Teaching Medical Students to Help Patients Manage Their Weight: Outcomes of an Eight-School Randomized Controlled Trial.
medical school curriculum
medical student behaviors
objective structured clinical examination
randomized controlled trial
weight management counseling
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
17
08
2020
accepted:
29
12
2020
pubmed:
10
4
2021
medline:
26
10
2021
entrez:
9
4
2021
Statut:
ppublish
Résumé
Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. The MME implemented over three years included a web-based course, a role-play classroom exercise, a web-patient encounter with feedback, and an enhanced clerkship experience with preceptors trained in weight management counseling (WMC). Counseling focused on the 5As (Ask, Advise, Assess, Assist, Arrange) and patient-centeredness. The outcome was student 5As WMC skills assessed using an objective measure, an OSCE, scored using a behavior checklist, and a subjective measure, student self-reported skills for performing the 5As. Among MME students who completed two of three WMC components compared to those who completed none, exposure was significantly associated with higher OSCE scores and self-reported 5A skills. Variability in medical schools requiring participation in the WMC curriculum. This trial revealed that medical students struggle with delivering weight management counseling to their patients who have overweight or obesity. Medical schools, though restrained in adding curricula, should incorporate should incorporate multiple WMC curricula components early in medical student education to provide knowledge and build confidence for supporting patients in developing individualized plans for weight management. R01-194787.
Sections du résumé
BACKGROUND
Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts.
OBJECTIVE
To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change.
DESIGN
A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE).
SETTING/PARTICIPANTS
Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys.
INTERVENTIONS
The MME implemented over three years included a web-based course, a role-play classroom exercise, a web-patient encounter with feedback, and an enhanced clerkship experience with preceptors trained in weight management counseling (WMC). Counseling focused on the 5As (Ask, Advise, Assess, Assist, Arrange) and patient-centeredness.
MEASUREMENTS
The outcome was student 5As WMC skills assessed using an objective measure, an OSCE, scored using a behavior checklist, and a subjective measure, student self-reported skills for performing the 5As.
RESULTS
Among MME students who completed two of three WMC components compared to those who completed none, exposure was significantly associated with higher OSCE scores and self-reported 5A skills.
LIMITATIONS
Variability in medical schools requiring participation in the WMC curriculum.
CONCLUSIONS
This trial revealed that medical students struggle with delivering weight management counseling to their patients who have overweight or obesity. Medical schools, though restrained in adding curricula, should incorporate should incorporate multiple WMC curricula components early in medical student education to provide knowledge and build confidence for supporting patients in developing individualized plans for weight management.
NIH TRIAL REGISTRY NUMBER
R01-194787.
Identifiants
pubmed: 33835315
doi: 10.1007/s11606-020-06571-x
pii: 10.1007/s11606-020-06571-x
pmc: PMC8034040
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
3000-3007Subventions
Organisme : NHLBI NIH HHS
ID : K12 HL138049
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA194787
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021. The Author(s).
Références
Health NIo. The practical guide. Identification, evaluation, and treatment of overweight and obesity in adults. In: Washington, DC: In: Initiative NOE, ed.; 2000.
Kass DA, Duggal P, Cingolani O. Obesity could shift severe COVID-19 disease to younger ages. The Lancet. 2020;395(10236):1544-1545.
doi: 10.1016/S0140-6736(20)31024-2
Ryan DH, Ravussin E, Heymsfield S. COVID 19 and the Patient with Obesity – The Editors Speak Out. Obesity (Silver Spring, Md). 2020;28(5):847-847.
doi: 10.1002/oby.22808
Hales CM CM, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. In. NCHS Data Brief, no 360: National Center for Health Statistics. 2020; 2017-2018.
Kraschnewski JL, Sciamanna CN, Pollak KI, Stuckey HL, Sherwood NE. The epidemiology of weight counseling for adults in the United States: a case of positive deviance. Int J Obes (Lond). 2013;37(5):751-753.
doi: 10.1038/ijo.2012.113
Kraschnewski JL, Sciamanna CN, Stuckey HL, et al. A silent response to the obesity epidemic: decline in US physician weight counseling. Med Care. 2013;51(2):186-192.
doi: 10.1097/MLR.0b013e3182726c33
Pool AC, Kraschnewski JL, Cover LA, et al. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. 2014;8(2):e131-e139.
doi: 10.1016/j.orcp.2013.03.003
Galuska DA, Will JC, Serdula MK, Ford ES. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282(16):1576-1578.
doi: 10.1001/jama.282.16.1576
Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians' counseling on diet and nutrition among the U.S. adult population, 2000-2011. Prev Med. 2016;89:70-75.
doi: 10.1016/j.ypmed.2016.05.014
Abid A, Galuska D, Khan LK, Gillespie C, Ford ES, Serdula MK. Are healthcare professionals advising obese patients to lose weight? A trend analysis. MedGenMed. 2005;7(4):10.
pubmed: 16614632
Vitolins MZ, Crandall S, Miller D, Ip E, Marion G, Spangler JG. Obesity educational interventions in U.S. medical schools: a systematic review and identified gaps. Teach Learn Med. 2012;24(3):267-272.
doi: 10.1080/10401334.2012.692286
Ockene IS, Hebert JR, Ockene JK, et al. Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). Arch Intern Med. 1999;159(7):725-731.
doi: 10.1001/archinte.159.7.725
Jay M, Gillespie C, Schlair S, Sherman S, Kalet A. Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight? BMC Health Serv Res. 2010;10:159.
doi: 10.1186/1472-6963-10-159
Tsai AG, Wadden TA. Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med. 2009;24(9):1073-1079.
doi: 10.1007/s11606-009-1042-5
Wadden TA, Volger S, Sarwer DB, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969-1979.
doi: 10.1056/NEJMoa1109220
Haas WC, Moore JB, Kaplan M, Lazorick S. Outcomes from a medical weight loss program: primary care clinics versus weight loss clinics. Am J Med. 2012;125(6):603 e607-611.
doi: 10.1016/j.amjmed.2011.07.039
Tsai AG, Wadden TA, Rogers MA, Day SC, Moore RH, Islam BJ. A primary care intervention for weight loss: results of a randomized controlled pilot study. Obesity (Silver Spring). 2010;18(8):1614-1618.
doi: 10.1038/oby.2009.457
Rose SA, Poynter PS, Anderson JW, Noar SM, Conigliaro J. Physician weight loss advice and patient weight loss behavior change: a literature review and meta-analysis of survey data. Int J Obes (Lond). 2013;37(1):118-128.
doi: 10.1038/ijo.2012.24
Moyer VA, Force USPST. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
pubmed: 22733087
Adams KM, Butsch WS, Kohlmeier M. The State of Nutrition Education at US Medical Schools. Journal of Biomedical Education. 2015;2015:357627.
doi: 10.1155/2015/357627
Colleges AoAM. Report VIII Contemporary Issues in Medicine: The Prevention and Treatment of Overweight and Obesity. Medical School Objectives Project. 2007.
Ockene JK, Ashe KM, Hayes RB, et al. Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized controlled trial. Contemp Clin Trials. 2018;64:58-66.
doi: 10.1016/j.cct.2017.11.006
Bandura A. Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall; 1977.
Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10:282–298.
doi: 10.4278/0890-1171-10.4.282
Mazor KM, Jolicoeur D, Hayes RB, Geller AC, Churchill L, Ockene JK. Assessing Medical Students' Tobacco Dependence Treatment Skills Using a Detailed Behavioral Checklist. Teach Learn Med. 2015;27(3):292-298.
doi: 10.1080/10401334.2015.1044660
Fitzmaurice GM, Laird N, Ware JH. Applied longitudinal analysis. New York: JohnWiley & Sons; 2004.
Little RJA, Rubin DB. Statistical Analysis with Missing Data. 3rd Edition ed: Wiley; 2019.
Murray DM, Varnell SP, Blitstein JL. Design and analysis of group-randomized trials: a review of recent methodological developments. American journal of public health. 2004;94(3):423-432.
doi: 10.2105/AJPH.94.3.423
Andridge RR. Quantifying the impact of fixed effects modeling of clusters in multiple imputation for cluster randomized trials. Biom J. 2011;53(1):57-74.
doi: 10.1002/bimj.201000140
Raghunathan T, Lepkowski J, Hoewyk J, Solenberger P. A Multivariate Technique for Multiply Imputing Missing Values Using a Sequence of Regression Models. Survey Methodology. 2000;27.
Molenberghs G, Verbeke, G. Models for Discrete Longitudinal Data. 1 ed: Springer-Verlag New York; 2005.
Eno CA, Guck TP, Soleymani T, et al. Medical Student Weight Bias: the Relationship of Attitudinal Constructs Related to Weight Management Counseling. Medical Science Educator. 2018;28:327-333.
doi: 10.1007/s40670-018-0546-1
[SAS Institute, Cary, NC]
StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
Ockene JK, Hayes RB, Churchill LC, et al. Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial. J Gen Intern Med. 2016;31(2):172-181.
doi: 10.1007/s11606-015-3508-y
Reading, Jean M.; Snell, Morgan; and LaRose, Jessica G., A systematic review of weight-related communication trainings for physicians. Translational Behavior Medicine.2020 October 12; 10(5):1110-1119.
doi: 10.1093/tbm/ibaa014