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Pasarica M, Boring M, Lessans S. Current practices in the instruction of lifestyle medicine in medical curricula. PATIENT EDUCATION AND COUNSELING 2022; 105:339-345. [PMID: 34116891 DOI: 10.1016/j.pec.2021.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/23/2021] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A review of current practices of educational interventions for lifestyle medicine was performed to inform the design of interventions with long-term goals of improving patient outcomes. METHODS Systematic review of PubMed, MedEdPORTAL, and Cochrane using keywords "lifestyle medicine," "education," "medical students," and "medical school" was done by 3 independent reviewers. Location, learner, curricular hours, focus, outcomes, and impact are reported. RESULTS Of 452 identified citations, 32 met criteria. Most studies (81%) were conducted in the U.S. and designed for medical students (72%). Studies focused primarily on nutrition (78%) and exercise (59%). Curricula were delivered on average across 13.7 h. Lectures were used in 53% of papers. The outcomes most commonly studied were satisfaction (66%,), knowledge perception (66%), and reported clinical practices (34%). Intervention impact at level 2b (31%) and level 3 (34%) were most common. CONCLUSION Medical educators looking to integrate lifestyle education curriculum should consider current resources as a starting point, especially ones with higher outcome measurements. PRACTICE IMPLICATIONS Novel interventions should target lifestyle medicine competencies with equitable distribution among learners using active learning approaches. The authors propose initial efforts focusing on instruction of clinical educators and practicing physicians, with advocacy for increased reimbursement.
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Affiliation(s)
| | - Michael Boring
- College of Medicine, University of Central Florida, Orlando, USA
| | - Spencer Lessans
- College of Medicine, University of Central Florida, Orlando, USA
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Kanat BH, Doğan S. Is gastroscopy necessary before bariatric surgery? World J Gastrointest Endosc 2022; 14:29-34. [PMID: 35116097 PMCID: PMC8788171 DOI: 10.4253/wjge.v14.i1.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/26/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is the abnormal accumulation of fat or adipose tissue in the body. It has become a serious health problem in the world in the last 50 years and is considered a pandemic. Body mass index is a widely used classification. Thus, obese individuals can be easily classified and standardized. Obesity is the second cause of preventable deaths after smoking. Obesity significantly increases mortality and morbidity. We thought of preparing a publication about routine procedures for the preoperative evaluation of obesity. The question that we asked as bariatric and metabolic surgeons but which was not exactly answered in the literature was "Is esophagogastroduodenoscopy (EGD) necessary before bariatric surgery?" We found different answers in our literature review. The European Association of Endoscopic Surgery guidelines recommend EGD for all bariatric procedures. They strongly recommend it for Roux-en-Y gastric bypass (RYGB). As a result of a recent study by the members of the British Obesity & Metabolic Surgery Society, preoperative EGD is routinely recommended for patients undergoing sleeve gastrectomy, even if they are asymptomatic, but not recommended for RYGB. It is recommended for symptomatic patients scheduled for RYGB. According to the International Sleeve Gastrectomy Expert Panel Consensus Statement, preoperative EGD is definitely recommended for patients scheduled for sleeve gastrectomy, but its routine use for RYGB is controversial. However, a different view is that the American Society for Gastrointestinal Endoscopy recommends endoscopy only for symptomatic patients scheduled for bariatric surgery. In the literature, the primary goal of EGD recommended for sleeve gastrectomy has been interpreted as determining esophagitis caused by gastroesophageal reflux. In the light of the literature, it is stated that this procedure is not necessary in America, while it is routinely recommended in the European continent. Considering medicolegal cases that may occur in the future, we are in favor of performing EGD before bariatric surgery. In conclusion, EGD before bariatric surgery is insurance for both patients and physicians. There is a need for larger and prospective studies to reach more precise conclusions on the subject.
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Affiliation(s)
- Burhan Hakan Kanat
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
| | - Serhat Doğan
- Department of General Surgery, Malatya Turgut Özal University, School of Medicine, Malatya 44100, Turkey
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Katz NJ, Neary E, Tang N, Braund H, Cofie N, Zevin B. Undergraduate medical education interventions aimed at managing patients with obesity: A systematic review of educational effectiveness. Obes Rev 2021; 22:e13329. [PMID: 34378850 DOI: 10.1111/obr.13329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022]
Abstract
The growing obesity epidemic requires an evidence-based approach to management of patients with obesity. Two systematic reviews on obesity-management interventions in undergraduate medical education, both published in 2012, reported discrepant findings. This study aimed to build on previous research by identifying, systematically reviewing, and synthesizing current literature on the effectiveness of educational interventions aimed at teaching management of patients with obesity to medical students. A comprehensive search of seven databases was performed with no date or language restrictions. Database search identified 6462 studies; 5373 were screened against title and abstract, 156 full-text articles were retrieved, 31 met eligibility criteria, and 17 were included after critical appraisal of study methodology. Nine cohort-studies, three qualitative, two case-controls, two mixed-methods, and one randomized controlled trial were included. Findings supported the educational effectiveness of brief (<3 h) educational interventions, the value of video-clips to deliver content, and the importance of in-person teaching. Findings also demonstrated an increase in the number of studies describing educational interventions aimed at teaching management of patients with obesity to medical students. These results can be used by medical educators to inform the design of educationally effective curricula focused on the management of patients with obesity in undergraduate medical education.
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Affiliation(s)
- Nathan J Katz
- Office of Professional Development and Education Scholarship, Queen's University, Kingston, Ontario, Canada.,School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Emma Neary
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Natasha Tang
- Office of Professional Development and Education Scholarship, Queen's University, Kingston, Ontario, Canada.,School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Heather Braund
- Office of Professional Development and Education Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Nicholas Cofie
- Office of Professional Development and Education Scholarship, Queen's University, Kingston, Ontario, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
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Cook J, Puckett HL, Steinauer JE. Management of Obesity During Pregnancy and Periconception: Case-Based Learning for OB/GYN Clerkships. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11129. [PMID: 33816791 PMCID: PMC8015635 DOI: 10.15766/mep_2374-8265.11129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Medical students lack knowledge about the effects of bariatric surgery on pregnancy and medical management of obesity as it relates to reproductive health. Additionally, there is bias toward obese patients among clinicians and learners. Our goal is to improve knowledge and make students aware of the possibility of bias in their management of obese patients. METHODS We designed a flipped classroom learning experience focused on teaching students about the impacts and management of obesity and bariatric surgery on pregnancy and reproductive health. Before the seminar, students took the Implicit Attitude Test (IAT) and read two articles. During the 60-minute seminar, students worked in small groups discussing clinical vignettes, IAT results, and how bias affects patient care. One faculty preceptor oversaw the work and led discussions. We evaluated pilot seminars using Kirkpatrick levels 1 (reaction) and 2 (knowledge) outcomes. We measured change in knowledge after the seminar (using pre- and postseminar quizzes) and assessed students' feedback using a postseminar survey. RESULTS This module was piloted with one in-person group (n = 9) and one virtual group (n = 11) of third-year medical students. Students' knowledge improved (48% vs. 84% correct, p < .001), and they displayed statistically significant improvements in quiz scores postseminar. DISCUSSION Educators striving to teach learners about the management of obesity in pregnancy using evidence-based medicine should integrate this module into their medical student clerkship curricula.
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Affiliation(s)
- James Cook
- Clinical Associate Professor, Department of Obstetrics and Gynecology, Prisma Health Midlands Affiliate; Assistant Dean of Clinical Learning, Office of Curricular Affairs, University of South Carolina School of Medicine - Columbia
| | - Hannah L. Puckett
- Fourth-Year Medical Student, University of South Carolina School of Medicine - Columbia
| | - Jody E. Steinauer
- Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, Zuckerberg San Francisco General and University of California, San Francisco, School of Medicine
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Lessans S, Vega X, Foley B, Bossan A, Baker A, McElroy M, Crouse E, Pasarica M. A patient-centredness improvement study for efficacy of behaviour change for healthy lifestyle and weight loss in a student-run free clinic. Fam Pract 2021; 38:38-42. [PMID: 32667977 DOI: 10.1093/fampra/cmaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary care is the ideal place to implement behaviour change interventions for weight management. However, most primary care physicians are not managing patient weight as a standard of care due to lack of knowledge, skills and reimbursement. Generating more physicians who are familiar and comfortable with providing weight management is essential in leveraging a global change. In our university free clinic, medical students provide healthy lifestyle counselling using shared decision making to each patient at every clinic visit. OBJECTIVE Improve the efficacy of behaviour change interventions via increased patient responsiveness and adherence. METHODS The needs assessment demonstrated a subpar patient response rate to check-ins regarding behavioural change goals. In the first and second interventions, check-in message structure and contact schedule were varied to maximize patient responsiveness and goal achievement. RESULTS In the needs assessment, 58% of patients responded to follow-ups and 58% of patients accomplished their goal. The first intervention cycle resulted in an improvement of responsiveness to 70% and accomplishment of goals to 59%. The second intervention cycle resulted in an improvement of responsiveness to 78% and accomplishment of goals to 74%. CONCLUSIONS Messages that were frequent, unique, succinct and delivered within 4 weeks after the clinic visit resulted in the highest response rate and goal attainment. Other primary care clinics can use these interventions to increase patient completion of implemented behaviour changes for a healthier lifestyle.
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Affiliation(s)
- Spencer Lessans
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Xamil Vega
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Brandon Foley
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Alexia Bossan
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Alexandra Baker
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Mitchell McElroy
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Eloisa Crouse
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Magdalena Pasarica
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
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Rockfeld J, Koppel J, Buell A, Zucconi R. An Interactive Lifestyle Medicine Curriculum for Third-Year Medical Students to Promote Student and Patient Wellness. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10972. [PMID: 32964121 PMCID: PMC7499809 DOI: 10.15766/mep_2374-8265.10972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Although lifestyle intervention and behavior modification are effective in the prevention and treatment of chronic disease, few medical schools provide specific training in stress management, nutrition, or physical activity. While the prevalence of chronic disease rises, medical students and physicians lack sufficient knowledge and skills to promote their patients' as well as their own wellness across these domains. METHODS We developed three hour-long workshops delivered to third-year medical students. We employed interactive lectures, small-group discussions, and reflective activities to teach the pillars of lifestyle medicine. These sessions focused on knowledge and skills to advance lifestyle counseling and behavior modification interventions with patients and to promote student wellness. We assessed student satisfaction with each session as well as self-perceived knowledge, skills, and attitudes toward lifestyle medicine and behavior change before and after the curriculum. RESULTS Over 2 years, 183 students participated in the workshop series. The sessions received high ratings, with a mean of 4.2 on a 5-point Likert scale. Participating in the curriculum significantly enhanced students' understanding of the connection between lifestyle factors and the health of patients and improved their confidence about counseling for behavioral change. DISCUSSION Lifestyle medicine provides an evidence-based framework for teaching students about the impact of lifestyle modification on chronic disease. While receiving knowledge and skills to advance patient care in the domains of stress management, nutrition, and physical activity, students who completed this curriculum also had the opportunity to reflect on their own health promotion, which could mitigate professional burnout.
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Affiliation(s)
- Jennifer Rockfeld
- Assistant Professor, Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University; Assistant Course Director, Clinical Arts and Sciences Course, Frank H. Netter MD School of Medicine at Quinnipiac University
| | - Jonathan Koppel
- Intern, Primary Care Residency Program, Icahn School of Medicine at Mount Sinai
| | - Alexander Buell
- Fourth-Year Medical Student, Frank H. Netter MD School of Medicine at Quinnipiac University
| | - Rebecca Zucconi
- Assistant Professor, Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University; Course Director, Foundations of Medicine Course, Frank H. Netter MD School of Medicine at Quinnipiac University
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Berz J, Donovan K, Eyllon M. An Interprofessional Nutrition Education Session for Senior Medical Students on Evidence-Based Diet Patterns and Practical Nutrition Tips. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10876. [PMID: 32051854 PMCID: PMC7012311 DOI: 10.15766/mep_2374-8265.10876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Dietary factors are recognized as a major contributor to the global burden of disease, and the obesity epidemic continues to be a major public health problem. Patients rely on doctors for dietary advice and to serve as role models for health behaviors. However, nutrition content is significantly underrepresented in medical school curricula. METHODS We created an interactive session to address this gap during the ambulatory medicine rotation for senior medical students and delivered it as a 90- to 120-minute interactive monthly didactic session. We focused on reviewing evidence-based diet patterns for weight loss and hypertension and on use of practical tools for diet assessment and counseling. Immediately and 1 month after delivery, we administered a knowledge and confidence assessment survey to evaluate the session impact. RESULTS We incorporated the session into the regular didactic time of the clerkship. Sixty-six students attended over an 8-month period, of whom 42 completed the survey. Immediately and 1 month after delivery, participants reported statistically significant improvements (p < .001) in their confidence in the domains measured. Participants' knowledge scores increased immediately and 1 month after the session compared to before participation. DISCUSSION We delivered a single recurring seminar on diet patterns and practical tips that was well received by fourth-year medical students during the ambulatory medicine clerkship. The seminar was a practical and interactive way of delivering important nutrition content to the medical school curriculum, and we demonstrated retention of confidence and knowledge of the delivered content.
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Affiliation(s)
- Jonathan Berz
- Assistant Professor, Department of Medicine, Boston University School of Medicine
| | - Kate Donovan
- Clinical Dietitian, Department of Pediatrics, Boston Medical Center
| | - Mara Eyllon
- Postdoctoral Researcher, Department of Medicine, Boston University School of Medicine
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ACOG Committee Opinion No. 763: Ethical Considerations for the Care of Patients With Obesity. Obstet Gynecol 2019; 133:e90-e96. [PMID: 30575680 DOI: 10.1097/aog.0000000000003015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity is a medical condition that may be associated with bias among health care professionals, and this bias may result in disrespectful or inadequate care of patients with obesity. Obstetrician-gynecologists regularly care for patients with obesity and play an integral role in advocating for best practices in health care and optimizing health outcomes for patients with obesity. Obstetrician-gynecologists should be prepared to care for their patients with obesity in a nonjudgmental manner, being cognizant of the medical and societal implications of obesity. This Committee Opinion has been updated from its previous version to focus on obesity bias within the medical community and to provide practical guidance using people-first language instead of labels (ie, "patients with obesity" versus "obese patients") to help obstetrician-gynecologists deliver effective, compassionate medical care that meets the needs of patients with obesity.
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Pasarica M, Kay D, Cameron R. Using active pedagogies to advance learning for lifestyle medicine: an approach for medical students. ADVANCES IN PHYSIOLOGY EDUCATION 2019; 43:191-195. [PMID: 30998102 DOI: 10.1152/advan.00195.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Magdalena Pasarica
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| | - Denise Kay
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
| | - Rebecca Cameron
- Department of Medical Education, University of Central Florida College of Medicine , Orlando, Florida
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