Acosta Andres, Azzalin Alice, Emmons Claudia J, Shuster Jonathan J, Jay Melanie, Lo Margaret C
Division of Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, Florida, USA.
Postgrad Med J. 2014 Nov;90(1069):630-7. doi: 10.1136/postgradmedj-2014-132821. Epub 2014 Sep 11.
BACKGROUND/OBJECTIVES: Obesity has been declared a 21st century pandemic by WHO. Yet surveys reveal physicians-in-training are uncomfortable managing obesity. One major barrier is the lack of residency education on obesity management. This study incorporates an obesity-specific didactic curriculum into an internal medicine (IM) residency programme and assesses its impact on residents' knowledge, attitudes, practice behaviours, and clinical outcomes in patients with obesity.
The intervention consisted of four, 1 h, obesity-specific lectures in the University of Florida Resident Noon Conference. Lectures were taught by multidisciplinary experts and offered to 75 IM residents every 2 weeks from 5 November 2010 to 17 December 2010. Impact on IM residents' knowledge and attitudes was assessed by a pre- and post-intervention Obesity Awareness Questionnaire (OAQ). IM residents' clinical performance was assessed by chart reviews of 238 patients with body mass index >25 kg/m(2) in residents' clinics 4 months pre- and 6 months post-intervention for three clinical outcomes and seven practice behaviours on obesity management. Pre- and post-intervention outcomes were compared via paired t tests (quantitative data) or McNemar's test (binary data).
Mean lecture attendance was 25/75 residents (33%) per lecture. Survey response was 67/75 residents (89%) pre-OAQ and 63/75 residents (84%) post-OAQ. While most attitudes remained unchanged, IM residents gained significant confidence in exercise counselling, safety of bariatric surgery, and patients' weight loss potential; they were more likely to address obesity in the plan and referrals to bariatric surgery. Clinical outcomes and IM residents' knowledge demonstrated no improvement.
Our brief lecture-based curriculum has the potential to improve IM residents' attitudes and practice behaviours towards obesity. The lack of improvement in clinical outcomes and resident knowledge prompts the need for multimodal, longitudinal curricula with experiential application of obesity medicine.
背景/目的：世界卫生组织已宣布肥胖是21世纪的大流行病。然而，调查显示，接受培训的医生在管理肥胖症方面感到不自在。一个主要障碍是缺乏关于肥胖症管理的住院医师教育。本研究将特定于肥胖症的教学课程纳入内科住院医师培训计划，并评估其对住院医师的知识、态度、实践行为以及肥胖症患者临床结果的影响。
干预措施包括在佛罗里达大学住院医师午餐会议上进行的四次为时1小时的特定于肥胖症的讲座。讲座由多学科专家授课，从2010年11月5日至2010年12月17日，每两周向75名内科住院医师提供一次。通过干预前后的肥胖症认知问卷（OAQ）评估对内科住院医师知识和态度的影响。通过对干预前4个月和干预后6个月住院医师诊所中238名体重指数>25kg/m²的患者的病历审查，评估内科住院医师在肥胖症管理的三个临床结果和七种实践行为方面的临床表现。通过配对t检验（定量数据）或McNemar检验（二元数据）比较干预前后的结果。
每次讲座的平均出勤人数为25/75名住院医师（33%）。OAQ前的调查回复率为67/75名住院医师（89%），OAQ后的调查回复率为63/75名住院医师（84%）。虽然大多数态度保持不变，但内科住院医师在运动咨询、减肥手术的安全性以及患者的减肥潜力方面获得了显著的信心；他们更有可能在计划中提及肥胖症并转诊进行减肥手术。临床结果和内科住院医师的知识没有改善。
我们基于讲座的简短课程有可能改善内科住院医师对肥胖症的态度和实践行为。临床结果和住院医师知识缺乏改善促使需要采用多模式、纵向的课程，并将肥胖医学进行实践应用。
