Ashe Karen M, Geller Alan C, Pendharkar Jyothi A, Pbert Lori, Crawford Sybil, Clark Melissa A, Frisard Christine F, Eno Cassie A, Faro Jamie, Ockene Judith K
Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Am J Prev Med. 2021 May;60(5):711-715. doi: 10.1016/j.amepre.2020.10.026. Epub 2021 Feb 22.
Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, observation, and direct experience.
A cross-sectional survey, conducted in 2017, of 730 third-year medical students in 8 U.S. medical schools assessed the frequency of direct patient, observational, and instructional weight management counseling experiences that were reported as summed scores with a range of 0‒18. Analysis was completed in 2017.
Students reported the least experience with receiving instruction (6.5, SD=3.9), followed by direct patient experience (8.6, SD=4.8) and observational experiences (10.3, SD=5.0). During the preclinical years, 79% of students reported a total of ≤3 hours of combined weight management counseling instruction in the classroom, clinic, doctor's office, or hospital. The majority of the students (59%-76%) reported never receiving skills-based instruction for weight management counseling. Of the Ask, Advise, Assess, Assist, Arrange framework, scores were lowest for assisting the patient to achieve their agreed-upon goals (31%) and arranging follow-up contact (22%).
Overall exposure to weight management counseling was less than optimal. Medical school educators can work toward developing a more coordinated approach to weight management counseling.
临床指南支持医生对肥胖成人采取符合“询问、建议、评估、协助、安排”框架的干预措施。然而,不同医学院校的体重管理咨询课程各不相同。目前尚不清楚学生接受体重管理咨询相关经历(如指导、观察和直接实践)的频率如何。
2017年对美国8所医学院校的730名三年级医学生进行了一项横断面调查,评估了直接接触患者、观察和指导的体重管理咨询经历的频率,这些经历以0至18分的总和分数形式报告。分析于2017年完成。
学生报告接受指导的经历最少(6.5分,标准差=3.9),其次是直接接触患者的经历(8.6分,标准差=4.8)和观察经历(10.3分,标准差=5.0)。在临床前阶段,79%的学生报告在课堂、诊所、医生办公室或医院接受的体重管理咨询指导总计不超过3小时。大多数学生(59%-76%)报告从未接受过基于技能的体重管理咨询指导。在 “询问、建议、评估、协助、安排” 框架中,协助患者实现商定目标(31%)和安排后续联系(22%)的得分最低。
总体而言,体重管理咨询的接触程度低于最佳水平。医学院校教育工作者可以努力制定一种更协调一致的体重管理咨询方法。