Up Close Interview: Opening Up Diabetes Education Programs Across the WorldFriday, April 29, 2011
As Director of Clinical Education Programs at Joslin Diabetes Center, Melinda Maryniuk, M Ed, RD, CDE, travels the world to open up new education affiliates for the center.
By John Parkinson, DiabetesCare.net Clinical Content Coordinator
Melinda Maryniuk is a highly recognized industry professional. She won the prestigious Medallion Award from the American Dietetic Association this past November. This award, for outstanding service and leadership to the association and the dietetics profession, is one of many she has won over the years, including the Outstanding Educator in Diabetes American Diabetes Association, the Award for Excellence in Clinical Nutrition, and Recognized Young Dietitian both from American Dietetic Association.
She credits part of her success to her involvement with professional dietetic associations. Now she is in a management role at Joslin—where her career began—she spends a lot of her time traveling the globe working with the numerous Joslin affiliates outside of Boston. Along with distinguishing herself with numerous accolades, she has been an educator first and foremost who wants to help people.
DiabetesCare.net sat down with Maryniuk right before she was headed to Kuwait for a Joslin-related function. Here are some of the highlights from that conversation:
DiabetesCare.net: Why did you decide to get into diabetes education and achieve your CDE?
Melinda: While I was still a student, and before I had narrowed in on diabetes education, I was on a student health team project for the American Medical Student Association. I worked for a summer in Appalachia with a student doctor and nurse. They were trying to give us a sense of what it was like to work on teams in medically underserved areas. I worked in a very poor physician’s office without a lot of resources. The physician asked me to take a woman to lunch. She had diabetes and she wanted a companion. It turns out she was blind and they wanted me to escort her and help her eat. And I think they thought I could teach her some nutrition advice. She ended up teaching me a lot—what it was like to be blind, living with diabetes, figuring out where the food is on your plate. It was my very first connection with food and diabetes.
My first job was at Joslin. I haven’t been here the whole time, but that first job, I just became passionate about the people. I didn’t see sick people, but I saw people who happened to have a condition that they lived with, but I could see that being more active, eating better could make their lives easier. Back then, there was no such thing as a CDE, but I knew this is where I was destined to be (she laughs).
DiabetesCare.net: Can you describe what you overall role as director of clinical education programs at Joslin involves?
Melinda: The role I have had at Joslin for the last 15 years or so involves diabetes activities that are external to the Joslin clinic in Boston. We setup and run affiliates in about 40 different locations around the world, because some of them are outside the United States. We do lots of collaborative programs with pharmaceutical companies and food companies that have an interest in diabetes and want materials, programs, or trainings set up for their customers or their employees. (We do things) such as training sales reps of pharmaceutical companies to know more about diabetes or developing special programs that can be implemented in primary care physicians’ offices. We have a broad mission of improving the lives of people with diabetes to give them as much information and knowledge to make their conditions better.
DiabetesCare.net: You have been recognized with several professional awards, including most recently the Medallion Award. How have you managed to distinguish yourself with numerous accolades?
Melinda: It was a great honor to be nominated and supported by people you have worked with, and it was very humbling to know it was peer-supported nomination and award (the Medallion Award).
When I started over 30 years ago, I didn’t know other diabetes educators. There just weren’t that many of us. I got involved in professional organizations to widen my network of people who did what I did. There were a few educators in Boston, but I wanted to learn more. What I found interesting was looking outside of Boston and looking at what other people were doing and how they were doing it. I realized this could be a profession that could grow.
A lot was being done, but it was being done by volunteers, and I could help. I could help write a newsletter for this organization or help draft a position statement for another organization. It was a slow learning process that if you want something done in your field, you have to do it with a group of people. You don’t get paid for it, but boy you reap a lot of benefits meeting a lot of interesting colleagues in a similar field around the country.
I learned a lot, met a lot of people and I think it helped me develop better diabetes education counseling skills and programs and service because I have this wide network of excellent colleagues that were also learning and growing as I was.
DiabetesCare.net: What do you see as the primary challenges in the CDE field today?
Melinda: There have been a lot of steps forward, and some of the steps are not forward enough. Yes, we are getting some reimbursement for what we do as diabetes educators, but not enough to really cover the salary we feel we should get. Not enough physicians are aware of where diabetes educators are located and how to refer to them. Many CDEs don’t have a large enough patient base to really keep them as busy as they can be with the large number of people with diabetes that are out there. You would think every diabetes educator would have a long waiting list.
There is still a disconnect between patients who maybe feel they don’t need this service yet. How do we make what we offer even more interesting and valuable to the consumer so they are clamoring to see the CDE, because once they do, they go, ‘Ah, this is so helpful why didn’t anyone tell me before?’
DiabetesCare.net: In looking at patients who are not in compliance with their diets, how do you combat that and try to get them back on track?
Melinda: One of the things we do differently now is try not to tell people what to do. That’s what they think they want, but whatever the challenges we see, such as they are eating too much carbohydrates, not losing weight, eating too much fat, or whatever it is, try to turn it back to them as much as possible. Ask them, ‘what is getting in the way? Why is this hard? Do you want your A1C at goal? You have got to get them help come up with the solution. Using more of the techniques from motivational interviewing. The point of this is to have most of these changes be patient selected and driven. Our job as counselors to increase compliance is to help break it down into smaller steps to see exactly what they need to do and to help them define with as much specificity and clarity what they will do. Research has shown the more specifically someone will describe their implementation and intention of exactly what they are going to be doing to get back on track, the more likely they will be to do it.
DiabetesCare.net: What are your most important gauges and metrics you use in determining if a patient with diabetes is doing well?
Melinda: I try to focus on their biomarkers. I’m wanting to looking at their A1C, blood pressure, and LDLs.Those are the three most important clinical parameters to know. Now certainly, if a patient has an appointment and he doesn’t show up that is a flag as well. We don’t just look at how they are doing medically, but we also assess by looking at things like if my no-show rate is increasing, people aren’t returning for visits, or they are not engaged. We do try to look at a couple of different metrics when we look at success.
DiabetesCare.net: You have been traveling abroad and learning how diabetes education is applied internationally. Are there any particular tips or approaches that may work here in the U.S.?
Melinda: Everywhere I have traveled in both the U.S., and abroad you meet interesting people who are passionate about improving diabetes care. I have been fascinated about meeting these people; I don’t think it is unique to being abroad, but everywhere I go, diabetes is one of those conditions where people have worked in it for a while they really put their heart and soul into helping their patients.
That being said, one of the centers that comes to mind that I have worked with is in Japan, and there is this couple that runs a diabetes clinic. They are so creative and devoted in the ways that they have offered a number of different education programs that blend in music and the arts in some way. For example, a physician will give a series of lectures and in-between segments they will have a small musical ensemble playing. People never get bored.
In Hong Kong, I met a group of nurses and dietitians that take a group of adults with type 2 diabetes every month on a Saturday on a hike. And they may do that in the U.S.—there are a lot of devoted healthcare workers (everywhere).
DiabetesCare.net: How much of an influence does technology have on continuing education for CDEs and for patients in managing their own care?
Melinda: It is changing the way we operate. For continuing education, I can get a lot of my credits online. Technology and how it affects the patient is huge—changes like insulin pumps and glucose monitors, where they can see where their glucose is minute by minute.
At the same time, there are advancements in the way that patients can get educated and get motivated through technologies. Joslin has launched a Facebook game called Healthseeker (in collaboration with Boehringer Ingelheim Pharmaceuticals), which helps patients who choose to do this on Facebook and have their network of friends help them. We are doing our best to keep up with social media to stay ahead and to reach more people through the use of technology.
Feedback: Are you interested in finding out more about the Healthseeker game? You can go here to find out more. Have you heard of any interesting education approaches?
Do you work for any of the Joslin affiliates? What has your experience been like? E-mail me your thoughts at firstname.lastname@example.org.
Originally posted by DiabetesCare.net on April 29, 2011.