Assistant Instructor, Division of General Internal Medicine, University of Texas Southwestern Medical Center.
Data Analyst, Center for Research on Health Care (CRHC) Data Center, University of Pittsburgh.
MedEdPORTAL. 2020 Nov 11;16:11027. doi: 10.15766/mep_2374-8265.11027.
Primary care providers play a critical role in reducing patients' risk for cardiovascular disease, including providing dietary counseling. However, few physicians feel adequately trained to provide this counseling, and most internal medicine (IM) residencies do not offer nutrition education.
We created an interactive, case-based activity for IM residents to improve the delivery of nutrition counseling to patients with hypertension, hyperlipidemia, overweight, and obesity. The curriculum was given over two in-person small-group sessions facilitated by physician preceptors. It reviewed evidence for relevant dietary patterns, provided resources for dietary referrals, and allowed residents to practice counseling based on a patient's stage of behavioral change.
Residents completed electronic surveys prior to curriculum implementation, immediately after, and 2 months after completion of the curriculum. Aggregate percent correct scores of knowledge questions improved significantly in the immediate postsurvey ( = 24 paired responses, = .004). We also reviewed electronic health records of patients with body mass index ≥ 25, hypertension, or hyperlipidemia who were seen in our resident clinics 2 months prior ( = 503) and 2 months after ( = 473) curriculum delivery. Residents' documented nutrition counseling increased from 35% to 41% (odds ratio, 1.27; 95% CI, 0.97-1.67; = .085).
We demonstrated improved knowledge of nutrition interventions to reduce cardiovascular risk and reported improvement of resident-provided nutrition counseling for appropriate patients. This activity offers IM residents effective initial nutrition training for patients at risk for cardiovascular disease and is practical to implement as part of an ambulatory curriculum.
初级保健提供者在降低患者心血管疾病风险方面发挥着关键作用，包括提供饮食咨询。然而，很少有医生觉得自己有足够的能力提供这种咨询，而且大多数内科（IM）住院医师培训项目都不提供营养教育。
我们为 IM 住院医师创建了一个互动的、基于案例的活动，以提高向高血压、高血脂、超重和肥胖患者提供营养咨询的能力。该课程在两名医生导师的指导下，通过两次面对面的小组会议进行。它回顾了相关饮食模式的证据，为饮食推荐提供了资源，并允许住院医师根据患者的行为改变阶段进行咨询练习。
住院医师在课程实施前、实施后立即和实施后 2 个月完成了电子调查。知识问题的总正确分数在即时后测中显著提高（=24 对响应，=0.004）。我们还回顾了在我们的住院医师诊所就诊的 BMI≥25、高血压或高血脂患者的电子健康记录，这些患者在课程实施前 2 个月（=503）和后 2 个月（=473）。住院医师记录的营养咨询从 35%增加到 41%（比值比，1.27；95%置信区间，0.97-1.67；=0.085）。
我们证明了减少心血管风险的营养干预措施的知识有所提高，并报告了适当患者的住院医师提供的营养咨询有所改善。该活动为有心血管疾病风险的患者提供了有效的初始营养培训，并且作为门诊课程的一部分是切实可行的。
