Faculty Bibliography

BACKGROUND: It is uncertain whether training improves physicians' obesity counseling. OBJECTIVE: To assess the impact of an obesity counseling curriculum for residents. DESIGN: A non-randomized, wait-list/control design. PARTICIPANTS: Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1-8 months post-intervention) 163 of the residents' obese patients were interviewed after their medical visits. INTERVENTION: A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients. MAIN MEASURES: Patient-report of physicians' use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics. KEY RESULTS: A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std beta = 0.18; R(2) change = 2.9%, P < 0.05). CONCLUSIONS: Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account

BACKGROUND: The competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents' perceptions of their professional competence and the professionalism of their learning environment. METHODS: A survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described. RESULTS: Cronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, p<.001) and in demonstrating respect. Some residents reported having trouble being sensitive to patients (n = 5 to 23). Disrespectful behaviors were the most frequently witnessed professionalism lapse in the learning environment (mean = 41.1%; F = 8.1, p<.001). While serious lapses in professionalism were not witnessed with great frequency in the learning environment, instances of over-representing qualifications were reported. Problems in accountability in the learning environment were negatively associated with residents' perceived competence. CONCLUSIONS: Residents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents' professionalism

OBJECTIVE: Food label use is associated with better food choices, an essential part of the management of many chronic diseases. Previous studies suggest lack of comprehension of food labels. We studied a multimedia intervention to improve food label comprehension in a sample of low income patients in New York City. METHODS: This randomized study took place at Gouverneur Healthcare Services from 2005 until 2007. The intervention group (n=29) received a Nutrition Facts Label pocket card and viewed a video explaining card use. The control group (n=27) received written materials. Participants completed a 12-item pre- and post-intervention nutrition food label quiz. Quiz scores were analyzed using repeated measures analysis of variance. RESULTS: The intervention group had greater improvement on the quiz than the control group (p<0.001). There was a three way interaction by time with health literacy and treatment group where the greatest improvement occurred in patients with adequate health literacy in the intervention group (p<0.05). There was no improvement in patients with limited health literacy. CONCLUSION: A multimedia intervention is an effective way to improve short-term food label comprehension in patients with adequate health literacy. Further research is necessary to improve understanding of food labels in patients with limited health literacy