Bass Iii Pat F, Stetson Barbara A, Rising William, Wesley Gina C, Ritchie Christine S
a Louisiana State University Health Science Center-Shreveport.
b University of Louisville , Louisville KY.
Med Educ Online. 2004 Dec;9(1):4359. doi: 10.3402/meo.v9i.4359.
Few Americans follow recommendations regarding nutrition or physical activity, and few physicians provide nutritional counseling (NC) or physical activity counseling (PAC) to patients. Clinical, systems-based, and institutional barriers to teaching and providing NC and PAC exist, but theoretical models of behavior change and principles of adult learning theory (ALT) can enable medical educators to overcome these barriers.
We developed an educational intervention consisting of interactive lectures and two standardized patient experiences to provide first-year medical students with practical experience in PAC and NC. Students completed pre and post educational assessments of attitudes, knowledge, and self-efficacy with the counseling techniques.
Knowledge scores increased from 6.1 to 8.5 (p<.001) on a 13-item test. Self-confidence scores for NC increased from 45 to 78 (p<.001), and self-confidence scores for PAC increased from 51 to 82 (p<.001). While overall attitudes regarding the necessity and utility of counseling with specific disease states were not different pre/ post test (necessity pre/post 6.3 to 6.2 p= .71; utility pre/post 5.8 to 5.7 p=.88), necessity and utility scores for disease states treated primarily with counseling were different compared to disease states students perceive to be primarily pharmacologically treated (counseling vs. pharmacological necessity 5.9 vs. 6.6 p<.001; utility 5.4 vs. 6.1 p<.001).
An educational intervention based on theoretical models of behavior change and ALT can increase knowledge and self confidence scores regarding counseling for NC and PAC.
很少有美国人遵循关于营养或体育活动的建议,而且很少有医生为患者提供营养咨询(NC)或体育活动咨询(PAC)。在教学和提供NC及PAC方面存在临床、系统和制度上的障碍,但行为改变的理论模型和成人学习理论(ALT)的原则可以使医学教育工作者克服这些障碍。
我们开发了一种教育干预措施,包括互动讲座和两次标准化患者体验,为一年级医学生提供PAC和NC方面的实践经验。学生完成了关于态度、知识和咨询技巧自我效能的教育前后评估。
在一项13项测试中,知识得分从6.1提高到8.5(p<0.001)。NC的自信得分从45提高到78(p<0.001),PAC的自信得分从51提高到82(p<0.001)。虽然关于针对特定疾病状态进行咨询的必要性和实用性的总体态度在测试前后没有差异(必要性测试前/后6.3至6.2,p = 0.71;实用性测试前/后5.8至5.7,p = 0.88),但与学生认为主要通过药物治疗的疾病状态相比,主要通过咨询治疗的疾病状态的必要性和实用性得分有所不同(咨询与药物治疗必要性5.9对6.6,p<0.001;实用性5.4对6.1,p<0.001)。
基于行为改变理论模型和ALT的教育干预可以提高关于NC和PAC咨询的知识和自信得分。