Small Priya, Adkins Sherry, Bell Amanda
Assistant Professor and Program Manager, Department of Medical Education, Wright State University Boonshoft School of Medicine.
Clinical Assistant Professor, Department of Family Medicine, and Associate Program Director, Rural Family Medicine, Wright State University Boonshoft School of Medicine.
MedEdPORTAL. 2024 Dec 30;20:11478. doi: 10.15766/mep_2374-8265.11478. eCollection 2024.
Physicians face barriers to counseling patients regarding lifestyle, specifically, low perceived importance of and confidence in counseling, leading to underuse. There is a dearth in the literature evaluating educational interventions for counseling skills among preclinical medical students. Closing this gap is crucial to taking advantage of critical opportunities early in training.
We taught a session on evidence-based counseling for lifestyle changes to 124 preclinical medical students using case scenarios and role-plays. Our evaluation included (1) measures of perceived importance of and confidence in counseling and (2) measures of perceived gains related to learning objectives. We also undertook qualitative analysis of the session evaluation and thematic analysis of written assignments.
There were statistically significant increases in perceived importance of and confidence in lifestyle counseling. Postintervention student responses demonstrated the highest gain for listing and addressing obstacles to physician counseling, followed by applying physician counseling interventions. Students applied models correctly; however, our thematic analysis of written assignments demonstrated room for continued improvement in application of motivational interviewing techniques.
It is significant that our session impacted students' attitudes on the importance of lifestyle counseling. Based on the session evaluation, we are refining assignment instructions for clarity, providing more time for each role-play, and starting with a faculty role-play demonstration. Aggregate data over time will be more robust than our single cohort. Our evaluation was limited to self-reported attitudes and role-play transcript review, but future interventions could use thematic analysis of recorded role-plays or direct observation of patient simulations.
医生在就生活方式问题向患者提供咨询时面临障碍，具体而言，他们认为咨询的重要性较低且缺乏信心，这导致咨询未得到充分利用。在评估临床前医学生咨询技能的教育干预措施方面，文献资料匮乏。弥补这一差距对于在培训早期利用关键机会至关重要。
我们使用案例场景和角色扮演，为124名临床前医学生开展了一次关于基于证据的生活方式改变咨询的课程。我们的评估包括：（1）对咨询重要性的认知和信心的测量；（2）与学习目标相关的认知收获的测量。我们还对课程评估进行了定性分析，并对书面作业进行了主题分析。
在对生活方式咨询的重要性认知和信心方面，有统计学意义的显著提高。干预后学生的回答显示，在列出并解决医生咨询的障碍方面收获最大，其次是应用医生咨询干预措施。学生们正确应用了模型；然而，我们对书面作业的主题分析表明，在动机访谈技巧的应用方面仍有持续改进的空间。
我们的课程影响了学生对生活方式咨询重要性的态度，这一点很重要。根据课程评估，我们正在完善作业说明以使其更清晰，为每个角色扮演提供更多时间，并以教师角色扮演示范开始。随着时间推移的汇总数据将比我们单一队列的数据更具说服力。我们的评估仅限于自我报告的态度和角色扮演记录审查，但未来的干预措施可以对录制的角色扮演进行主题分析或直接观察患者模拟。
