Unit 1: Introduction to Lifestyle Medicine Core Competencies | Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM
Lifestyle medicine is the evidence-based therapeutic approach to prevent, treat and reverse lifestyle-related chronic diseases. Core competencies for lifestyle medicine were developed by a national consensus panel to serve as a framework for training healthcare professionals. They include leadership, knowledge, assessment skills, management skills, and use of office and community support. This eCourse emphasizes the importance of lifestyle medicine, compares and contrasts lifestyle medicine to other fields of health and medicine, describes the unique role of lifestyle medicine, as well as explains each of the core competencies in lifestyle medicine and how they impact both healthcare practitioner learning and practice.
Unit 2: Personal Health and Community Advocacy | Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM
The leadership core competency for lifestyle medicine focuses on the need for healthcare practitioners to not only promote health behaviors in others but to also engage in such behaviors. This eCourse cites the data supporting that providers who practice healthy lifestyles are more likely to offer counseling and improve patient outcomes, reviews strategies for incorporating wellness into clinic, medical office or other health care settings, and guides the participant to develop a personal action plan. Providers need to routinely practice healthy behaviors to serve as role models for patients and achieve optimal personal well-being. Course participants will learn to personally practice healthy behaviors to achieve optimal personal well-being, avoid burn-out and serve as role models for patients.
A key component of leadership is being able to advocate for efforts to improve healthy lifestyles. This eCourse also describes how to conduct effective advocacy on behalf of lifestyle medicine with policy makers and community decision makers. Course participants will learn basic advocacy skills to support public policy endeavors in their communities that support healthy lifestyles.
Unit 3: Health Behavior Change Theories and Approaches | Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM
Behavior change is key to improving patient health outcomes, especially in those with chronic conditions related to lifestyle factors such as diet, exercise, and smoking. This eCourse reviews major health behavior change theories and their potential application to clinical practice and the key elements of conducting patient readiness assessment and stage matched responses. The process of building effective relationships with patients, motivational interviewing, and cognitive behavioral and positive psychology techniques are critical in patient care and are summarized here. The eCourse also provides strategies for supporting patients’ behavior change, developing action plans, building patient self-efficacy, maintaining healthy behaviors and relapse prevention planning.
Unit 4: Health Behavior Change Counseling | Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM
Unit 5: Health Behavior Change Action Planning and Relapse Prevention | Liana Lianov, MD, MPH, FACLM, FACPM, DipABLM
Unit 6: Healthy Behavior is Foundational to Lifestyle Medicine | Marc Braman, MD, MPH, FACLM, FACPM
- Lifestyle medicine focuses on behavioral determinants, which are the causes of most modern disease.
- Changing unhealthy behaviors reverses the direct causes of modern disease.
- Lifestyle medicine has a key role in the spectrum of treatment options (is foundational), because of its emphasis on the cause of disease.
- Financial and clinical factors force the advancement of lifestyle medicine for sustainable healthcare.
- An essential skill of a lifestyle medicine practitioner is to promote lifestyle change as the foundational approach to achieving health outcomes.
Unit 7: Lifestyle Medicine Evidence Base | Marc Braman, MD, MPH, FACLM, FACPM
- Lifestyle medicine is powerful in treating and preventing diseases.
- Intensive lifestyle programs, such as Ornish, Pritikin, Complete Health Improvement Program (CHIP), are available and effective.
- Counseling guidelines and USPSTF grades provide useful guidance.
- Specific conditions can be treated with lifestyle interventions, such as hypertension and diabetes mellitus.
- Upstream (root cause) interventions are key to lifestyle medicine.
Unit 8: Healthcare Provider Engagement in Lifestyle Medicine Practice | Marc Braman, MD, MPH, FACLM, FACPM
- Patient-provider interactions based on patient stage of readiness to make change and empathy are key to engagement with patients for behavior change.
- Effective interactions with patients involve empathy, attentiveness, active listening, and connection.
- Patient engagement requires a patient centered approach with focus on patient priorities.
- Evidence that provider counseling is effective is mixed, due to differences in counseling techniques and intensity. Intensive counseling is needed for greater behavior change success.
Unit 9: Patient Predisposition for Change | Marc Braman, MD, MPH, FACLM, FACPM
- Upstream determinants lead to adaptive lifestyle behavior patterns that produce either disease or health.
- The “Tree of Life” model looks at the patient in the context of the continuum of ancestry to the present
- Past social and environmental factors significantly influence one’s identity and value, beliefs and thinking, emotions, and behavior patterns.
- Current social and environmental factors significantly influence one’s identity and value, beliefs and thinking, emotions, and behavior patterns.
- Health literacy is one’s mental understanding and processing of health reality, impacting risk conditions and health behaviors.
Unit 10: The Patient History and Physical Exam | Marc Braman, MD, MPH, FACLM, FACPM
- The “Tree of Life” informs the provider what constitutes the “training” of the actor, while current environment is the “stage” on which he presently performs.
- The history and physical exam find their place in the context of the past and present “upstream” factors of lifestyle medicine.
- Lifestyle "vital signs" are the basic metrics of lifestyle medicine and should be understood in the context of how they relate to each other.
- Stress and one’s emotional state are often the most direct drivers of lifestyle behaviors and are often a large factor in those seeking healthcare services.
- Conduct the lifestyle medicine oriented history and physical exam with the objective to support the valued and empowered patient.
Unit 11: Incorporating Practice Guidelines | Marc Braman, MD, MPH, FACLM, FACPM
- National practice guidelines generally align with and can be adapted, as needed, according to lifestyle medicine principles and its evidence-base.
- The trend of practice guidelines increasingly reflects lifestyle medicine foundational principles.
- Some practice guidelines are developed based on conditions and diagnoses.
- Some practice guidelines are developed based on lifestyle modalities, including nutrition, physical activity and addressing tobacco use.
- Emphasize the importance of patient-focused care vs. guidelines-focused care.
Unit 12: Working with Interdisciplinary Teams | Marc Braman, MD, MPH, FACLM, FACPM
- Lifestyle medicine is a team sport
- Patient-centered models of care bring a variety of healthcare providers together into a common process
- An effective team is needed for a high quality lifestyle medicine practice
- Clinical, operational, and business issues must be addressed when putting together a healthcare team
Unit 13: Applying Office Systems | Marc Braman, MD, MPH, FACLM, FACPM
- New models of care use the team approach in all medical settings, not only lifestyle medicine practices
- Business aspects create the foundation for clinical care, including financial sustainability and human resources
- Office systems should enable the provision of effective patient-centric clinical care, such as group visits and digital technology
- Decision and engagement support technology and systems can facilitate desired outcomes
Unit 14: Incorporating Quality Measures | Marc Braman, MD, MPH, FACLM, FACPM
- Quality improvement processes drive the best lifestyle medicine outcomes
- Quality processes in a rapidly changing healthcare environment include digital technology, big data, artificial intelligence, and more
- Using Plan – Do – Study – Act (PDSA) is one of the most common and useful quality improvement processes
- Using root cause analysis as a method of identifying causative factors in a process or situation
- Using process mapping is a useful approach to understand a process and how components relate or flow
Unit 15: Using Referral Services | Marc Braman, MD, MPH, FACLM, FACPM
- Healthcare practices need to effectively utilize national or global resources for healthy lifestyle support
- Healthcare practices need to effectively utilize local resources for healthy lifestyle support
- Healthcare practices need to modify and update systems and office flow to effectively utilize local resources for healthy lifestyles support
- Lifestyle medicine professionals are a community resource for healthy lifestyle
Liana Lianov, MD, MPH, FACPM, FACLM
Chair, Happiness Science and Positive Health Committee, American College of Lifestyle Medicine
President, Positive Health and Wellness Division, International Positive Psychology Association
Founder and Principal, HealthType LLC
Lead Faculty, ACLM Physician and Health Professional Well-Being Program
As an innovative leader in lifestyle medicine, Dr. Lianov has advanced the movement in the US and internationally, including facilitating the panel that developed the lifestyle medicine core competencies for physicians and health professionals and leading the first of its kind comprehensive lifestyle medicine curriculum. She serves as the President of the Positive Health and Wellness Division of the International Positive Psychology Association, Chair of the Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine (ACLM), lead faculty for the ACLM Physician and Health Professional Well-Being Program, and vice-chair of the American Board of Lifestyle Medicine. A few of her notable past roles include serving as president of the ACLM, Director for the Healthy Lifestyles Division of the American Medical Association and board regent for the American College of Preventive Medicine. She also directed programs in heart disease, stroke and cancer prevention at the California Department of Health Services. In 2018, she convened the inaugural Summit on Happiness Science in Health Care, which led to scholarly publications and a groundbreaking book on how to integrate happiness science into medical practice, Roots of Positive Change, Optimizing Health Care with Positive Psychology. She is currently working on launching the Global Positive Health Institute, which is advancing the mission of integrating positive psychology interventions into health care.
Marc Braman, MD, MPH, FACLM, FACPM
Owner, NW Lifestyle Medicine
Marc Braman, MD, MPH, FACLM, FACPM, spent 5 years full-time building the national professional association the American College of Lifestyle Medicine from the ground up. He was its second President and first Executive Director. Under his leadership the association put lifestyle medicine on the professional map with national conferences, collaborations with other professional organizations including the American College of Preventive Medicine and the AMA, and education and professional development for physicians and other practitioners. Initial efforts toward establishing professional standards included projects such as the JAMA publication on competencies for all physicians in prescribing Lifestyle Medicine (Lianov, Johnson, JAMA, July 14, 2010). He has practiced lifestyle medicine in settings from hospital departments to private practice in fitness centers, and continues to develop new and better systems of health care for the patients we all serve.