Pojednic Rachele, Frates Elizabeth
Institute of Lifestyle Medicine, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
Clin Teach. 2017 Feb;14(1):27-31. doi: 10.1111/tct.12475. Epub 2015 Dec 6.
Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours such as diet, physical activity or weight control, despite the prediction by the World Health Organization that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. This gap in patient-clinician dialogue is perhaps the result of a lack of structured training in medical school surrounding the components of lifestyle medicine.
Although Harvard Medical School does have a required course in nutrition, there are no requirements for the other components of lifestyle medicine, including physical activity, behaviour change and self-care.
Since 2009 Harvard Medical School has addressed this absence in the curriculum by developing a student-led, faculty member-advised, parallel curriculum in lifestyle medicine. Medical student participants were invited to take part in anonymous questionnaires between 2009 and 2013, which gathered data about personal ability and attitude in counselling patients on lifestyle behaviours, as well as subjective data on the curriculum content and applications to effective medical practice. Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours IMPLICATION: Each year, students have pointed to a lack of lifestyle medicine knowledge because of a gap in the traditional curriculum surrounding topics such as physical activity, nutrition and behaviour-change strategies, and indicated that the inclusion of this knowledge and these skills was an important component of medical education. Although participation is currently voluntary, this is the first such curriculum of this type and addresses a critical gap in undergraduate medical education.
尽管世界卫生组织预测到2020年全球三分之二的疾病将归因于不良的生活方式选择,但美国不到50%的初级保健医生会定期就饮食、体育活动或体重控制等生活方式行为为患者提供指导。患者与临床医生之间对话的这种差距可能是医学院校在生活方式医学组成部分方面缺乏结构化培训的结果。
虽然哈佛医学院确实有一门营养必修课,但对生活方式医学的其他组成部分,包括体育活动、行为改变和自我保健,并无要求。
自2009年以来,哈佛医学院通过开发一门由学生主导、教师指导的生活方式医学平行课程来弥补课程中的这一缺失。2009年至2013年期间,邀请参与该课程的医学生参加匿名问卷调查,收集他们在为患者提供生活方式行为咨询方面的个人能力和态度数据,以及关于课程内容和在有效医疗实践中的应用的主观数据。美国不到50%的初级保健医生会定期就生活方式行为为患者提供指导
每年,学生们都指出由于传统课程在体育活动、营养和行为改变策略等主题方面存在差距,导致缺乏生活方式医学知识,并表示纳入这些知识和技能是医学教育的重要组成部分。尽管目前参与是自愿的,但这是此类课程中的首个课程,填补了本科医学教育中的一个关键空白。