1
|
Anees A, Saeed ZI, Kemper S, Haggerty T, Davisson L. Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity. J Gen Intern Med 2024:10.1007/s11606-024-08777-9. [PMID: 38671204 DOI: 10.1007/s11606-024-08777-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. OBJECTIVE This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. DESIGN A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. PARTICIPANTS Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. MAIN MEASURES The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. KEY RESULTS The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. CONCLUSIONS Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.
Collapse
Affiliation(s)
- Amna Anees
- Department of Internal Medicine, Charleston Area Medical Center and WVU School of Medicine-Charleston Division, Charleston, WV, USA.
| | - Zeb Ijaz Saeed
- Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, IN, USA
| | - Suzanne Kemper
- Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
| | - Laura Davisson
- Department of Internal Medicine, West Virginia University School of Medicine and WVU Medicine's Medical Weight Management Program, Morgantown, WV, USA
| |
Collapse
|
2
|
Faro JM, D'Addario A, King AM, Mazor KM, Pbert L, Sadasivam RS, Geller AC, Murphy EA, Ockene JK. Video-based communication assessment for weight management counseling training in medical residents: a mixed methods study. BMC Med Educ 2022; 22:899. [PMID: 36578064 PMCID: PMC9795434 DOI: 10.1186/s12909-022-03984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents. METHODS This study was a mixed methods pilot conducted in 3 phases. First, we created five vignettes based on our prior data and expert feedback, then administered the vignettes via the VCA to Internal Medicine categorical residents (n = 16) from a University Medical School. Analog patients rated responses and also provided comments. We created individualized feedback reports which residents were able to view on the VCA. Lastly, we conducted debriefing interviews with the residents (n = 11) to obtain their feedback on the vignettes and personalized feedback. Interviews were transcribed, and we used thematic analysis to generate and apply codes, followed by identifying themes. RESULTS Descriptive statistics were calculated and learning points were created for the individualized feedback reports. In VCA debriefing interviews with residents, five themes emerged: 1) Overall the VCA was easy to use, helpful and more engaging than traditional learning and assessment modes, 2) Patient scenarios were similar to those encountered in the clinic, including diversity, health literacy and different stages of change, 3) The knowledge, skills, and reminders from the VCA can be transferred to practice, 4) Feedback reports were helpful, to the point and informative, including the exemplar response of how to best respond to the scenario, and 5) The VCA provide alternatives and practice scenarios to real-life patient situations when they aren't always accessible. CONCLUSIONS We demonstrated the feasibility and acceptability of the VCA, a technology delivered platform, for delivering WMC to residents. The VCA exposed residents to diverse patient experiences and provided potential opportunities to tailor providers responses to sociological and cultural factors in WMC scenarios. Future work will examine the effect of the VCA on WMC in actual clinical practice.
Collapse
Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA.
| | | | - Ann M King
- National Board of Medical Examiners, Philadelphia, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, University of Massachusetts Medical School, 385 Grove St, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard University, 677 Huntington Ave, Cambridge, MA, USA
| | - Elizabeth A Murphy
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Judith K Ockene
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| |
Collapse
|
3
|
Kraschnewski JL, Kong L, Bryce CL, Francis EB, Poger JM, Lehman EB, Helbling S, Soleymani T, Mancoll RE, Villalobos V, Yeh HC. Intensive behavioral Therapy for weight loss in patients with, or At-Risk of, type 2 Diabetes: Results from the PaTH to health diabetes study. Prev Med Rep 2022; 31:102099. [PMID: 36820381 PMCID: PMC9938299 DOI: 10.1016/j.pmedr.2022.102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Intensive behavioral therapy (IBT) is an important component of obesity treatment and can reduce the risk of type 2 diabetes (T2DM). Objective was to compare the effectiveness of IBT to usual care in achieving weight loss in two study cohorts within PaTH Network: T2DM and At-Risk of T2DM. The TD2M cohort was defined as age 18 years and older with an indication of T2DM in the EHR based on a validated algorithm and at least 2 outpatient primary care visits. The At-Risk of T2DM cohort was defined by a BMI ≥ 25 kg/m2. The primary outcome was weight change within 1-year of index date. Mixed-effects models assessed the effectiveness of IBT by comparing the changes between study groups. Between 2009 and 2020, a total of 567,908 patients were identified in the T2DM cohort and2,054,256 patients in the At-Risk of T2DM cohort. Both IBT patients and matched non-IBT patients in the T2DM cohort had decreased mean weight (primary outcome) (-1.56 lbs, 95 %CI: -1.88, -1.24 vs -1.70 lbs, 95 %CI: -1.95, -1.44) in 1-year after index date. In the At-Risk of T2DM cohort, both IBT and non-IBT patients experienced weight gain and resultant increased BMI. Patients with more than one IBT visit gained less weight than those with only one visit (1.22 lbs, 95 %CI: 0.82, 1.62 vs 6.72 lbs, 95 %CI: 6.48, 6.97; p < 0.001). IBT was unlikely to result in clinically significant weight loss. Barriers to utilizing IBT require further research to ensure broader adoption of obesity management in primary care.
Collapse
Affiliation(s)
- Jennifer L. Kraschnewski
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Cindy L. Bryce
- Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erica B. Francis
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jennifer M. Poger
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA,Corresponding author at: Penn State College of Medicine, 90 Hope Drive, Suite 1103, Mail Code A145, Hershey, PA 17033, USA.
| | - Erik B. Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - Taraneh Soleymani
- Department of Medicine, Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Rebecca E. Mancoll
- Department of Medicine, Division of General Internal Medicine, UPMC, Pittsburgh, PA, USA
| | | | - Hsin-Chieh Yeh
- Department of Medicine, School of Medicine, Johns Hopkins University, Maryland, USA
| |
Collapse
|
4
|
Cameron NA, Kushner RF. Development of a telehealth obesity OSCE and reliable checklist for assessment of resident physicians: a pilot study. BMC Med Educ 2022; 22:630. [PMID: 35986272 PMCID: PMC9389479 DOI: 10.1186/s12909-022-03672-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obesity is a major public health problem, yet residents undergo little formal training and assessment in obesity-related care. Given the recent growth of telehealth, physicians must further learn to apply these skills using a virtual platform. Therefore, we aimed to develop an objective structured clinical examination (OSCE) with reliable checklists to assess resident ability to take a patient-centered obesity-focused history that was feasible over telehealth based on published obesity competencies for medical education. METHODS We developed a 15-minute telehealth OSCE to simulate an obesity-related encounter for residents modified from a script used to assess medical student obesity competencies. We designed three checklists to assess resident skills in history taking, communication and professionalism during the obesity-related encounter. Resident performance was assessed as the percentage of obesity-related history taking questions asked during the encounter and as the mean communication and professionalism scores on a scale of 1 through 5 with 1 representing unacceptable/offensive behavior and 5 representing excellent skills. Encounters and assessments were completed by two commissioned actors (standardized patients) and 26 internal medicine residents over a secure online platform. We assessed the reliability of each checklist by calculating the percent agreement between standardized patients and the kappa (κ) statistic on each checklist overall and by each checklist item. RESULTS Overall agreement between standardized patients on the history taking, communication and professionalism checklists were 83.2% (κ = 0.63), 99.5% (κ = 0.72) and 97.8% (κ =0.44), respectively. On average, residents asked 64.8% of questions on the history taking checklist and scored 3.8 and 3.9 out of 5 on the communication and professionalism checklists, respectively. CONCLUSIONS Results from this pilot study suggest that our telehealth obesity OSCE and checklists are moderately reliable for assessing key obesity competencies among residents on a virtual platform. Integrating obesity OSCEs and other educational interventions into residency curricula are needed to improve resident ability to take an obesity-focused history.
Collapse
Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - Robert F Kushner
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA.
- Departments of Medicine and Medical Education, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 645 North Michigan Avenue, Suite 530, Chicago, USA.
| |
Collapse
|
5
|
Katz NJ, Lovrics O, Zevin B. A Canadian survey of medical students and undergraduate deans on the management of patients living with obesity. BMC Med Educ 2022; 22:562. [PMID: 35864483 PMCID: PMC9302212 DOI: 10.1186/s12909-022-03636-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With over 26% of Canadian adults living with obesity, undergraduate medical education (UGME) should prepare medical students to manage this chronic disease. It is currently unknown how the management of patients living with obesity is taught within UGME curricula in Canada. This study (1) examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity, and (2) explored how this topic is taught within UGME curricula in Canada. METHODS We distributed two online surveys: one to final-year medical students, and another to UGME deans at 9 English-speaking medical schools in Canada. The medical student survey assessed students' knowledge and self-reported competence in managing patients living with obesity. The dean's survey assessed how management of patients living with obesity is taught within the UGME curriculum. RESULTS One hundred thirty-three (6.9%) and 180 (9.3%) out of 1936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Mean knowledge score was 10.5 (2.1) out of 18. Students had greatest knowledge about etiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviors and calculating body mass index. Five (56%) out of 9 deans completed the survey. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities. CONCLUSIONS Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity. Changes to UGME curricula may help address this gap in education.
Collapse
Affiliation(s)
- Nathan J. Katz
- School of Medicine, Office of Professional Development and Educational Scholarship, Queen’s University, Kingston, ON Canada
| | - Olivia Lovrics
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Boris Zevin
- Department of Surgery, Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| |
Collapse
|
6
|
Orjuela-Grimm M, Butsch WS, Bhatt-Carreño S, Smolarz BG, Rao G. Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey. BMC Fam Pract 2021; 22:132. [PMID: 34167487 PMCID: PMC8229273 DOI: 10.1186/s12875-021-01484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Background U.S. physicians lack training in caring for patients with obesity. For family medicine, the newly developed Obesity Medicine Education Collaborative (OMEC) competencies provide an opportunity to compare current training with widely accepted standards. We aimed to evaluate the current state of obesity training in family medicine residency programs. Methods We conducted a study consisting of a cross-sectional survey of U.S. family medicine residency program leaders. A total of 735 directors (including associate/assistant directors) from 472 family medicine residency programs identified from the American Academy of Family Physicians public directory were invited via postal mail to complete an online survey in 2018. Results Seventy-seven program leaders completed surveys (16% response rate). Sixty-four percent of programs offered training on prevention of obesity and 83% provided training on management of patients with obesity; however, 39% of programs surveyed reported not teaching an approach to obesity management that integrates clinical and community systems as partners, or doing so very little. Topics such as behavioral aspects of obesity (52%), physical activity (44%), and nutritional aspects of obesity (36%) were the most widely covered (to a great extent) by residency programs. In contrast, very few programs extensively covered pharmacological treatment of obesity (10%) and weight stigma and discrimination (14%). Most respondents perceived obesity-related training as very important; 65% of the respondents indicated that expanding obesity education was a high or medium priority for their programs. Lack of room in the curriculum and lack of faculty expertise were reported as the greatest barriers to obesity education during residency. Only 21% of the respondents perceived their residents as very prepared to manage patients with obesity at the end of the residency training. Conclusion Family medicine residency programs are currently incorporating recommended teaching to address OMEC competencies to a variable degree, with some topic areas moderately well represented and others poorly represented such as pharmacotherapy and weight stigma. Very few program directors report their family medicine residents are adequately prepared to manage patients with obesity at the completion of their training. The OMEC competencies could serve as a basis for systematic obesity training in family medicine residency programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01484-y.
Collapse
Affiliation(s)
- Manuela Orjuela-Grimm
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - W Scott Butsch
- Departments of Surgery and Internal Medicine and Geriatrics, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Silvia Bhatt-Carreño
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Goutham Rao
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|