then I need to look back, think back to that metaphor I said of, you know, I’m 30 steps down the road, and you’re one, how did that happen? How did a clinician move 29 steps forward before noticing that the patient wasn’t there? So I’d encourage people to think about that in the sense that take, you know, that emotional reaction to like, “I don’t know what to do next,” and say, “Hey, what do you think we should do next?” Because if you turn after you move to the second step, and you turn to the person who’s back at step one, you say, “Hey, is this working for you? Where do you think we should go next together?” So it’s interesting in a way, isn’t it, Michelle? We’re the experts. But what we’re really talking about here is dealing with this distress of letting go of control and actually understanding that collaboration means that it’s the co-creation of the solutions that manages my emotions, but also keeps the patient and the provider connected.

– So let’s talk about a little bit more about what that looks like in the real world. So you’ve worked with healthcare professionals, and I think we’re getting into this a little bit more. I love your mention of trust, because it is the cornerstone of the relationship that we have with patients, and yet it flies in the face of our education system that intentionally or unintentionally reinforces the importance of control over patients. Whether we like to talk about it or not, control and power end up being a very central component to our education system in the healthcare professions, not just in medicine. So you’ve worked with a lot of different healthcare professionals. What are some of those strategies that we can use, or concepts that we can use, that can really shift that focus, again, given how deeply rooted the importance of control is within each of these professions?

– Absolutely. I love the way you presented that, Roshan, because when you think about how we’re in control, this is when abuse, this is when stigma, this is when bad things happen, when a person sort of wants to take control in a relationship. So we know this from psychology, we call this the sort of interpersonal circumplex, how people stay connected.

– Right.

– And if one person is dominant, and the second person is dominant, you have conflict, you can’t stay connected. So if you’re a help seeker, I’m struggling with my weight, I’m worried about my health, I want to achieve a goal, I’m vulnerable, and I come to you, and you’re taking control, and you’re dominant, I have no choice but to submit to you. And because the only way you can stay connected to someone who’s dominant is to be submissive.

– Correct.

– And this sets up that really negative, negative. So what often occurs to clinicians when we think about power and control, do they really want to be in power? I don’t believe so. Do they really want to be in control? No, I don’t believe so. I’m with Michelle. I think they want to do the best for their patients, and they have an idea in their head. So what I would say to the clinicians is, take your ideas in your head, what’s really good about your advice to your patients? Write it down, make a podcast, make a poster, record it, and have it there, and then offer that to the patient. In other words, what I’m suggesting is that you can be reassured that your competency will be represented. You don’t have to dominate the conversation. You could take all of your evidence-based clinical practice guidelines influenced and experiential knowledge, put it into a document and say, “Here it is.” Now, all of a sudden, you’ve got what we psychologists call the third object in the room. So let’s say I want to make some recommendation to you. And I say, “Roshan, I want you to eat differently.” Well, if that’s exactly what you want in this moment, you might say, “Thanks, Michael, let’s go.” But that’s not really where you are, you might kinda say, “Hey, who are you to tell me what to do? I’m not sure this is really right for me. I guess I’m not really comfortable.” You’ve got this sort of tension. But if you kind of said, “Would it be okay if I shared something with you?” And then you hold up this document, and it’s like you and me looking at this document, this third object in the room allows you to introduce this information. And then, as a clinician, you can say, “As you are ready, we can look at this. Here it is.”

– Yeah.

– “It’s there.” If I made a five-minute video of basic stress management interventions, I’m a psychologist, I’m competent at delivering stress reduction strategies, I could make a list on a poster, a video, an audio, and I said to the person, “Here it is, you got it. You can listen to it a million times.” And it takes that dynamic that comes across as power and control, which I think is negative, and it allows you then to say, “I’m an expert. Here’s my expertise. You are an expert in your life. Let’s work together.”

– That’s so well put. And I love that as a practical tidbit for our clinicians. I know I’ve thought about something similar in our practice, and I think I’m going to take that home with me, and bring it actually to our clinic and think about, and it’s, again, not just for obesity, it’s for all chronic disease management. It’s a lot of the outpatient management that we have to look at. We have to really examine the power differentials that exist within our practice. A lot of our community has heard the mention, and you’ve mentioned, about the grand apology. And I think it’s important to sort of segue into this concept because it does ultimately talk about and speak to power and trust. Can you elaborate on this for us a little further?

– Yeah, I appreciate that this concept that I have labeled the grand apology is beginning to get a little bit of traction, because I think it’s really important. The best way that I could communicate it is that anyone listening to this as a health professional, just think about the next patient you see for the very first time. And all of the evidence would tell us all that we know about stigma and bias is that that next patient you’re about to see knows that you hate them before they’ve even walked into your office. Now, that’s a very, very strong thing to say. But why would I say that publicly? Because the evidence on stigma would support that. That the person living in a larger body about to see a clinician is anticipating rebuke, criticism, and being blamed and shamed, because that’s happened across their experience throughout their life, as early as the development of their challenges with obesity. And so this is the essence of the grant apology. How do you establish trust? Because as we reframe obesity from a behavioral failure to eat less, move more using willpower, the idea that weight is under behavioral control, as we revise that to, obesity is a chronic disease, primarily centered in the brain, biologically controlled, weight loss is neurobiologically resisted, and therefore we need to look at the appetite system in a very neurobiological way, that’s great. But here’s the catch, Roshan, clinicians do not have memory. As new findings come on, we learn about new discoveries, we have new methods of doing things. We say, “Great, we’ll stop doing the old, and we’ll do the new because it’s working.” Excellent. We don’t have a memory, we let go of all that stuff. But your patient has a memory. So how do you deal with this issue of saying, “Oh, I’m different, Michelle, from every other clinician you’ve seen. I believe this new model. Trust me, I’m a doctor.” It’s just not going to work. So the concept of the grand apology is that we, clinicians, have to view people with obesity as vulnerable. We have to accept, and this is where the apology comes in, we have to accept that the person has been discriminated against by us, by our profession, maybe not you as an individual, but by you as a professional. And as a result, we need to own that. And so the grand apology is recognizing that, labeling that, and taking responsibility for that, and say, “Would you be willing to start over again under a new framework, in which I would look at you, we can look together at you from a much broader than eat less, move more using willpower?” And we have been here before, we did this exact same thing with type 2 diabetes about 25 years ago after the release of the United Kingdom Prospective Diabetes Study. Prior to the UK PDS, we looked at type 2 diabetes as a behavioral problem. And we would threaten people with insulin. We would tell people that they had to get their act together, or we would’ve to increase their medication. We made them feel guilty, even to the point now, where we have a psychological phenomenon in type 2 diabetes called psychological insulin resistance, where people have developed attitudes towards insulin in which they feel that insulin is a failure, et cetera, et cetera. So we’ve been there before. We had to revise our relationship with our patients after the UK PDS. And now, we’re doing that in obesity. And so labeling that as the grand apology is a way of us taking responsibility for that, and then offering the person living with obesity an opportunity. And so imagine, Michelle, if I say to you, “Would you be willing to maybe start afresh, and then you’ll judge how well we do together?” That’s the grand apology.

– So speaking from a patient, I’m going to be really honest, I’ve seen a lot of health professionals. I have never actually received, as a patient in a room, the grand apology. So I think we have some space to move there. But I do think that it’s important, as you said, because that grand apology opens up a safe space, right? Without it, I think you’re going on an uphill battle here. You know, until you have that safe space, that patient isn’t going to open up to you and be involved in this relationship, right? It’s going to be the power dynamic again, where you say, “Do this, do this, do this.” And I, as the patient, will go either, “Yeah, already doing that, don’t want to do that, can’t do that.” But am I going to tell you that? No, no, no, no, no, no, right? Because you’re the person in power, like I’m not going to say it. So from the grand apology, what are your ideas about making it a safe space to have a conversation, a productive conversation, with your patient?

– I think it’s fairly straightforward if you can think about a rhythm of communication. And so, again, let me use that sort of journey metaphor. And so, one, two, check in with the person, one, two, check in with the person. Don’t give more than two bits of information, two aspects of your recommendation, before you then stop and say, “Michelle, what did you think of that? Does that make sense to you? Are you okay with that?” And that will establish the trust because then you’ve demonstrated to the patient. So let’s say, as a clinician, you say, “Okay, I want to review maybe five or six concepts today.” Well, that means three, four times during that session, you will have stopped and asked the person about their perspective there. In your mind, it may slow down the process. In my mind, it makes the process much more efficient, because if you’re in the collaborative journey with the patient, you don’t have to repeat your steps over again. And this, I think, is a huge point. Many people say, “I don’t have time to explain it fully, so I’ll just rush through it and just hope it sticks.” Whereas, in fact, a more efficient way is to make a step that you don’t fall back on. Because then what you’ll see over time, and remember, chronic diseases don’t go away, so people with chronic diseases deserve continual care over time. So there’s much, much more opportunity. So one, two, one, two, one, two, and you can check in with the person, and then once a person kind of feels trust, and I’d like to sort of, you know, ask you, Michelle, when you think about that, if you know that that clinician is open to your opinion, truly interested in you as a person, and really wants to kind of, to meet you where you are, what impact does that have on your receptivity to the message?

– Yeah, and also that piece that you talked about briefly, about it being a collaboration, right? So this isn’t, “I tell you what to do, you go do it.” It’s like, “Let’s have a conversation about here are the things I think we should, as a team, work on.” And it’s a conversation because people are complex, right? There are so many factors into behavioral changes around obesity, that one size will never fit everyone, right? So it really does have to be that collaboration. It’s so important, so important.

– And the message, thank you for saying that, because the message that I would like to send is that the solution to that complexity is creativity.

– Yeah.

– And who is the person who’s got the power to be creative in the solution? The patient, not the clinician. We would be hopeless at trying to figure out just exactly what am I going to say to Michelle that’s going to kind of be the key in the lock? Good luck. But if you think to it, “Okay, what do you think would work for you? Let’s talk about various options.” I have learned to trust the patient. So trust is a two-way street, that I believe the patient has power and has the ability to understand exactly where they are in the moment, and exactly what some of the potential issues are. So some of that can be solved with that creativity that I believe we need, as clinicians, to respect. Because if we respect the power of our patients in their creativity to adapt and adopt what we’re saying to fit their lives, that’s what their expertise really is. And we never have to go into that, right? We just respect that that’s their journey, then we’ll be matched in our space.

– I think there’s a certain power to this as well, just to bring it back to the clinician actually being open to creativity. Like as soon as you mentioned creativity, it just sparked a lot of thought in my mind, because that’s something that drives me in all the work that I do. It stems from my background, it stems from my interests. And we don’t see nearly enough of that through our training processes in the health professions education programs. We don’t even bother to talk about creativity. So, yes, the creativity comes from the patient, but we also need to create that space. And I think our clinicians need to actually about creativity themselves, right? Coming back to what you were talking about at the start, about how it actually comes from the person itself, that clinician, and how they actually want to create that space, there could be creative ways of doing that within the clinical space that actually opens up a safe enough environment to have the conversation, to actually allow then the patient to be creative. So I do think it is, there is a two-way street sort of in this, in that we do need to encourage our clinicians to actually think creatively, not to impose their creativity on the patient, because that doesn’t necessarily help it. But if we at least encourage it, we could maybe get some progress in the way that we create that openness and that safe space.

– Interesting that you say that, because we will talk about our training program, and we try to model our training program on the exact same dynamics that we’ve just described. So we offer a training program, but we would say we never tell a clinician what to do. It’s not our job to teach them what to do, it’s to help them think it through, so they can make their own creative choices using some of the principles. And that’s where our educational framework would come from.

– And hopefully, we’re going to get to that. Before we move on, though, we always like to take a moment for our bias break, a chance to pause and reflect on how bias, even when it’s unintentional, can shape the way that we communicate with and care for people living with obesity. So Dr. Vallis, you’ve worked with so many healthcare professionals who come into this work with good intentions, but sometimes hold assumptions they don’t even realize. Can you share a real moment or story that illustrates how bias can show up in care, and what happens when we approach those moments differently?

– Yeah, I had a really interesting experience this morning, quite an academic experience, but I found it quite interesting. I was doing a review of journals, as we all would do. And I was reviewing the recent issue of the “Journal of Behavioral Medicine,” and encountered a paper that looked at presenting scenarios to people around weight loss, whether it was achieved through GLP-1 receptor agonists or healthy lifestyle behaviors, and matched that with whether the person was sort of a description as to whether there was a behavioral sort of foundation of their obesity, or a genetic foundation of their obesity. And what was super interesting and terrifying to me is that when this was then implemented, so people were made ratings of either judgments towards these individuals who were the sort of descriptors of the patients. And the perception is that GLP-1 is an easy way out, and it increases the bias against those people that, and it was, you know, fascinating to hear that, even if it was presented as genetically caused or behaviorally caused. So I found that to be alarming because, you know, as Michelle was saying, you know, you’ve never really heard that grand apology from a clinician. And I sometimes think that, you know, I feel really excited about the obesity domain. I really love being a professional in the obesity domain because I feel we’re co-creating solutions. Then I read a paper like that, and I think, “Oh, boy, do we have a lot of a journey to travel on.” And I’ve kind of felt personally that maybe the following phrase that I’ve been touting for a long time has been overused, and that is don’t confuse behavior with biology. And all of a sudden, it’s like, holy cow, people still view obesity as a lifestyle choice. And not only is that their dominant, but that, you know, I like you even less if you pursue what we know as the effective treatments, because I am so excited about the advancement of medical therapies for obesity. I’ve been with practice a very long time. And when I started, diabetes type 2 was a, you know, behavioral problem, then we revised it. And so in the excitement of that, I think we’ve got a great environment. Go to the our summits, our workshops, and we talk and in such an advanced way. And I sometimes think, “Wow, we’re really good.” I want to pat myself on the back and think we’ve come a long way. I read a paper like this, and I think, “Holy cow, we’re just scratching the surface.” So I think, for me, that’s my story of the day.

– Wow.

– Wow.

– Wow.

– You’re not making me feel any better today. No, and I’ll explain why, because as someone who lives with this chronic condition, right, and knows the falsehoods of, you know, just eat less, move more, I really thought that once we had a medication that worked on the brain, I thought the fight would be with society. Apparently, we still have to fight with the people who are scientists at heart, right? Medical professionals are scientists at heart. And if even them can’t see that we have a medication that works on the brain, and they still think it’s a lack of willpower or that kind of thing, oh, we got a bigger hill to climb than I thought when I woke up this morning.

– Let me see if I can inject a little bit of optimism, because I think the message is that it’s not enough just to give a solution. You gotta tackle the problem head-on. And I heard this in a meeting yesterday for another chronic disease. I’ve been invited to do a webinar in the cancer area in September. And we were talking about this. Dan Drucker, who you all would know as one of the founders of the GLP-1 receptor agonist, has been invited as well. And then a person who’s organizing it was saying, “Well, this is great, because what we’re thinking is that, you know, what we do, we bring that person, you know, involved in the GLP-1, and then we can talk about how you can get off the medication.” It was like, “What?”

– And so I said, “Well, what do you do with people who have hypertension? What do you do with people”-

– Exactly.

– “Who have type 2 diabetes? When do you tell them that it’s now time to move off the medication?” And it was an uncomfortable few moments, but I think for us, I think the optimism is, now, we’ve got the evidence, and now, we can tackle the issue. And that’s why I love the idea that we’ve developed the medical therapy so well, because now, the psychological pillar, we no longer have to help people create and maintain a calorie deficit. And that’s where I have come from that don’t confuse behavior with biology, because that calorie deficit is managed primarily by interfering and intervening on the appetite system, which we know a lot about now. And so, now, the behavioral and psychological pillar is really open to things like, how do we then really go after our colleagues? And so for me, you know, whenever I see that, Michelle, in a colleague, and because I am a health professional, and I’m recognized as working in obesity data, I think I can get away with this. And I say to my colleague, I say, “Do you believe in evidence-based medicine?” And Roshan, you could imagine as a physician what physician would say no. And you see, I’m setting them up, right? Because I say, “Do you believe in evidence-based medicine?” They say, “Of course, I do.” And then I say, “Why aren’t you practicing it?”

– Yeah. Oof.

– And it stops the conversation. And so I think what we need now, Michelle, are conversation stoppers. And in that pause that happens, and you see, this is what Piaget told us a very long time ago, that most of the time, we just a accommodate information, and we need to create new cognitive structures. And the only way to create the new cognitive structure is to disrupt, he called it disequilibrium. And so it’s that disruption. So we need to be disruptors now, which I think is great, because we’ve got so much evidence to be able to disrupt it. And when we started the pharmacotherapy journey, the FDA, the EMA, Health Canada, held, and still holds, these pharmacotherapy agents for obesity at the highest ever standards for the clearance of these drugs. These drugs are so super examined at levels that you wouldn’t believe. As you know, some of the trials that have been behind these newer medications, you’re getting retention rates over 95%, you’re getting, you know, CBOT trials required before therapies can be validated. So we’ve cleared that hurdle. So, now, we’ve got more evidence than is necessary to be able to disrupt. So I’m actually getting optimistic about we zeroing in on the challenge. And now, we need to be kind of, I think, a bit of a disruptive force with our colleagues.

– I think this is a fantastic conversation, I do want to bring it back to sort of the clinical realm. One thing that stood out for me in your work is how often clinicians actually report that once they learn these skills, they actually feel more effective and more connected to their patients. This is clearly transformational on both sides. Why do you feel this is the case? And if you’ve worked in interdisciplinary teams, right, have you seen this approach change for how teams communicate with each other too? Because I think there are parallels with that as well, and I think there’s really valuable parallels that we can see.

– 100%, yeah. I think the kind of feedback that Tiffany and I have received from our learners across the disciplines, and that’s one of the really nice things, I think, that I’m happy about with the program that we’ve been working to develop, is that it’s really the health professional, it’s the common factors across all of us, whether you’re a physician, a dietician, a patient representative, whatever it would be, and that is when we heard feedback like, “I cannot unknow this.” And so, and then what ends up happening is that when they see these, say, what we call teach and tell, and then more of a judgemental perspective with their colleagues, they’re just kind of in this situation where they become those sort of disruptors. So I think that yeah, it’s actually, is transformative, and that sort of disruptive disequilibrium that allows people to do that. And then that comment, “I cannot unknow this,” it really shows up as relevant.

– So much of what we’re describing, the tools, the mindset approaches, feels like the kind of thing that should have been part of our clinical education from the very beginning. But for those of us who didn’t get it, where do we begin?

– Yes, so we’ve developed a course called the Advanced Obesity Counseling Certification Program. It’s a relatively intensive course, and I can share some details about that, if you’d like, in a few minutes here that we think is addressing a lot of these concerns that have been raised, and providing clinicians with the opportunity to develop these skills and this mindset. And we actually kind of refer to it as a mind map that will allow them to enter into these interactions in more effective ways. So the program is about eight months long, just shy of that. And it’s broken into three segments, we’re calling them awareness, competence, and confidence. So the first segment, the awareness sessions, are a self-directed learning module, it’s five weeks, where the learners go through the program and get all of the content upfront in those first five weeks. So even though it’s a lengthy program and it’s almost eight months long, we actually don’t introduce any new content after the first five weeks. We repeat it again and then again in confidence and in competency, and then in the confidence sessions. After the self-directed learning modules are done, we start the live sessions, where we have weekly 90-minute sessions that are focused primarily on practicing the skills. So it sort of follows the see one, do one, teach one kind of model, where the awareness is, you see one, you get the background and all the basics, in competency, we do one, we practice all the skills, we really dive down and kind of like look at them individually, and give lots of opportunities to practice in the live sessions, as well as doing homework in between. And then in the third segment, confidence, the learners do a teach-back, where they come back, and we do eight weekly sessions again, where the learners are providing the content one more time to one another. And so this is a really intensive program, as it sounds like, but there’s a lot of things that we’ve done to try to, you know, support the difficulty that goes along with this type of learning, because change is hard, as we’ve been talking about, and this is sort of, you know, uncomfortable work for a lot of folks to kind of get in and actually need to like practice these skills with one another and get in front of us, and get in front of another, and try these counseling skills out. We really emphasize creating a safe environment. We normalize how this feels clunky. We normalize how we’re not trying to achieve perfection at all. We never, like Michael said, say, “Here’s what you say in this interaction.” “When my patient says this, what do I do?” We steer clear of that entirely. And rather our focus is to help the learners develop what we call this mind map, which is the sort of constellation of these different competencies that we believe supports helping patients move through behavior change.

– Just in the last little minute or so, is there any sort of feedback from learners so far, any sort of initial takeaways from the learners about applying these skills in the real world?

– Absolutely. So even throughout the program itself, the learners will come to session and tell us about times that they’ve trialed things out, how it went, when it felt clunky, when it, you know, worked really, really well. And then after, we’ve, you know, either had email interactions or just run into learners at different sort of conferences and whatnot, where they’ll say, you know, like, “This has really changed my practice.” Michael said earlier that, you know, we hear you can’t unknow this. And it really does sort of change that fundamental, you know, mindset, it seems, based on the feedback that we’re getting. So we do hear them using it, trying it out, and seeing positive outcomes.

– Awesome. Awesome.

– Awesome. Yes, I think we could talk about this and this new way of interacting with patients for hours and hours and hours. Unfortunately, due to time constraints, I’m going to close things out today. And what I want to just say is, as a patient, what I can say is that the biggest difference it makes to me when I’m in the room with someone is that I’m involved in the process. And I think we’ve emphasized that today. And I just want to thank Dr. Vallis and Dr. Shepherd for bringing that forward, because I think that’s such an important message to get to our audience.

– Yeah. If you’re a healthcare professional looking to go deeper in your work to have better conversations with patients and support real change, the AOCC might be a great next step. The next cohort starts November 20th, and seats are limited to just 20 participants. You can learn more or register today by visiting the link in the show notes below.

– And as always, if you found this episode helpful, share it with a colleague. And if you’ve been enjoying the podcast, we’d really appreciate it if you leave a rating or a quick review. This’ll really help others find this valuable podcast as well.

– Until next time, stay curious, stay kind, and keep scaling up your practice. This podcast is intended for informational and educational purposes only, and does not constitute medical advice. The content shared in this podcast should never be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional with any questions you may have regarding your health or a medical condition. The information and treatments discussed in this podcast are based on Canadian guidelines and approved practices as of the time of recording. If you’re listening from outside of Canada, please consult your local healthcare professional to ensure compliance with your region’s medical standards, guidelines, and recommendations. The creators of this podcast disclaim all liability for any decisions or actions taken based on the content discussed. Listening to this podcast does not establish a professional or patient-client relationship.