Personal and clinical exercise-related attitudes and behaviors of freshmen U.S. medical students

Metabolic Health Immersion for Medical Education: A Pilot Program with Continuous Glucose Monitors in Medical and Dental Students

Diet-related chronic diseases are increasing in prevalence and poised to dominate the future careers of current medical students. While the value of nutritionally-informed care and nutrition-based health interventions is increasingly recognized, nutrition education is inconsistently and often inadequately included in medical school curricula. One obstacle to incorporating nutrition into medical and dental school curricula is the density of existing coursework, with incorporation of new material necessitating removal of other material. One solution is to engage students outside the classroom in immersive education in nutrition and metabolism using health-wearables. We report the Metabolic Health Immersion for Medical Education pilot program, spearheaded and designed by Harvard Medical students centering on use of continuous glucose monitors (CGM). Students reported enjoyment with the study, felt encouraged to improve health behaviors, and shared that the experience enhanced their understanding of nutrition and metabolism, was valuable to their medical education, and would influence their future patient care. This study demonstrates proof-of-principle that metabolic health immersion opportunities for health care trainees provide a means of helping to address the current deficit in medical school nutrition education.

Medical Student Perception of Lifestyle Medicine and Willingness to Engage in Lifestyle Counseling: A Pilot Study of Allopathic and Osteopathic Medical Students

Introduction. This study assessed medical students' perception of lifestyle medicine and readiness to engage in lifestyle counseling. Methods. All medical students in one allopathic and one osteopathic medical school received a survey involving items designed to measure their awareness and interest in lifestyle medicine, perception of physicians serving as lifestyle role models for patients, and intent to practice lifestyle counseling. Results. Two hundred and eight-nine subjects (145 allopathic and 144 osteopathic students) responded to the survey. A total of 24.1% of responding allopathic students had heard about lifestyle medicine compared with 53.9% of responding osteopathic students (P < .01). A total of 90.5% of allopathic students rated their current knowledge of lifestyle medicine as inadequate or poor compared with 78.7% of osteopathic students (P < .01). Ninety-two percent of all respondents wanted to learn more about lifestyle medicine, while 95.2% believed they would provide more effective counseling if they were trained sufficiently to serve as a healthy lifestyle role model for their patients. Conclusions. Both cohorts favored learning more about lifestyle medicine and believed physicians should provide lifestyle counseling to patients with chronic diseases. Given these findings, and the demonstrated benefits of lifestyle medicine-based health care, the authors suggest that training in lifestyle medicine be increased in undergraduate medical education.

Trends in medical students' health over 5 years: Does a wellbeing curriculum make a difference?

BACKGROUND

Trends in New Zealand (NZ) medical students' health and the influence of a wellbeing curricula are unknown.

METHODS

The author's collected self-report data from NZ medical students on 'Graduation Day' from 2014 to 2018, using a serial cross-sectional survey design with validated scales assessing psychological health, stigma, coping, and lifestyle. Comparisons were made with NZ general population same-age peers. Analyses examined trends, differences between 'cohorts' of students receiving different exposures to a wellbeing curriculum, and correlations between students' own lifestyle practices and their frequency of talking with patients about those topics.

RESULTS

Of 1,062 students, 886 participated. The authors found statistically significant self-reported increases from 2014 to 2018 for negative psychological indices, including scores for distress and burnout, suicidal thoughts in the preceding year, and the likelihood of being diagnosed with an anxiety disorder. There was a significant increase in numbers of students reporting having their own doctor as well as increased healthy coping strategies and a significant decrease in stigma scores. Academic cohorts of students who had completed a wellbeing curriculum were more likely to report high distress levels, having been diagnosed with a mood disorder, and being non-drinkers than students without wellbeing training. When compared to NZ peers, medical students smoked less, exercised more, and were less likely to have diagnosed mood and anxiety disorders, but reported more distress. The authors found a significant correlation between the amount of exercise students undertook and their likelihood to discuss exercise with patients.

CONCLUSIONS

NZ medical students have better physical health than general population peers and are more likely to discuss exercise with patients if exercising themselves. However, cohorts of graduating students report increasing distress despite the implementation of a wellbeing curriculum. Research is needed into mechanisms between students' self-awareness, willingness to report distress, stigma, mind-set, coping, and psychological outcomes, to inform curriculum developers.

Relationship between exercise intensity and stress levels among U.S. medical students

BACKGROUND

Physical activity may protect the mental health of medical students, yet it is unknown which types and intensities of physical activity have the greatest potential to improve medical student well-being.

OBJECTIVE

We characterize the relationship between exercise intensity and stress levels of U.S. medical students, thereby informing the design of future well-being interventions.

DESIGN

Two cross-sectional validated surveys assessing stress and physical activity were administered one year apart at the David Geffen School of Medicine at UCLA. A total of 1,046 out of 1,392 medical students responded (75%). An ordered logistic regression was used to determine the association between stress and each level of exercise intensity (inactivity, moderate-activity, and health-enhancing physical activity [HEPA]). These exercise intensity groupings were compared to the CDC guidelines for aerobic exercise.

RESULTS

While achieving either moderate-activity or HEPA is compliant with the CDC guidelines for aerobic exercise, the additional intensity of exercise required to achieve HEPA was associated with a 26% increase in the probability of being in the lowest stress quartile and a 22% decrease in the probability of being in the highest stress quartile. Medical student physical activity levels were on-par with the national average per the CDC exercise guidelines (65% vs. 58%), but medical student HEPA levels were significantly lower than the national average (27% vs. 64%; OR 0.21; 95% CI 0.12-0.37).

CONCLUSIONS

There is a large disparity in rates of the highest intensity physical activity (HEPA) between medical students and the age-adjusted national average, which has previously been overlooked by the binary CDC exercise guidelines. The fact that HEPA levels are not optimized and more strongly associated with lower stress levels relative to less intense forms of exercise makes it a promising new target for future well-being interventions among medical trainees.

Physically active primary care doctors are more likely to offer exercise counselling to patients with cardiovascular diseases: a cross-sectional study

BACKGROUND

Regular physical activity had been shown to reduce morbidity and mortality from chronic diseases such as cardiovascular diseases, hypertension, type 2 diabetes mellitus, dyslipidaemia, obesity/metabolic syndrome, osteoarthritis, osteoporosis, bronchial asthma and chronic obstructive pulmonary disease. Research had shown that physically active doctors were more likely to offer exercise counselling to patients. However, few studies looked into this association with counselling practices to patients with specific chronic diseases. This study aims to determine the association between physical activity levels of primary care doctors (PCDs) in Malaysian private practice with physical activity counselling to patients with chronic diseases.

METHODOLOGY

A cross-sectional study involving PCDs in private practice in 3 states was done. Participants were recruited from members of the Malaysian Academy of Family Physicians and attendees of a conference. A self-administered questionnaire obtained information on sociodemography, initiation of exercise counselling to patients with chronic diseases as well as physical activity levels using the International Physical Activity Questionnaire (IPAQ).

RESULTS

The response rate was 32.3% (272/842). 47.1% of the respondents were post-graduate holders. 50% of participants had a moderate level of physical activity and 24.3% a high level. Most respondents answered 'always' or 'often' for initiation of exercise counselling to patients with cardiovascular diseases (59.9%), hypertension (72.8%), type 2 diabetes mellitus (78.6%), obesity/metabolic syndrome (86.4%), dyslipidaemia (81.6%), osteoarthritis/osteoporosis (41.9%) and bronchial asthma/COPD (29.5%). PCDs being physically active and non-smokers were associated with a higher initiation of exercise counselling to patients with cardiovascular diseases. Doctors with post-graduate degrees were more likely to offer exercise counselling to hypertensive patients.

CONCLUSION

The association between PCDs' physical activity levels and their physical activity counselling varies between different types of chronic diseases. Primary care doctors with higher physical activity levels were more likely to initiate physical activity counselling in patients with cardiovascular disease during chronic disease follow up visits.

Precision Medicine and Physical Therapy: A Healthy Living Medicine Approach for the Next Century

There is a reciprocal relationship between common health conditions encountered in physical therapist practice, disability, and healthy living factors, such as physical inactivity, blood pressure, sleep quality, diet, and obesity. This relationship is apparent across all practice settings. Physical therapists are well positioned in the health care system to mitigate chronic disease by routinely screening and addressing healthy living factors to improve overall health and lower the risk for chronic disease (healthy living medicine). However, there are several challenges to the successful implementation of this framework in physical therapist practice. This Perspective will elucidate this relationship between healthy living behaviors and physical therapist practice, review the current state of practice regarding screening and intervention of 5 key healthy living behaviors, and outline future steps the profession can take toward implementing precision medicine using a healthy living medicine approach.

Using Evidence Mapping to Examine Motivations for Following Plant-Based Diets

Motivations to adopt plant-based diets are of great public health interest. We used evidence mapping to identify methods that capture motivations to follow plant-based diets and summarize demographic trends in dietary motivations. We identified 56 publications that described 90 samples of plant-based diet followers and their dietary motivations. We categorized the samples by type of plant-based diet: vegan (19%), vegetarian (33%), semivegetarian (24%), and other, unspecified plant-based diet followers (23%). Of 90 studies examined, 31% administered multiple-choice questions to capture motivations, followed by rate items (23%), Food Choice Questionnaire (17%), free response (9%), and rank choices (10%). Commonly reported motivations were health, sensory/taste/disgust, animal welfare, environmental concern, and weight loss. The methodological variation highlights the importance of using a structured questionnaire to investigate dietary motivations in epidemiological studies. Motivations among plant-based diet followers appear distinct, but evidence on the association between age and motivations appears limited.

Medical students' perceptions of the importance of exercise and their perceived competence in prescribing exercise to older people

OBJECTIVE

To determine the effects of a 4.5-week geriatric medicine course on fifth year medical students' perception of the importance of and their competence in prescribing exercise to older people.

METHODS

The modified Exercise and Physical Activity Competence Questionnaire was administered to 81 students before and after the course. Scores ranged from 0 to 6. One open-ended question about perceived barriers to exercise prescription was asked.

RESULTS

Students' perceptions of the importance of designing an exercise prescription (P = 0.038), determining the training heart rate (P = 0.021), determining the body mass index (P > 0.001), referring an older person to an exercise program (P > 0.001) and identifying age-related limitations (P = 0.029) improved significantly after the course. Students' self-perceived competence improved significantly across all items (P > 0.001). Barriers to exercise prescription included lack of: knowledge (57%), patient compliance (39%) and time (33%).

CONCLUSION

A geriatric medicine course contributes to improved senior medical students' perceptions of importance of and their competence in prescribing exercise to older people.

Are we adequately preparing the next generation of physicians to prescribe exercise as prevention and treatment? Residents express the desire for more training in exercise prescription

BACKGROUND

Physical activity (PA) is a key intervention for chronic disease, yet few physicians provide exercise prescription (EP). EP is an important component in larger strategies of reducing non-communicable disease (NCD). Our objective was to assess Family Medicine Residents (FMR) knowledge, competence, and perspectives of EP to help inform future curriculum development.

METHODS

A 49-item cross-sectional survey was administered to 396 University of British Columbia FMR. Residents' EP knowledge, competence, attitudes/beliefs, current practices, personal physical activity levels, and perspectives of training were assessed using, primarily, a 7-point Likert scale.

RESULTS

The response rate was 80.6% (319/396). After eliminating 25 that failed to meet the inclusion criteria, 294 were included in the final analysis. The majority 95.6% of FMR reported EP as important in their future practice, despite having low knowledge of the Canadian PA Guidelines (mean score 1.77/4), low self-reported competence prescribing exercise as prevention (mean score 13.35/21), and rating themselves "somewhat incompetent" prescribing exercise to patients with chronic disease (mean score 11.26/21). FMR believe PA is integral to their patients' health (98.0%), sedentary behaviour is harmful (97.9%), and feel a responsibility to discuss PA with patients (99.7%). Few FMR (14.9%) perceived their training in EP as adequate and 91.0% desire more.

CONCLUSIONS

FMR report EP is important, yet do not perceive they are sufficiently prepared to provide EP. In future curricular development, medical educators should consider residents' low knowledge, competence, perceived program support, and their expressed desire for more training in exercise prescription.

The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models

Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.

Risky drinking and its detection among medical students

The drinking patterns of physicians may affect their own health and how they treat patients with substance use disorders. This is why we wanted to find out risky drinking among medical students. A questionnaire was delivered to all medical students at the University of Tampere and risky alcohol drinking was defined as a minimum score of five for women and six for men in the AUDIT-C alcohol screen (rating 0 to 12). The respondent rate was 94% (n=465). Of the whole sample 33% were risky drinkers, 24% of women and 49% of men. After the first study year the female risky drinkers significantly decreased and men increased their drinking. Significantly more men but not women with moderate alcohol use reduced drinking during the first year of studies compared with risky drinkers of the same gender. The AUDIT-C scored higher in the subgroups of risky drinkers willing to reduce drinking compared with those who did not want to cut down drinking (7.3. and 6.5., p<0.001). In the male sample the third AUDIT-C sub-question on binge drinking (=AUDIT-3, rating 0 to 4) at a cut-off point of ≥2 was nearly as effective as the whole AUDIT-C at a cut-off point of ≥6. This was not the case in the female sub-sample. Risky drinking is common among medical students and continues throughout the studies especially among men. AUDIT-3 is a short and reliable screening tool for male but not for female students.

Do US medical students report more training on evidence-based prevention topics?

Little is known about the extent to which evidence-based prevention topics are taught in medical school. All class of 2003 medical students (n = 2316) at 16 US schools were eligible to complete three questionnaires: at the beginning of first and third years and in their senior year, with 80.3% responding. We queried these students about 21 preventive medicine topics, concerning the extent of their training and their patient counseling frequency at some of these time points. At the beginning of the third year, self-reported extensive training was low for all preventive medicine topics (range 7-26%). USPSTF-recommended topics received more curricular time (median for topics: 36% if recommended versus 24.5% if not, P = 0.025), as did topics addressed through testing rather than through discussion (median for topics: 37% for testing and 25% for discussion, P = 0.005). Extensive training was always associated with higher counseling frequency, and intention to go into primary care, female gender, a positive attitude toward prevention and positive personal health habits were associated with higher counseling frequency. Although some bemoan the overall low levels of US medical students' prevention-related training and practice, we demonstrate that at least they are preferentially evidence-based, a novel and encouraging finding for preventionists.

Physical activity in students of the Medical University of Silesia in Poland

BACKGROUND

Medical students and other health care professionals have substantial knowledge of the benefits of regular physical activity. Furthermore, as they have an ethical obligation to prescribe suitable exercises, they can influence their patients' attitude toward physical activity and can become role models for their patients. Physical therapists, who are primary care practitioners, have great potential for promoting physical activity; however, their role is still underestimated by patients and health care professionals.

OBJECTIVE

The objectives of this study were to evaluate physical activity level in students of the Medical University of Silesia in Poland and to focus on the role of physical therapist students in promoting physical activity.

DESIGN

This was a cross-sectional study.

METHODS

The final analysis included 300 students from the schools of physical therapy, midwifery, nursing, pharmacy, cosmetology, and medicine at the Medical University of Silesia. The short form of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity level.

RESULTS

Physical therapist students demonstrated the highest level of physical activity, with 46% demonstrating a high level of physical activity, 54% a moderate level of physical activity, and none a low level of physical activity. The largest group of students with a low level of physical activity comprised students from the school of medicine (26%).

LIMITATIONS

The number of respondents was relatively small. The main study limitations included its cross-sectional nature and the possibility of self-report biases. Further research is warranted to expand the study nationally and determine which factors influence physical activity.

CONCLUSIONS

There was a large group of medical students who, despite being aware of benefits of physical activity, did not meet the recommended level of physical activity. Physical therapist students are well trained and qualified to promote healthy habits and encourage individuals to undertake regular physical activity.

Factors affecting weight counseling attitudes and behaviors among U.S. medical students

PURPOSE

To identify the factors associated with perceived relevance and reported frequency of weight counseling among medical students.

METHOD

The authors surveyed all medical students in the Class of 2003 at 16 U.S. medical schools during first-year orientation (1999), orientation to wards (2000-2001), and fourth year (2002-2003).

RESULTS

Across the three time points, response rates were, respectively, 89% (1,846/2,080), 82% (1,630/1,982), and 77% (1,469/1,901); a total of 2,316 medical students participated. More than half of the students felt that weight counseling was highly relevant to their intended practice (respectively, 63% [1,149/1,812], 70% [1,050/1,509], and 54% [717/1,329]). Among fourth-year students, 25% (350/1,393) reported that they "usually-always" provided weight counseling to general medicine patients. Perceived relevance peaked at orientation to wards (odds ratio [OR]=1.88), then declined to initial levels.Greater school support for health promotion was positively associated with high counseling frequency (OR=1.06). Students interested in non-primary-care specialties were less likely than others to consider weight counseling highly relevant (OR=0.59) or, in their fourth year, to provide it to patients (OR=0.50). Finally, higher personal fruit/vegetable consumption and confidence that this intake would increase were positively associated with high perceived relevance (both OR=1.07) and frequency of weight counseling (OR=1.09 and 1.16, respectively).

CONCLUSIONS

The majority of medical students consider weight counseling relevant to their intended careers. Promoting healthy personal behaviors and encouraging acquisition of skills in weight management across all specialties would likely improve clinical practice.

Do as I do: exercise habits of physical therapists, physical therapist assistants, and student physical therapists

BACKGROUND

Physical therapy practitioners are among the many health care professionals who can counsel their patients to address the public health care concern of physical inactivity. Health care providers who are physically active themselves are more likely to counsel patients on the benefits of activity.

OBJECTIVE

The purposes of this study were: (1) to examine the leisure-time physical activity habits of physical therapists, physical therapist assistants, and student physical therapists in the United States using Centers for Disease Control and Prevention and American College of Sports Medicine (CDC-ACSM) recommendations and (2) to compare these habits with those of the general population and other health care professionals.

DESIGN

A cross-sectional survey design was used.

METHODS

There were 2 data sources. A random sample of American Physical Therapy Association members completed an online survey that included questions about physical activity habits worded in same manner as the leisure-time activities section of the 2005 National Health Interview Survey (NHIS). The final study sample comprised 1,238 participants: 923 physical therapists, 210 student physical therapists, and 105 physical therapist assistants. The 2005 NHIS public use data files were the source for the same information about the general US population and for a subset of health care professionals. Rates of participation in vigorous and moderate physical activity were analyzed.

RESULTS

Physical therapists, physical therapist assistants, and student physical therapists exercised at higher rates than adults and health-diagnosing professionals in the 2005 NHIS. Limitations The study may be limited by sampling and response bias.

CONCLUSIONS

This study identified that physical therapists, physical therapist assistants, and student physical therapists are meeting CDC-ACSM physical activity guidelines at higher rates than the US adult population and health-diagnosing professionals. These rates exceed the physical activity targets set for adults in Healthy People 2010.

Personal and clinical tobacco-related practices and attitudes of U.S. medical students

OBJECTIVES

Medical students' tobacco-related practices particularly matter because practicing physicians' smoking predicts their tobacco counseling; the objective of this study was to determine when this relationship between personal and clinical tobacco practices develops, and to determine predictors of medical students' personal smoking habits, and predictors of their patient tobacco counseling practices.

METHODS

We surveyed the Class of 2003 between 1999 and 2003, at freshman orientation (n=1836), entrance to wards (n=1616), and senior year (n=1441) in a nationally representative sample of 16 U.S. medical schools (response rate=80.3%). Tobacco use questions came from Centers for Disease Control and Prevention datasets, and tobacco counseling questions from validated instruments.

RESULTS

12% of female and 15% of male U.S. medical students report smoking, with no differences in usage over time. More tobacco counseling training and strongly believing in prevention significantly predicted both more perceived counseling relevance and frequency. Additionally, intention to practice primary care predicted relevance (OR=3.5, 95% CI: 2.5-4.9), and tobacco users were 77% (95% CI: 64%-94%) as likely as non-users to report frequently counseling smokers.

CONCLUSIONS

U.S. medical students are less likely to smoke than other young U.S. adults, but more likely than U.S. physicians, and showed no clear decrease during medical school. It is encouraging that medical students with more exposure appreciate tobacco counseling's importance more, and are more likely to counsel. Students' personal tobacco use was also associated with counseling frequency. These data should help educators seeking better methods to reduce tobacco use.

Physicians' attitudes about obesity and their associations with competency and specialty: a cross-sectional study

Background

Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics.

Methods

We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor.

Results

The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors–Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty.

Conclusion

Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care.

Medical students' self-perceived competence and prescription of patient-centered physical activity

OBJECTIVE

The primary objective of this study was to explore medical students' perceptions of their own competence and the importance they assign to patient-centered physical activity (PA) prescription.

METHODS

246 undergraduate medical students (27% response rate) from two large universities in Western Canada completed an online survey designed to assess their perceived competence and importance related to patient-centered PA prescription. Data collection took place in September and October of 2007.

RESULTS

While medical students perceived PA-related prescription to be important (M(response)=26.6 out of 36, SD=5.1), students perceived they had only moderate competence at conducting PA-related prescription (M(response)=20.7 out of 36, SD=6.8). Students achieving national PA guidelines perceived significantly higher competence than students not achieving PA guidelines. Students in their first or second year of medical school perceived PA-related prescription to be of higher importance than students in their third or fourth years.

CONCLUSION

Medical students indicated that patient-centered PA prescription was important. However, they indicated less than moderate competence at performing several fundamental PA prescription behaviors. This study suggests that medical students may not be adequately prepared to dispense patient-centered PA prescriptions with their patients.

Self-report of quality of medical student health care

OBJECTIVES

To summarise survey results for the quality of medical students' personal health care, characterise the results according to the demographics and career orientations of the students, and evaluate the relationship between the perceived quality of health care received and the degree of emphasis on prevention in the health care provided.

METHODS

We carried out a cross-sectional study with 2316 medical students in the class of 2003 from 16 medical schools, surveyed at 3 points during their training. We used a self-administered questionnaire designed to assess personal health care and related variables in medical students.

RESULTS

The majority (92%) reported receiving health care that was at least good, but only a minority (23%) said they received excellent health care. Half had a regular doctor. Health care quality was rated more highly at Year 1 orientation than at later timepoints by students who had a regular personal doctor, and especially by those with personal doctors who emphasised prevention.

CONCLUSIONS

The majority of medical students perceived that they had received health care that was good or better, but most did not believe it was excellent. As the provision of preventive care is important to students, increasing the amount of preventive care provided to students may both increase their personal satisfaction with their health care and model good clinical preventive practices for them.

Personal and professional correlates of US medical students' vegetarianism

OBJECTIVE

To determine prevalence and correlates of US medical students' self-identification as vegetarians.

DESIGN

Medical students were anonymously surveyed via questionnaire three times: at freshmen orientation, orientation to wards, and during senior year.

SUBJECTS

Medical students in the Class of 2003 (n=1,849) at 15 US medical schools (response rate 80%).

OUTCOME MEASURES

We examined self-reported vegetarianism, abstinence from meat items on a food frequency questionnaire, and associations between students' vegetarianism and their health-related outcomes.

STATISTICAL ANALYSES

Bivariate associations were tested with chi(2) tests.

RESULTS

During medical school, 7.2% of students self-identified as vegetarians; this percentage declined over time. Those who were vegetarians for health reasons (66% of vegetarians) ate more fruits and vegetables than those who were vegetarians for nonhealth reasons (P=0.02). Vegetarians were more likely (P<0.01) than nonvegetarians to eat more fruits and vegetables (P=0.002); be women (P=0.009); be Hindu, Buddhist, or Seventh Day Adventist (P< or =0.0004); be politically liberal (P=0.007); have a body mass index < or =25 (P=0.008); or, as freshmen, to perceive nutrition counseling as highly relevant to their intended practices (P=0.007). Vegetarian students were no more likely to counsel patients about nutrition than were nonvegetarians.

CONCLUSIONS

Prevalence of vegetarianism was higher among US medical students than among other US adults, although the prevalence declined during medical school. Medical students and physicians with healthful personal practices are more likely to encourage such behaviors in their patients, although the specific nutrition habit of vegetarianism among medical students was unassociated with their nutrition counseling practices.

A national survey of medical students' beliefs and knowledge in screening for prostate cancer

BACKGROUND

Today's medical students are being educated at a time when there are no evidence-based guidelines for prostate cancer screening.

OBJECTIVE

To examine medical students' knowledge and beliefs concerning prostate cancer screening and specific determinants for their beliefs.

DESIGN, SETTING, AND PARTICIPANTS

One thousand six hundred and forty four students were sampled at 20 medical schools using a web-based, cross-sectional survey.

MAIN OUTCOME MEASURES

Basic knowledge and beliefs about prostate cancer testing, epidemiology, and therapy were ascertained.

RESULTS

Four of 8 knowledge items were answered incorrectly by 50% or more of students. Seven of 8 students believe that early diagnosis from screening can improve survival from prostate cancer. Second- and third-year students were more likely than fourth-year students to believe that the digital rectal exam (DRE) and the prostate-specific antigen test were accurate, adjusted odds ratio (AOR) 1.8; 95% confidence interval (CI), 1.2 to 2.7 and 1.7; 1.3 to 2.2 for second and third years, respectively, for the DRE. Black and Hispanic students were no more likely than white students to agree that early screening diagnosis improves survival, but blacks were more likely to agree with screening black or Hispanic men (AOR 7.8; 95% CI, 5.3 to 11.4 and 3.2; 2.2 to 4.7, respectively). More knowledgeable students were less likely to believe in the benefit of early detection and the accuracy of the prostate-specific antigen (AOR 0.3; 95%CI, 0.2 to 0.5).

CONCLUSIONS

Medical students generally are very optimistic about the benefits of screening for prostate cancer. Increased knowledge about prostate cancer is associated with a more conservative view of screening. Other predictors are independent of this knowledge.

Vitamin and Mineral Supplement Use among US Medical Students: A Longitudinal Study

OBJECTIVE

To provide data on medical students' multivitamin and calcium supplement use during medical school.

DESIGN

Medical students were anonymously surveyed at three time points: freshman orientation, orientation to wards, and during senior year.

SUBJECTS

Medical students (n = 2,316) at 16 US medical schools (response rate = 80.3%).

OUTCOME MEASURES

Prevalence and correlates of multivitamin and calcium supplement use throughout medical school.

STATISTICAL ANALYSES

Chi2 tests with associated P values, and logistic regression with associated odds ratios and confidence intervals.

RESULTS

Half of medical students surveyed used multivitamins, and 19% used calcium supplements, at least once per week as freshmen. Consumption of calcium, but not multivitamin, supplements increased during subsequent years (P = 0.0001) and both supplements were more commonly used by women (P < 0.0003). Of 970 students tracked across all three time points, 14% of women, compared with only 2% of men (P < 0.0001), took calcium at all three time points. Using multivariate models, we found that medical students were more likely to use multivitamins if they exercised regularly, had children, were underweight, or were women who were not heavy users of alcohol (P < 0.0001 to P < 0.05). Similarly, students who were women, underweight, exercised regularly, or had a personal or family history of osteoporosis were more likely to consume supplemental calcium (P < 0.0001 to P = 0.04).

CONCLUSIONS

Medical students of all types used supplements at moderate rates, and women used supplements more commonly and consistently than did men. Medical students, especially nonunderweight and nonexercising students, may be particularly important targets for messages regarding appropriate and adequate vitamin/mineral use.