Faculty Bibliography

OBJECTIVE: It is unclear whether training physicians to counsel obese patients leads to weight loss. This study assessed whether a 5-h multimodal longitudinal obesity curriculum for residents on the basis of the 5As (assess, advise, agree, assist, and arrange) was associated with weight loss in their obese patients. DESIGN AND METHODS: Twenty-three primary care internal medicine residents were assigned by rotation schedule to intervention (curriculum) or control groups. We then conducted follow-up chart reviews to determine weight change at up to 12 months following the index visit. 158 obese patients (76 in the intervention group and 82 in the control group) completed exit interviews; 22 patients who presented for acute care at the index visit were excluded. Chart reviews were conducted on the 46 patients in the intervention group and 41 patients in the control group who were seen again within 12 months of the index visit and had follow-up weight measurements. RESULTS: The main outcome of interest was mean change in weight at 12 months compared between the intervention and control groups. Patients of residents in the intervention group had a mean weight loss of -1.53 kg (s.d. = 3.72) although the patients of those in the control group had a mean weight gain of 0.30 kg (s.d. = 3.60), P = 0.03. Six (15.8%) patients in the intervention group and 2 (5.4%) patients in the control group lost >5% body weight (P = 0.14). CONCLUSIONS: Although the magnitude of weight loss was small, this study shows that training physicians to counsel patients can produce measurable patient outcomes.

NEEDS AND OBJECTIVES: Despite an increasing need for physicians trained in Internal Medicine (IM), the number of medical students entering residencies in IM has declined. Misconceptions about careers in IM, pay differentials between disciplines, student debt and work hours are thought to contribute to this decline. We developed an "IM Speed Dating Event" to increase first year medical student's awareness of the breadth and richness of IM training and careers. SETTING AND PARTICIPANTS: Faculty members from each Division within the Department of Medicine at our institution were asked to participate to emphasize the diversity of careers paths after IM training. Medical Students were recruited via email, flyers and word-of-mouth. Over 3 years of the event (2009-2011), 51 medical students participated (14-19/year). DESCRIPTION: This "speed dating" event was structured so that students rotated, in timed, five-minute blocks, speaking to a total of 10 faculty. Faculty members were organized to optimize diversity of disciplines to which students were exposed. Students asked questions about faculty members' career and training paths, current roles/responsibilities, work life, and work/life balance. The event was very informal, easy to set up and organize, and the speed dating format encouraged friendly, compelling and direct, but brief, discussions. EVALUATION: All 51 participants (n=18 in 2009, 19 in 2010, and 14 in 2011), completed a pre-event anonymous assessment of their attitudes toward and understanding of IM residency and career pathways and practices as well as their specialty and career intentions. After the event, 47 completed an evaluation of the "Speed Dating" event including listing 3 things they learned and the degree to which the event led them to become more interested in exploring IM. Pre-event assessment results suggest that medical students are quite unsure about IM careers (e.g., 45% reported being not sure whether faculty within IM Departments have all done IM residencies and 58% rep!

NEEDS AND OBJECTIVES: Our annual residency retreat brainstorms innovations to meet needs. In 2010 needs were: to introduce foundation concepts and enable primary care (PC) residents to feel/be competent in clinic earlier; to spiral learning of core concepts, skills and attitudes from the start; and to have residents and faculty connect from the outset.We aim to equip PC clinicians to deliver bio-psychosocial, comprehensive, best evidence-based systems savvy care and to become change agents, leaders, and scholars. To meet these aims we designed a learner centered, team oriented, skills-based Essentials for PC Clinicians (EPIC) curriculum utilizing an initial, rigorous 4 week block with spiral reinforcement through 3 years. The innovation is a comprehensive, reproducible, effective method to ensure residents' progress on paths of clinical, humanistic, and intellectual excellence consistent with the generalist paradigm. SETTING AND PARTICIPANTS: EPIC is part of the NYU Internal Medicine PC Residency. Residents attend public hospital and community continuity clinics. 8 interns take the EPIC block and 24 residents spiral through the curriculum. DESCRIPTION: EPIC begins with a 4 week intern block dedicated to core topics in PC; is reinforced in precepting and subsequent blocks; and has a weekly EPIC conference where these topics are deepened and extended. EPIC Block: The overarching themes throughout the 4 weeks focus on understanding and practice of core skills: workshops/precepting on time management, efficient use of EHR, obtaining best practices, consultation, how one learns best, practice in the medical home and engaging community resources. Week 1 focuses on diabetes, and introduces the pillars: psychosocial medicine, evidence-based practice, and systems-based policy awareness and skill. The second week focuses on hypertension. The last 2 weeks introduce 7 common, high-risk high gain conditions from smoking to hepatitis B. Teaching methods combine group learning and reflective written exercises!