Effect of didactic lectures on obesity documentation and counseling among internal medicine residents

Abstract

BackgroundScreening 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.ObjectiveWe examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents.MethodsWe 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.ResultsOf 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.ConclusionsObesity 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.

Pediatric Residency Obesity and Overweight Training Curricula: A Systematic Review

“…There were only 6 published trainings that occurred in 1 hour or less of training time, despite evidence that direct, simple training tools are overall more useful for resident education and comfort in obesity-related counseling in comparison to longer tutorial sessions. 10,14,15,18,20,21,23 Given this, an examination of training duration, specifically whether brief training sessions can sustain this efficacy and demonstrate reproducible benefits, is needed. Additionally, only 2 studies documented improvement in expected follow-up visits, 15,20 and none investigated the time frame and follow through for these visits to determine if closer evaluations and management took place as a result of these interventions.…”

Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review

“…Two of these studies examined implicit and explicit bias in medical students [28,33], while the other examined obesity counseling confidence in medical students during an objective structured clinical examination (OSCE) [34]. Four studies involved a chart review [19,[35][36][37]. All four of these programs studied resident education.…”

Development and Implementation of a New OSCE for Assessing Resident Competency in Weight Loss Counseling

“…Several studies have identified concerns related to teaching weight loss counseling topics through didactic instruction alone. Indeed, research demonstrates that didactic instructional style is negatively associated with attitudes and perceived professional norms toward counseling (Antognoli et al 2016) and the rate of obesity documentation and weight loss counseling appeared unchanged following a didactic presentation (Ren et al 2016). Program directors have called for additional opportunities for residents to practice and receive feedback on counseling skills (Antognoli et al 2014, Smith et al 2015.…”