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Olson A, Watowicz R, Seeholzer E, Lyons K, Butsch WS, Croniger C. Preclinical obesity curriculum: audit, implementation, and evaluation. BMC MEDICAL EDUCATION 2024; 24:639. [PMID: 38849838 PMCID: PMC11157830 DOI: 10.1186/s12909-024-05606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND This study aimed to (1) evaluate the current status of obesity education at Case Western Reserve University School of Medicine (CWRU) (2), introduce a comprehensive first-year curriculum on obesity, and (3) assess the impact of the curriculum on self-reported attitudes and knowledge regarding obesity among first-year medical students. METHODS The preclinical curriculum at CWRU was reviewed to determine the degree of coverage of Obesity Medicine Education Collaborative (OMEC) competencies for healthcare professionals, and recommendations were provided for revising the curriculum to better adhere to these evidence-based competencies. A survey on obesity attitudes and knowledge was given before and after the implementation of the new curriculum to measure intervention-related changes. Changes in obesity attitudes and knowledge were compared (1) before and after the intervention for the class of 2025 and (2) after the intervention for the class of 2025 to a historical cohort that did not receive the intervention. RESULTS Among the 27 competencies examined in the audit, 55% were unmet and 41% were partially met. Of 186 first-year medical students (M1s), 29 (16%) completed the baseline survey and 26 (14%) completed the post-intervention survey. Following the intervention, there was a notable improvement in attitudes and knowledge regarding obesity. Specifically, there was a significant decrease in the belief that obesity is caused by poor personal choices, and knowledge of obesity in fourteen out of fifteen areas showed significant improvement from pre- to post-intervention. Additionally, obesity attitudes and knowledge were significantly better post-intervention when compared to the historical cohort. CONCLUSIONS The improvements made to the preclinical curriculum through this project improved obesity attitudes and knowledge among first-year medical students. This method provides a practical approach for evaluating and enhancing obesity education in medical school curricula.
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Affiliation(s)
- Amber Olson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Rosanna Watowicz
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Eileen Seeholzer
- Adult Weight Loss Surgery & Weight Management Center, MetroHealth System, Cleveland, OH, USA
| | - Katherine Lyons
- Adult Weight Loss Surgery & Weight Management Center, MetroHealth System, Cleveland, OH, USA
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Colleen Croniger
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Aker S, Şahin MK. Obesity Bias and Stigma, Attitudes, and Beliefs Among Intern Doctors: a Cross-sectional Study from Türkiye. Obes Surg 2024; 34:86-97. [PMID: 37968559 DOI: 10.1007/s11695-023-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The purpose of this study was to determine intern physicians' attitudes and beliefs toward obesity and individuals with obesity and the frequency at which they encounter discriminatory language in their work environments. METHODS This cross-sectional study was performed with intern physicians at the Ondokuz Mayıs University Medical Faculty in Samsun, Türkiye. A questionnaire was employed for data collection (Appendix). Two hundred eighteen (82.2%) interns took part in the study. The questionnaire consisted of 53 questions in five sections, and included the attitudes toward obese persons (ATOP) and beliefs about obese persons (BAOP) scales. RESULTS The interns most frequently cited genetic factors (98.1%) and endocrine disorder-metabolic disorders (98.1%) as non-behavioral causes of obesity, and overeating (96.2%) and physical immobility (96.2%) as behavioral causes. Lifestyle changes and exercise were most frequently recommended for treatment. The interns' attitudes toward individuals with obesity were very slightly negative, but close to neutral. Analysis showed that 46.8% of the interns reported hearing members of academic staff, intern physicians, or health workers make negative or derogatory comments or jokes about obese patients during their education, while 22.0% reported witnessing an obese patient being subjected to discriminatory treatment in the hospital environment. CONCLUSION Medical faculties must develop curricula aimed at comprehensively addressing obesity-related bias. Such a curriculum should allow students to reflect on their biases, be aimed at reducing the effect of those biases on patient communication, and involve strategies directed toward eliminating those effects from physicians' treatment decisions.
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Affiliation(s)
- Servet Aker
- Department of Medical Education, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
| | - Mustafa Kürşat Şahin
- Department of Family Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Nagpal TS, Pearce N, Sockalingam S, Hawa R, Dhaliwal KK, Lee-Baggley D, El-Hussein M, Nutter S, Piccinini-Vallis H, Vallis M, Dennett L, Forhan M, Hadjiyanakkis S, Kushner RF, McMillan M, Wharton S, Wiljer D, Abraham JR. A scoping review of obesity education interventions for current and prospective medical professionals in Canada. OBESITY PILLARS (ONLINE) 2023; 8:100085. [PMID: 38125662 PMCID: PMC10728706 DOI: 10.1016/j.obpill.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
Background Obesity is a prevalent chronic disease in Canada. Individuals living with obesity frequently interact with medical professionals who must be prepared to provide evidence-based and person-centred care options. The purpose of this scoping review was to summarize existing educational interventions on obesity in Canada for current and prospective medical professionals and to identify key future directions for practice and research. Methods A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The search strategy was conducted using Medline (via PubMed), Embase, Eric, CBCA, Proquest Education, and Proquest Theses. The inclusion criteria included delivery of an educational intervention on obesity for current medical professionals, medical undergraduate trainees, or residents administered in Canada. Data were extracted from the included studies to thematically summarize the intervention content, and main outcomes assessed. Future directions for research and practice were identified. Results Eight studies met the inclusion criteria. The interventions ranged in terms of the mode of delivery, including interactive in-person workshops and seminars, online learning modules, webinars, and videos. The main outcomes assessed were attitudes towards patients living with obesity, self-efficacy for having sensitive obesity-related discussions, skills to assess obesity and provision of management options. All studies reported improvements in the outcomes. Future directions identified were the need to develop standardized obesity competencies for inclusion across medical education programs, further research on effective pedagogical approaches to integrating content into existing curricula and the need for broader awareness and assessment of the quality of obesity education resources. Conclusion Although there have been few obesity-specific educational interventions for current and prospective medical professionals in Canada, existing evidence shows positive learning outcomes. These findings advocate for continued investment in the development of obesity medical training and educational interventions.
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Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Khushmol K. Dhaliwal
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohamed El-Hussein
- Faculty of Health, Community & Education, School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Liz Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton Alberta Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stasia Hadjiyanakkis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert F. Kushner
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Sean Wharton
- University of Toronto, Wharton Medical Clinic, Toronto, Ontario, Canada
| | - David Wiljer
- University Health Network; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Grunvald E, Wei J, Lin T, Yang K, Tu XM, Lunde O, Ross E, Cheng J, DeConde J, Farber N. Exploring the Effect of Adding an Interactive Lecture to a Standardized Patient Curriculum on the Attitudes of Third-Year Medical Students About Patients With Obesity: A Quasi-Experimental Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231207683. [PMID: 37854280 PMCID: PMC10580723 DOI: 10.1177/23821205231207683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Anti-obesity bias is pervasive among medical professionals, students, and trainees. Stigmatization of patients leads to suboptimal care and clinical outcomes. Educational strategies in medical training are needed to reverse these attitudes. The aim of this study was to evaluate the effect of an innovative didactic intervention and a standardized patient (SP) exercise on attitudes towards patients with obesity among medical students. METHODS In 2016, a quasi-experimental study design was used at a US medical school. The class was divided into 2 groups according to a pre-determined protocol based on their clinical schedule, one assessed after exposure to a SP group and the other after exposure to the SP and an interactive lecture (IL + SP group) with real patients. The Attitudes about Treating Patients with Obesity and The Perceived Causes of Obesity questionnaires measured changes in several domains. A generalized estimating equations model was used to estimate the effect of the interventions both within and between groups. RESULTS Both groups showed improvements in negative and positive attitudes, although the reduction in scores for the negative attitude domain did not reach statistical significance in the IL + SP group (for the SP group, P = .01 and < .001, respectively; for the IL + SP group, P = .15 and .01, respectively). For perceived causes of obesity, there were no statistically significant changes for pre-post survey measures within each group, except for the physiologic causes domain in the SP group (P = .03). The addition of an IL to a SP curriculum did not result in any changes for any domain in between-group analyses. CONCLUSIONS Although adding a novel intervention utilizing real patients to a SP curriculum failed to show an additional educational benefit, our study showed that it is possible to influence attitudes of medical students regarding patients with obesity.
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Affiliation(s)
- Eduardo Grunvald
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jennie Wei
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Tuo Lin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kun Yang
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Xin M Tu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ottar Lunde
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Evelyn Ross
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Fox Chase Cancer Center, Temple University, Philadelphia, PA, USA
| | - Jessica Cheng
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Elica Health Centers, West Sacramento, CA, USA
| | - Jennifer DeConde
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Neil Farber
- University of California San Diego School of Medicine, La Jolla, CA, USA
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Kendrick KN, Marcondes FO, Stanford FC, Mukamal KJ. Medicaid expansion and health care access for individuals with obesity in the United States. Obesity (Silver Spring) 2022; 30:1787-1795. [PMID: 36000245 PMCID: PMC9413362 DOI: 10.1002/oby.23531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate associations of Medicaid expansion with health care access for adults with obesity and to explore racial/ethnic differences in these changes in health care access. METHODS Using 2011 to 2017 Behavioral Risk Factor Surveillance System data, the study compared health care access measures among adults who were aged ≥18 years and who had BMI ≥ 30 kg/m2 and household income ≤ 138% of the federal poverty line by state Medicaid expansion status using a difference-in-differences approach with logistic regression. The authors further stratified the main analysis by race/ethnicity. RESULTS Medicaid expansion was associated with improvements in health care access, including lower proportions of those without a usual source of care (-3.6%, 95% confidence interval [CI]: -5.8% to -1.4%, p < 0.01) and cost as a barrier to medical care (-4.5%, 95% CI: -7.0% to -1.9%, p < 0.01). No significant changes were found in routine medical checkups in the last year (-1.8%, 95% CI: -4.4% to 0.8%, p = 0.12). However, across these measures, Medicaid expansion was consistently associated with better access among non-Hispanic White adults (-6.0% to -7.9%, p < 0.01) and not at all among non-Hispanic Black and Hispanic adults (p > 0.05). CONCLUSIONS Medicaid expansion was associated with significant improvements in health care access among adults with obesity, but these improvements were variable across race and ethnicity.
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Affiliation(s)
- Karla N. Kendrick
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Felippe O. Marcondes
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA
| | - Kenneth J. Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
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Katz NJ, Lovrics O, Zevin B. A Canadian survey of medical students and undergraduate deans on the management of patients living with obesity. BMC MEDICAL EDUCATION 2022; 22:562. [PMID: 35864483 PMCID: PMC9302212 DOI: 10.1186/s12909-022-03636-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND With over 26% of Canadian adults living with obesity, undergraduate medical education (UGME) should prepare medical students to manage this chronic disease. It is currently unknown how the management of patients living with obesity is taught within UGME curricula in Canada. This study (1) examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity, and (2) explored how this topic is taught within UGME curricula in Canada. METHODS We distributed two online surveys: one to final-year medical students, and another to UGME deans at 9 English-speaking medical schools in Canada. The medical student survey assessed students' knowledge and self-reported competence in managing patients living with obesity. The dean's survey assessed how management of patients living with obesity is taught within the UGME curriculum. RESULTS One hundred thirty-three (6.9%) and 180 (9.3%) out of 1936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Mean knowledge score was 10.5 (2.1) out of 18. Students had greatest knowledge about etiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviors and calculating body mass index. Five (56%) out of 9 deans completed the survey. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities. CONCLUSIONS Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity. Changes to UGME curricula may help address this gap in education.
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Affiliation(s)
- Nathan J. Katz
- School of Medicine, Office of Professional Development and Educational Scholarship, Queen’s University, Kingston, ON Canada
| | - Olivia Lovrics
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON Canada
| | - Boris Zevin
- Department of Surgery, Kingston General Hospital, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
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