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Reading JM, Snell LM, LaRose JG. A systematic review of weight-related communication trainings for physicians. Transl Behav Med 2021; 10:1110-1119. [PMID: 33044535 DOI: 10.1093/tbm/ibaa014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Obesity is a leading cause of preventable death in the USA. Given the high number of adults seeking routine health care services, physicians have an opportunity to address weight loss during routine clinical encounters. It's often reported that physicians lack the training to address weight. Training programs are implemented in medical settings to prepare physicians to have conversations with patients. Yet, the degree of consistency among training programs and factors associated with better outcomes is unclear. The purpose of this study is to systematically review literature in physician communication trainings related to weight-to compare the content, outcomes, and implementation of existing studies examining weight-related communication training programs for physicians and determine factors associated with physician and patient outcomes. Articles were extracted from PubMed, Proquest, and Embase. Search terms included: health communication, physician training, weight, and obesity. Studies implementing a training program addressing weight among physicians were included. Trainings using either motivational interviewing (MI) or 5 As (Ask, Advise, Assess, Assist, and Arrange) framework found improvements in physicians' communication skills. A small number of trainings including experiential components were also associated with improvements in positive physician outcomes. Findings suggest trainings based in MI or 5 As framework improve physicians' communication skills, but few programs affected patient outcomes. Gaps remain with trainings that can demonstrate weight loss in patients. While work is needed to enhance the effects of these trainings on patient outcomes, data suggest that trainings should be longer in duration and include an experiential component.
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Affiliation(s)
- Jean M Reading
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - L Morgan Snell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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2
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Sykes JC, Eniola K, Shirley J, Mullis K. Nutrition Education in Family Medicine Residency Training. South Med J 2021; 114:123-125. [PMID: 33537795 DOI: 10.14423/smj.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeannie C Sykes
- From the Cone Health Family Medicine Center, Greensboro, North Carolina
| | - Kehinde Eniola
- From the Cone Health Family Medicine Center, Greensboro, North Carolina
| | - Jordan Shirley
- From the Cone Health Family Medicine Center, Greensboro, North Carolina
| | - Kiersten Mullis
- From the Cone Health Family Medicine Center, Greensboro, North Carolina
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3
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Butsch WS, Robison K, Sharma R, Knecht J, Smolarz BG. Medicine Residents are Unprepared to Effectively Treat Patients with Obesity: Results from a U.S. Internal Medicine Residency Survey. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520973206. [PMID: 33283047 PMCID: PMC7691912 DOI: 10.1177/2382120520973206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. METHODS Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. RESULTS Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. CONCLUSIONS Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.
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Affiliation(s)
- W Scott Butsch
- Bariatric and Metabolic Institute,
Cleveland Clinic, Cleveland, OH, USA
| | | | - Ranita Sharma
- Rutgers Robert Wood Johnson Medical
School, Department of Medicine, Brunswick, NJ, USA
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4
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Miller-Matero LR, Tobin ET, Fleagle E, Coleman JP, Nair A. Motivating residents to change communication: the role of a brief motivational interviewing didactic. Prim Health Care Res Dev 2019; 20:e124. [PMID: 31451128 PMCID: PMC6713881 DOI: 10.1017/s146342361900015x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents' knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. METHODS Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. RESULTS The residents' knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. CONCLUSION The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.
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Affiliation(s)
- Lisa Renee Miller-Matero
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Erin T. Tobin
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Elizabeth Fleagle
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
| | - Joseph P. Coleman
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Anupama Nair
- Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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5
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Hemming P, Revels JA, Tran AN, Greenblatt LH, Steinhauser KE. Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians. Int J Psychiatry Med 2019; 54:188-202. [PMID: 30269631 DOI: 10.1177/0091217418802159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners' and teachers' perceptions about appropriate behavioral health curricular components for internal medicine residents. METHOD Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents' successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups. RESULTS Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents' skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient's perspective, managing time in encounters, improving patients' understanding, and patient counseling. CONCLUSIONS Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care's role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.
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Affiliation(s)
- Patrick Hemming
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Jessica A Revels
- 2 Department of Clinical Research, Duke University Medical Center, Durham, NC, USA
| | - Anh N Tran
- 3 Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Lawrence H Greenblatt
- 1 Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Karen E Steinhauser
- 4 Center for Health Services Research in Primary Care, Durham, VA Medical Center, Durham, NC, USA.,5 Department of Medicine, Division of General Internal Medicine, Palliative Care Section, Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
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Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol 2017; 217:642-651. [PMID: 28549978 DOI: 10.1016/j.ajog.2017.05.040] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
Abstract
Prenatal care providers are advised to evaluate maternal weight at each regularly scheduled prenatal visit, monitor progress toward meeting weight gain goals, and provide individualized counseling if significant deviations from a woman's goals occur. Today, nearly 50% of women exceed their weight gain goals with overweight and obese women having the highest prevalence of excessive weight gain. Risks of inadequate weight gain include low birthweight and failure to initiate breast-feeding whereas the risks of excessive weight gain include cesarean deliveries and postpartum weight retention for the mother and large-for-gestational-age infants, macrosomia, and childhood overweight or obesity for the offspring. Prenatal care providers have many resources and tools to incorporate weight and other health behavior counseling into routine prenatal practices. Because many women are motivated to improve health behaviors, pregnancy is often considered the optimal time to intervene for issues related to eating habits and physical activity to prevent excessive weight gain. Gestational weight gain is a potentially modifiable risk factor for a number of adverse maternal and neonatal outcomes and meta-analyses of randomized controlled trials report that diet or exercise interventions during pregnancy can help reduce excessive weight gain. However, health behavior interventions for gestational weight gain have not significantly improved other maternal and neonatal outcomes and have limited effectiveness in overweight and obese women.
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Makuuchi A, Takemoto Y, Okamura H, Nakane T, Namikawa H, Fukumoto K, Kobayashi M, Kinuhata S, Morimura M, Hirohashi K, Hino M, Shuto T. Favorable effects of motivational interviewing and support in a patient with schizophrenia and alcohol abuse. J Gen Fam Med 2017; 18:271-274. [PMID: 29264040 PMCID: PMC5689419 DOI: 10.1002/jgf2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 09/23/2016] [Indexed: 11/30/2022] Open
Abstract
A 42‐year‐old man with schizophrenia was referred to our hospital after 2 weeks of worsening fatigue. His hemoglobin level was 2.8 g/dL owing to folic acid deficiency stemming from alcohol abuse and consumption of unbalanced meals. We induced behavioral changes in the patient by motivational interviewing. We had direct methodical conversations with medical staff involved with the patient as well as his family, and established new social support for him as well as public assistance. These have resulted in the patient maintaining a favorable lifestyle ever since.
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Affiliation(s)
- Ayako Makuuchi
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Yasuhiko Takemoto
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Hiroshi Okamura
- Department of Hematology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Takahiko Nakane
- Department of Hematology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Hiroki Namikawa
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Kazuo Fukumoto
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Masanori Kobayashi
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Shigeki Kinuhata
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Mina Morimura
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Kazuhiro Hirohashi
- Department of Emergency and General Practice; Higashisumiyoshi Morimoto Hospital; Osaka Japan
| | - Masayuki Hino
- Department of Hematology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Taichi Shuto
- Department of Medical Education and General Practice; Osaka City University Graduate School of Medicine; Osaka Japan
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8
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Teaching Physicians Motivational Interviewing for Discussing Weight With Overweight Adolescents. J Adolesc Health 2016; 59:96-103. [PMID: 27155958 PMCID: PMC4920712 DOI: 10.1016/j.jadohealth.2016.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/10/2016] [Accepted: 03/11/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE We tested whether an online intervention combined with a patient feedback report improved physicians' use of motivational interviewing (MI) techniques when discussing weight with overweight and obese adolescents. METHODS We randomized 46 pediatricians and family physicians and audio recorded 527 patient encounters. Half of the physicians received an individually tailored, online intervention. Then, all physicians received a summary report detailing patient's weight-related behaviors. We coded MI techniques and used multilevel linear mixed-effects models to examine arm differences. We assessed patients' motivation to change and perceived empathy after encounter. RESULTS We found arm differences in the Intervention Phase and the Summary Report Phase: Empathy (p < .001), MI Spirit (p < .001), open questions (p = .02), and MI consistent behaviors (p = .04). Across all three phases (Baseline, Intervention, and Summary Report), when physicians had higher Empathy scores, patients were more motivated to change diet (p = .03) and physical activity (p = .03). In addition, patients rated physicians as more empathic when physicians used more MI consistent techniques (p = .02). CONCLUSIONS An individually tailored, online intervention coupled with a Summary Report improved physicians' use of MI, which improved the patient experience.
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Ren V, Ellison K, Miller J, Busireddy K, Vickery E, Panda M, Qayyum R. Effect of didactic lectures on obesity documentation and counseling among internal medicine residents. J Community Hosp Intern Med Perspect 2016; 6:30931. [PMID: 27124168 PMCID: PMC4848431 DOI: 10.3402/jchimp.v6.30931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022] Open
Abstract
Background Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic. Objective We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents. Methods We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables. Results Of the 278 patients with BMI≥30 kg/m2, 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05–1.11; P<0.001). In addition, as compared to postgraduate year (PGY) 1 residents, PGY-3 residents were 56% (OR=0.44; 95% CI=0.21–0.95; P=0.03) less likely to counsel obese patients. Conclusions Obesity is inadequately addressed in primary care settings, and didactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed.
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Affiliation(s)
- Vicky Ren
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Kathleen Ellison
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Jonathan Miller
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Kiran Busireddy
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Erin Vickery
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mukta Panda
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA;
| | - Rehan Qayyum
- Department of Internal Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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Burton AM, Brezausek CM, Agne AA, Hankins SL, Willett LL, Cherrington AL. Evaluation of a workshop to improve residents' patient-centred obesity counselling skills. Postgrad Med J 2016; 92:455-9. [PMID: 27083209 DOI: 10.1136/postgradmedj-2015-133590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/02/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Primary care physicians are being asked to counsel their patients on obesity and weight management. Few physicians conduct weight loss counselling citing barriers, among them a lack of training and confidence. Our objective was to pilot test the effectiveness of a 3-h interactive obesity-counselling workshop for resident physicians based on motivational interviewing (MI) techniques. DESIGN This study used a pretest/post-test cross-sectional design. A convenience sample of resident physicians was invited to participate. Participating resident physicians completed a preintervention and postintervention questionnaire to assess their knowledge, beliefs and confidence in obesity counselling. MI techniques taught in the intervention were evaluated by audio recording interviews with a standardised patient (SP) pre intervention and post intervention. Audio recordings were transcribed and coded by two independent coders using a validated assessment tool. Paired t tests were used to assess preintervention and postintervention differences. RESULTS Eight-six residents attended the workshop. At baseline, the majority (71%) felt that there is not enough time to counsel patients about obesity and only 24% felt that residency trained them to counsel. After the intervention, knowledge and confidence in counselling increased (p<0.001). Among the 55 residents with complete pre-post SP interview data, MI adherent statements increased from a mean of 2.88 to 5.42 while the MI non-adherent statements decreased from 6.73 to 2.33 (p<0.001). CONCLUSIONS After a brief workshop to train physicians to counsel on obesity-related behaviours, residents improved their counselling skills and felt more confident on counselling patients. Future studies are needed to assess whether these gains are sustained over time.
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Affiliation(s)
- Amy M Burton
- Pediatric Endocrinology of North Texas, PLLC, Denton, Texas, USA
| | - Carl M Brezausek
- Center for Educational Accountability, School of Education, University of Alabama at Birmingham, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, Alabama, USA
| | - April A Agne
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shirley L Hankins
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Alabama at Birmingham, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, Alabama, USA
| | - Lisa L Willett
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pollak KI, Nagy P, Bigger J, Bilheimer A, Lyna P, Gao X, Lancaster M, Watkins RC, Johnson F, Batish S, Skelton JA, Armstrong S. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. PATIENT EDUCATION AND COUNSELING 2016; 99:300-303. [PMID: 26320822 DOI: 10.1016/j.pec.2015.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. METHODS We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. RESULTS Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. CONCLUSION This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. PRACTICE IMPLICATIONS It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA; Department of Community and Family Medicine, Duke School of Medicine, Durham, USA.
| | - Paul Nagy
- Department of Psychiatry, Duke School of Medicine, Durham, USA
| | | | - Alicia Bilheimer
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Pauline Lyna
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Xiaomei Gao
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | | | | | - Fred Johnson
- Division of Community Health, Department of Community and Family Medicine, Duke School of Medicine, Durham, USA
| | | | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke School of Medicine, Durham, USA
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Jones JL, Sundwall D. Health Care Systems and National Policy: Role of Leadership in the Obesity Crisis. Prim Care 2016; 43:19-37, vii. [PMID: 26896197 DOI: 10.1016/j.pop.2015.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, defined as a body mass index (BMI) of 30 or higher in adults and BMI in the 95th percentile or higher for children, is epidemic in the United States. The predominant culture of caloric excess and sedentary behaviors contributes to this problem. Obesity increases the risk of many chronic diseases and premature death. The broad response to this costly disease includes efforts from medical providers, local and federal governments, and nongovernmental agencies. Although obesity can be addressed on an individual basis, it is largely recognized as a public health issue.
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Affiliation(s)
- Jessica Lynn Jones
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA.
| | - David Sundwall
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Salt Lake City, UT 84108, USA
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Agley J, Gassman RA, DeSalle M, Vannerson J, Carlson J, Crabb D. Screening, Brief Intervention, Referral to Treatment (SBIRT), and Motivational Interviewing for PGY-1 Medical Residents. J Grad Med Educ 2014; 6:765-9. [PMID: 26140134 PMCID: PMC4477579 DOI: 10.4300/jgme-d-14-00288.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/18/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment (SBIRT) for alcohol use in primary care-often using motivational interviewing (MI)-is an effective preventive service. Medical residency programs have begun offering training in these areas, but little research has been conducted to examine the impact of SBIRT/MI training length on residents' satisfaction, affect, and behavioral intentions. OBJECTIVE We measured residents' satisfaction with their training in addition to variables shown in previous research to predict medical professionals' intention to perform SBIRT. METHODS This study focused on 2 SBIRT/MI training structures: a 4- to 6-hour training using didactic, experiential, and interactive methods and a brief 1-hour session explaining the same principles in a noninteractive format. Immediately following each training intervention, participating residents from internal medicine (IM), pediatrics (PEDS), medicine-pediatrics (IM-PEDS), and emergency medicine (EM) programs completed a 22-item instrument derived from established questionnaires; responses to each item were dichotomized, and comparisons were conducted between the training groups using Fisher exact test. RESULTS Of 80 participating residents, 59 IM, PEDS, and IM-PEDS residents completed the longer training, and 21 EM residents completed the shorter training. All participating residents reported high levels of satisfaction, although EM residents were comparatively less satisfied with their shorter training session. CONCLUSIONS Both SBIRT/MI training structures were feasible and were accepted by learners, although the 2 groups' perceptions of the training differed. Future research into the underlying causes of these differences may be useful to the application of SBIRT/MI training during residency.
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14
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Acosta A, Azzalin A, Emmons CJ, Shuster JJ, Jay M, Lo MC. Improving residents' clinical approach to obesity: impact of a multidisciplinary didactic curriculum. Postgrad Med J 2014; 90:630-7. [PMID: 25214540 DOI: 10.1136/postgradmedj-2014-132821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity has been declared a 21st century pandemic by WHO. Yet surveys reveal physicians-in-training are uncomfortable managing obesity. One major barrier is the lack of residency education on obesity management. This study incorporates an obesity-specific didactic curriculum into an internal medicine (IM) residency programme and assesses its impact on residents' knowledge, attitudes, practice behaviours, and clinical outcomes in patients with obesity. METHODS The intervention consisted of four, 1 h, obesity-specific lectures in the University of Florida Resident Noon Conference. Lectures were taught by multidisciplinary experts and offered to 75 IM residents every 2 weeks from 5 November 2010 to 17 December 2010. Impact on IM residents' knowledge and attitudes was assessed by a pre- and post-intervention Obesity Awareness Questionnaire (OAQ). IM residents' clinical performance was assessed by chart reviews of 238 patients with body mass index >25 kg/m(2) in residents' clinics 4 months pre- and 6 months post-intervention for three clinical outcomes and seven practice behaviours on obesity management. Pre- and post-intervention outcomes were compared via paired t tests (quantitative data) or McNemar's test (binary data). RESULTS Mean lecture attendance was 25/75 residents (33%) per lecture. Survey response was 67/75 residents (89%) pre-OAQ and 63/75 residents (84%) post-OAQ. While most attitudes remained unchanged, IM residents gained significant confidence in exercise counselling, safety of bariatric surgery, and patients' weight loss potential; they were more likely to address obesity in the plan and referrals to bariatric surgery. Clinical outcomes and IM residents' knowledge demonstrated no improvement. CONCLUSIONS Our brief lecture-based curriculum has the potential to improve IM residents' attitudes and practice behaviours towards obesity. The lack of improvement in clinical outcomes and resident knowledge prompts the need for multimodal, longitudinal curricula with experiential application of obesity medicine.
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Affiliation(s)
- Andres Acosta
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alice Azzalin
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Claudia J Emmons
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jonathan J Shuster
- Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Melanie Jay
- Departments of Medicine and Population Health, New York Harbor Veteran Affairs Administration, New York University School of Medicine, New York, New York, USA
| | - Margaret C Lo
- Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Dunhill D, Schmidt S, Klein R. Motivational interviewing interventions in graduate medical education: a systematic review of the evidence. J Grad Med Educ 2014; 6:222-36. [PMID: 24949125 PMCID: PMC4054720 DOI: 10.4300/jgme-d-13-00124.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/21/2013] [Accepted: 11/25/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial. OBJECTIVE To review the current evidence regarding the impact of MI education in graduate medical education. RESULTS Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures. CONCLUSIONS Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.
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16
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Lenders CM, Deen DD, Bistrian B, Edwards MS, Seidner DL, McMahon MM, Kohlmeier M, Krebs NF. Residency and specialties training in nutrition: a call for action. Am J Clin Nutr 2014; 99:1174S-83S. [PMID: 24646816 PMCID: PMC3985219 DOI: 10.3945/ajcn.113.073528] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite evidence that nutrition interventions reduce morbidity and mortality, malnutrition, including obesity, remains highly prevalent in hospitals and plays a major role in nearly every major chronic disease that afflicts patients. Physicians recognize that they lack the education and training in medical nutrition needed to counsel their patients and to ensure continuity of nutrition care in collaboration with other health care professionals. Nutrition education and training in specialty and subspecialty areas are inadequate, physician nutrition specialists are not recognized by the American Board of Medical Specialties, and nutrition care coverage by third payers remains woefully limited. This article focuses on residency and fellowship education and training in the United States and provides recommendations for improving medical nutrition education and practice.
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Affiliation(s)
- Carine M Lenders
- Division of Pediatric Nutrition, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, MA (CML); the Department of Community Health and Social Medicine, City College of New York, New York, NY (DDD); Harvard University Medical School, Boston, MA (BB); University of Texas Medical School, Houston, TX (MSE); the Vanderbilt Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN (DLS); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (MMM); University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (MK); and the Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO (NFK)
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