Internal Medicine Residents’ Comfort with and Frequency of Providing Dietary Counseling to Diabetic Patients

Tang, Joyce; Freed, Benjamin H.; Baker, Timothy D.; Kleczek, Julie; Tartaglia, Kimberly; Laiteerapong, Neda; Press, Valerie G.; Schwartz, Mindy A.; Arora, Vineet M.

doi:10.1007/s11606-009-1084-8

Cited by 13 publications

(13 citation statements)

References 15 publications

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“…9,10 We placed these recommendations in the context of competency-based residency training per the Accreditation Council of Graduate Medical Education (ACGME) and the American Board of Internal Medicine (ABIM), looking at curriculum development in physical activity and nutrition counseling as it relates to the six core competencies. 11 Literature review confirmed low counseling rates of patients at risk for CVD in our program 6 and in other residency programs [12][13][14] and documented studies on reported barriers to physician counseling. [15][16][17] We then conducted a targeted needs assessment defined in step two of Kern's six-step approach as "assessing the needs of one's targeted group of learners and their medical institution/ learning environment, which may be different from the needs of learners and medical institutions in general."…”

Section: Methodssupporting

confidence: 53%

“…To assess professional attitudes toward counseling, we developed open and closed ended questions regarding potential barriers based on published barriers to counseling. [12][13][14][15][16][17] We then developed questions on resident practices in physical activity and nutrition counseling. The self-administered KAP survey used multiple choice questions for the knowledge and practices portions and 5-point Likert scale questions for the attitudes portion.…”

Section: Kap Questionnairementioning

confidence: 99%

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Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

et al. 2010

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BACKGROUND: Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal. OBJECTIVES: To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs. DESIGN AND PARTICIPANTS: One hundred and fiftyeight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents' baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling. MAIN MEASURES: The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported. KEY RESULTS: Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers. CONCLUSIONS: We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness.

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Section: Methodssupporting

confidence: 53%

Section: Kap Questionnairementioning

confidence: 99%

Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

et al. 2010

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“…Our findings also support previous studies from other specialties that have demonstrated a correlation between resident comfort levels and frequency managing topics in medicine, underscoring the importance of direct and reinforced clinical exposure during residency training. 24,25 Perhaps it is not surprising then that we found no differences in comfort levels between residents at the beginning of their training compared with those completing training, as there was no increase in frequency managing 12 of 13 WH topics between the two groups.…”

Section: Discussionmentioning

confidence: 76%

Needs and Priorities in Women's Health Training: Perspectives from an Internal Medicine Residency Program

Hsieh

Nuñez-Smith

Henrich

2013

Journal of Women's Health

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Background: Few studies have examined residents' perspectives on the adequacy of women's health (WH) training in internal medicine (IM). This study sought residents' opinions regarding comfort level managing 13 core WH topics, their perceived adequacy of training in these areas, and the frequency with which they managed each topic. The association between reported comfort level and perceived adequacy of training and management frequency was also assessed. Methods: A 67-item questionnaire was administered from April to June 2009 to 100 (64%) of the 156 residents from the traditional, primary care, and IM-pediatrics residency programs at a single institution. Descriptive and correlation statistics were used to examine the relationships between self-reported comfort level, perceived adequacy of training opportunities, and frequency managing WH issues. Data was stratified by sex, IM program, and post-graduate year (PGY). Results: The majority of residents reported low comfort levels managing 7 of 13 topics. Over half of residents perceived limited training opportunities for 11 of 13 topics. With the exception of cardiovascular disease in women, greater than 75% of residents reported managing the 13 topics five or more times in the prior 6 months. Correlation analysis suggested a linear relationship between low comfort levels and limited training opportunities, and between low comfort levels and low frequency managing WH topics (r = 0.97 and r = 0.89, respectively). Stratified analyses by sex, IM program, and PGY showed no significant differences. Conclusions: Key gaps remain in WH training. Our results emphasize the importance of reinforcing WH training with hands-on management opportunities. Understanding institution-specific strengths and weaknesses may help guide the development of targeted initiatives.

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“…Certain predictors of residents ’ counseling practices have been identified, such as higher comfort levels and self-efficacy 13 ; having a practice preference for primary care; and working with supervising physicians committed to prevention. 14 However, no studies to date have examined the relationship between nutrition education in residency and residents’ counseling practices.…”

Section: Introductionmentioning

confidence: 99%

Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents’ Dietary Counseling Practices

Khandelwal

Zemore

Hemmerling

2018

Journal of Medical Education and Curricular Development

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Background:Although physicians are expected to provide dietary counseling for patients with cardiovascular (CV) risk factors such as hypertension, hyperlipidemia, diabetes, and obesity, nutrition education in graduate medical education remains limited. Few studies have recently examined nutrition education and dietary counseling practices in Internal Medicine (IM) residency training.Objectives:To conduct a contemporary assessment of outpatient nutrition education in IM residency programs in the United States, identify predictors of residents’ dietary counseling practices for CV risk factors, and identify barriers for educators in providing nutrition education and barriers for residents in counseling patients.Design:Cross-sectional anonymous surveys were completed by IM program directors (PDs) and residents throughout the United States. Linear regression was used to examine the association between the amount of nutrition education received and the number of instruction methods used by the residents and frequency of residents’ dietary counseling for patients with CV risk factors.Key Results:A total of 40 educators (PDs and ambulatory/primary care PDs) and 133 residents across the United States responded to the survey. About 61% of residents reported having very little or no training in nutrition. Nutrition education in residency, both the amount of education (β = 0.20, P = .05) and the number of instruction methods used (β = 0.26, P = .02), predicted frequency of residents’ dietary counseling practices independent of nutrition education in medical school, which was also significantly associated with counseling (β = 0.20, P = .03). Residents’ total fruit and vegetable intake likewise predicted frequency of counseling (β = 0.24, P < .001). Low perceived faculty expertise was a major barrier for educators and was associated with lower level of provided nutrition education (r = −.33, P = .04). Low resident and low perceived clinic preceptors’ interests in nutrition were also associated with lower frequency of residents’ dietary counseling (r = −.19, P = .04; r = −.18, P = .05).Conclusions:The provision of nutrition education in IM residency programs and IM residents’ dietary counseling for patients need to be systematically assessed nationally. This study’s preliminary findings suggest that multimodal nutrition education in IM residency and better resident dietary habits are associated with higher frequency of dietary counseling for patients. Lack of faculty expertise and low faculty and resident interests in patient counseling need to be addressed perhaps by mandating nutrition education in graduate and continuing medical education.

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Internal Medicine Residents’ Comfort with and Frequency of Providing Dietary Counseling to Diabetic Patients

Cited by 13 publications

References 15 publications

Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

Needs and Priorities in Women's Health Training: Perspectives from an Internal Medicine Residency Program

Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents’ Dietary Counseling Practices

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