Medicine Residents are Unprepared to Effectively Treat Patients with Obesity: Results from a U.S. Internal Medicine Residency Survey

Abstract

Background: In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. Methods: Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. Results: Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are “very prepared” to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to “a great extent.” Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to “very little extent” or “not at all.” Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. Conclusions: Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.

Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey

“…We based the family medicine survey on a similar survey of medical schools [ 22 ] and internal medicine residency programs [ 16 ]. To emphasize unique aspects of family medicine, the survey was adapted, through an iterative process, to include questions related to the prevention of obesity (in addition to its management), the extent to which programs integrate clinical and community systems as partners in obesity management, the degree to which patient-centered communication is emphasized, and the level of participation of other disciplines as part of the “medical home” team.…”

“…In addition to lack of sufficient clinic time and inconsistent reimbursement for obesity related codes [ 13 ], other reasons why primary care physicians may not effectively address obesity include discomfort discussing obesity with patients [ 14 ] and limited exposure to obesity as part of formal education in both medical school and residency. Studies have shown that less than one-third of medical schools meet the minimum recommended hours of nutrition education [ 15 ] and there is limited coverage of obesity-related topics in internal medicine programs [ 16 ] or medical licensing exams [ 17 ].…”

A Canadian Survey of Medical Students and Undergraduate Deans on Managing Patients With Obesity

“…8,9 This problem, however, is not unique to primary care; physicians in various specialties also report the same challenges. [10][11][12][13][14] As such, it is plausible that educational content regarding management of patients with obesity may be best delivered during undergraduate medical education (UGME), rather than being reserved for postgraduate medical education. In fact, there is consensus in the literature that medical students should be taught approaches to management of patients with obesity; [14][15][16][17][18][19][20][21] however, there is a lack of understanding on how this topic is currently being taught at the UGME level in Canada and whether graduating students are competent in managing patients with obesity.…”

Development of a telehealth obesity OSCE and reliable checklist for assessment of resident physicians: a pilot study

“…Although barriers to adequate obesity care exist at all levels of the medical system including lack of time and reimbursement, inadequate physician training remains an important obstacle [6,7]. Currently, up to one-fifth of internal medicine training programs, which are responsible for training primary care physicians who are at the frontlines of obesity care, provide very little instruction on physical activity and nutrition, and more than one-third provide very little or no instruction on psychosocial and behavioral components of obesity, weight stigma and discrimination [8]. In a national survey of primary care physicians in the United States, approximately 90% identified additional training in nutrition and physical activity counseling as a targetable intervention to improve obesity related care [9].…”