Marie Dacey

Physical activity counseling in medical school education: a systematic review

Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.

An interprofessional service-learning course: uniting students across educational levels and promoting patient-centered care.

Recognizing the importance of interprofessional education, we developed a pilot interprofessional education course at our institution that included a total of 10 nursing, BS health psychology, premedical, and pharmacy students. Course goals were for students to: 1) learn about, practice, and enhance their skills as members of an interprofessional team, and 2) create and deliver a community-based service-learning program to help prevent or slow the progression of cardiovascular disease in older adults. Teaching methods included lecture, role-play, case studies, peer editing, oral and poster presentation, and discussion. Interprofessional student teams created and delivered two different health promotion programs at an older adult care facility. Despite barriers such as scheduling conflicts and various educational experiences, this course enabled students to gain greater respect for the contributions of other professions and made them more patient centered. In addition, inter-professional student teams positively influenced the health attitudes and behaviors of the older adults whom they encountered.

The impact of lifestyle medicine continuing education on provider knowledge, attitudes, and counseling behaviors

Background: There is a need for effective continuing medical education (CME) programs to increase healthcare providers’ knowledge and skills in lifestyle medicine so that healthcare providers are better equipped to assist patients in adopting and maintaining healthier lifestyle behaviors. Aims: To evaluate the impact of five live face-to-face CME programs in lifestyle medicine on providers’ barriers, knowledge, confidence, and professional counseling behaviors. Methods: 200 participants completed researcher-generated surveys before and 90 days after each CME program. Paired t-tests measured significant changes for all outcome variables, and regression analyses assessed predictors of these changes. Results: Barriers that were targeted during the programs, i.e. lack of knowledge/skills, lack of materials, and perceived poor patient compliance showed highly significant improvement. Participants also reported significant changes in knowledge, confidence, and counseling behaviors in the areas of exercise and stress management. Some improvements occurred in areas that the CME programs did not target as much, i.e. nutrition, smoking, and weight management. The greatest predictor of change was the baseline level of scores. Those participants who could most benefit from change did show the largest improvements. Conclusions: Live CME programs can be effective in educating healthcare providers about topics within the rapidly expanding field of lifestyle medicine.

Bridging the gap - planning Lifestyle Medicine fellowship curricula: A cross sectional study

BackgroundThe emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution.MethodsIn September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a “Research Fellowship in Lifestyle Medicine”. A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test.ResultsThirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07).ConclusionsLifestyle fellowship curricula components were defined based on LM stakeholders’ input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.

Family physicians prescribing lifestyle medicine: feasibility of a national training programme

Background The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in ‘Healthy Israel 2020’, a national initiative created to enhance the health of Israelis. Methods Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants’ attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants. Results Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes’ meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in ones knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05). Conclusions A training programme in LM appears feasible and could have a positive impact on interested family physicians’ attitudes and confidence in prescribing LM. Thus, ‘Healthy Israel 2020’ and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training.

Medical students as health coaches: Implementation of a student-initiated Lifestyle Medicine curriculum

BackgroundBy 2020, the World Health Organization predicts that two-thirds of all diseases worldwide will be the result of lifestyle choices. Physicians often do not counsel patients about healthy behaviors, and lack of training has been identified as one of the barriers. Between 2010 and 2014, Hebrew University developed and implemented a 58-h Lifestyle Medicine curriculum spanning five of the 6 years of medical school. Content includes nutrition, exercise, smoking cessation, and behavior change, as well as health coaching practice with friends/relatives (preclinical years) and patients (clinical years). This report describes this development and diffusion process, and it also presents findings related to the level of acceptance of this student-initiated Lifestyle Medicine (LM) curriculum.MethodsStudents completed an online semi-structured questionnaire after the first coaching session (coaching questionnaire) and the last coaching session (follow-up questionnaire).ResultsNine hundred and twenty-three students completed the coaching questionnaire (296 practices were with patients, 627 with friends /relatives); and 784 students completed the follow-up questionnaire (208 practices were with patients, 576 with friends /relatives). They reported overall that health coaching domains included smoking cessation (263 students), nutrition (79), and exercise (117); 464 students reported on combined topics. Students consistently described a high acceptance of the curriculum and their active role in coaching. Further, most students reported that they were eager to address their own health behaviors.ConclusionsWe described the development and acceptance of a student-initiated comprehensive LM curriculum. Students perceived LM as an important component of physicians’ professional role and were ready to explore it both as coaches and in their personal lives. Thus, medical school deans might consider developing similar initiatives in order to position medical schools as key players within a preventive strategy in healthcare policy.

Time for food - training physiatrists in nutritional prescription.

INTRODUCTION Sub-optimal nutrition is a leading factor in all-cause mortality, the preponderance of non-communicable chronic diseases, and various health conditions that are treated by physiatrists, such as stroke and musculoske-letal disorders. Furthermore, patients with chronic pain have a high prevalence of nutritional deficiencies, and malnutrition has been associated with limited rehabilitation outcomes in elderly patients with hospital-associated deconditioning. Thus, physiatrists may find it valuable to include nutrition in their patient services. However, discussion of nutritional counselling in the physiatry literature is rare. OBJECTIVE To inform physiatrists about including nutritional counselling as part of the treatment they provide. METHODS The paper reviews recommended communication skills, behavioural change strategies, and opportunities for inter-professional collaboration. Further resources to educate physiatrists both in nutritional prescription and in improving their own personal health behaviours are provided. CONCLUSION Training physiatrists to address nutrition is a step-wise process, described here.

Time for Food—Including Nutrition on Physiatrists' Tables

Unhealthy nutrition is a leading factor in various rehabilitation diagnoses such as stroke and several musculoskeletal complications. Further, the association between nutrition, pain management, and brain plasticity support the importance of having rehabilitation patients follow healthy nutrition guidelines. The goal of this brief report is to emphasize the importance of nutritional counseling to physiatrists and to briefly describe recommended communication skills, behavioral change strategies, and opportunities for interprofessional collaborations. Potential next steps aimed at prescribing nutrition within physiatry clinics are provided. Incorporating healthy nutrition in the physiatrists personal and professional life presents an opportunity for a meaningful change. Physiatrists can lead the way one bite at a time. The time for a healthy approach to food is now.