Improving Residents' Clinical Approach to Obesity
Improving Residents' Clinical Approach to Obesity
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 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.
Obesity has been declared a 21st century pandemic by WHO and its prevalence is rapidly increasing in developed countries. With over 500 million people worldwide diagnosed with obesity, it has become a major public health and medico-economic crisis. Obesity is associated with the top 10 mortality and morbidity causes of death in the USA and increases the risk of several chronic diseases, including cardiovascular disease, diabetes mellitus, sleep apnoea, cancer, reproductive disorders, endocrine disorders, psychological disorders, bone, joints and connective tissue disorders, and gastrointestinal disorders.
Physicians are in a key position to combat the obesity pandemic. Yet, survey studies reveal both residents and primary care physicians feel uncomfortable managing obesity including one survey conducted by the Obesity Society to its physician members. The major barriers to obesity management cited in these studies include knowledge deficits about weight-related patient services; cynicism over the effectiveness of obesity counselling and treatments; lack of infrastructure for weight-related referral services; patient inertia for change; and inadequate training in effective weight counselling, nutritional plans, and behavioural modifications. These authors determined poor education during medical school and residency to be a leading factor for these barriers. Education in obesity medicine is barely mentioned in the guidelines for the American Board of Internal Medicine (ABIM) examination and is only addressed in the Accreditation Council of Graduate Medical Education (ACGME) guidelines through other disease-specific topics (ie, diabetes, fatty liver). While some resident-focused curricula have demonstrated improvement in the quality of counselling about obesity and weight loss in patients with obesity, the curricula were relatively resource-intensive (eg, utilising standardised patients and delivering to a small cohort of residents), did not report the impact on residents' clinical practice behaviours, and have not been replicated elsewhere.
This medical education study aims to assess the feasibility of a multidisciplinary obesity-specific didactic curriculum on: (1) enhancing internal medicine (IM) residents' knowledge, attitudes, and subsequent clinical practice behaviours on obesity management; and (2) improving future clinical outcomes among patients with obesity managed by IM residents in their own continuity clinics.
Abstract and Introduction
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 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.
Introduction
Obesity has been declared a 21st century pandemic by WHO and its prevalence is rapidly increasing in developed countries. With over 500 million people worldwide diagnosed with obesity, it has become a major public health and medico-economic crisis. Obesity is associated with the top 10 mortality and morbidity causes of death in the USA and increases the risk of several chronic diseases, including cardiovascular disease, diabetes mellitus, sleep apnoea, cancer, reproductive disorders, endocrine disorders, psychological disorders, bone, joints and connective tissue disorders, and gastrointestinal disorders.
Physicians are in a key position to combat the obesity pandemic. Yet, survey studies reveal both residents and primary care physicians feel uncomfortable managing obesity including one survey conducted by the Obesity Society to its physician members. The major barriers to obesity management cited in these studies include knowledge deficits about weight-related patient services; cynicism over the effectiveness of obesity counselling and treatments; lack of infrastructure for weight-related referral services; patient inertia for change; and inadequate training in effective weight counselling, nutritional plans, and behavioural modifications. These authors determined poor education during medical school and residency to be a leading factor for these barriers. Education in obesity medicine is barely mentioned in the guidelines for the American Board of Internal Medicine (ABIM) examination and is only addressed in the Accreditation Council of Graduate Medical Education (ACGME) guidelines through other disease-specific topics (ie, diabetes, fatty liver). While some resident-focused curricula have demonstrated improvement in the quality of counselling about obesity and weight loss in patients with obesity, the curricula were relatively resource-intensive (eg, utilising standardised patients and delivering to a small cohort of residents), did not report the impact on residents' clinical practice behaviours, and have not been replicated elsewhere.
This medical education study aims to assess the feasibility of a multidisciplinary obesity-specific didactic curriculum on: (1) enhancing internal medicine (IM) residents' knowledge, attitudes, and subsequent clinical practice behaviours on obesity management; and (2) improving future clinical outcomes among patients with obesity managed by IM residents in their own continuity clinics.
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