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Residencies Seek to Boost Training in Obesity Management, Lifestyle Issues
AAFP, AAP Team Up on 'Fit for Residents' Pilot
By Barbara Bein
Slightly more than half of respondents said childhood obesity training in residency is "extremely important," and the majority of programs said they offer training in various aspects of childhood obesity management, such as prevention, diagnosis and treatment. However, less than one in five residencies overall reported having a formal childhood obesity curriculum, and only about 14 percent of family medicine programs surveyed have such a curriculum.
"Given the high prevalence of childhood obesity, a greater emphasis should be placed on development and use of effective training strategies suitable for all specialties training physicians to care for children," the study concluded.
Fit for Residents
According to Wendy Slusser, M.D., an associate clinical professor of pediatrics at the Mattel Children's Hospital, University of California-Los Angeles, and principal investigator for Fit for Residents, the curriculum incorporates elements of the AAFP's Americans In Motion-Healthy Interventions program with those of the AAP's breastfeeding curriculum. The three family medicine programs participating in the pilot are Scripps Family Medicine Residency in Chula Vista, the Family Medicine Residency Program at White Memorial Medical Center in Los Angeles and the Contra Costa Family Practice Residency Program in Martinez.
Family physician Shaila Serpas, M.D., assistant program director of the Scripps residency, outlined some of the key features of the program, including
- training in motivational interviewing;
- incorporation of the AAP breastfeeding curriculum;
- chart reviews that focus on childhood obesity;
- improved documentation of obesity services;
- the addition of lifestyle key words to electronic medical records; and
- the integration of community resources and patient handouts.
As a result of the enhanced training, more children are getting follow-up visits to monitor their progress and more children are having their physical activity levels assessed -- both of which are important to support lifestyle changes in their families, Serpas said.
Other family medicine residencies also are striving to bolster residents' knowledge about healthy patient lifestyles.
Loma Linda Lifestyle Medicine Track
According to Wayne Dysinger, M.D., M.P.H., director of the combined residency, the program is based on the belief that a "significant proportion of physicians are better off if they have strong population-based skills, as well as skills to take care of patients one-on-one.
"We make people really good at systems and work with community groups and populations," he explained.
Lifestyle Track Graduate Honed Medical Counseling Skills
His training, especially in motivational interviewing, has given him confidence to counsel patients about such issues as nutrition, obesity, exercise and smoking cessation -- either one-on-one or in groups.
"This is a skill that many family physicians did not develop in residency. With the dawn of group medical visits as a core part of the patient-centered medical home, understanding how to facilitate a group is vital," said Steinke.
In the hospital, lifestyle residents do smoking cessation consultations with patients who are admitted for pulmonary problems or cardiac surgery. In the community, they participate in group visits with patients with diabetes and talk about healthy food choices.
In the clinic, they identify and address obesity issues and set specific goals with patients.
"Our lifestyle medicine residents have a search-and-destroy mission for fat cells. At a time when none of us gets paid (specifically) for obesity counseling, our residents document obesity and give recommendations for lifestyle changes better than the faculty," said Jamie Osborn, M.D., family medicine program director and associate director of the combined program.
UMKC Residency's Community Focus
"If patients sit in the doctor's office and there's a dietitian with (that physician), that's great. But people make decisions about food in the store when they're buying things," Shaffer explained.
Residents in the program also regularly tackle weight issues with patients, a "touchy subject" for both patients and resident physicians, said Shaffer. They learn tactful approaches to talking with families about weight and lifestyle issues and an awareness of cultural and ethnic differences in people's views of obesity, he said.
"If they gain 15 extra pounds during pregnancy, then after several babies, they end up being 45 pounds overweight," Shaffer said. "So it's important for the residents to advise them that if they don't gain that weight during pregnancy, they might not develop an overweight or obesity problem."
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Recommended Curriculum Guidelines for Family Medicine Residents: Nutrition
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BMC Medical Education: "Training in Childhood Obesity Management in the United States: A Survey of Pediatric, Internal Medicine-Pediatric and Family Medicine Residency Programs"
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Nutrition in Medicine: Nutrition Education for the Practicing Physician Resident/Fellow Courses (Free registration required)