Predictors of nutrition counseling behaviors and attitudes in US medical students

BACKGROUND: Nutrition counseling by physicians can improve patients' dietary behaviors and is affected by physicians' nutrition practices and attitudes, such as the perceived relevance of nutrition counseling. OBJECTIVE: The objective was to provide data on medical students' perceived relevance of nutrition counseling, reported frequency of nutrition counseling, and frequency of fruit and vegetable intakes. DESIGN: Students (n = 2316) at 16 US medical schools were surveyed and tracked at freshmen orientation, at the time of orientation to wards, and in their senior year. RESULTS: Freshmen students were more likely (72%) to find nutrition counseling highly relevant than were students at the time of ward orientation (61%) or during their senior year (46%; P for trend = 0.0003). Those intending to subspecialize had lower and declining perceptions of counseling relevance (P for trend = 0.0009), whereas the perceived relevance of counseling by primary care specialists remained high (P for trend = 0.5). Students were significantly more likely to find nutrition counseling highly relevant if they were female, consumed more fruit and vegetables, believed in primary prevention, had personal physicians who encouraged disease prevention, or intended to specialize in primary care. Only 19% of students believed that they had been extensively trained in nutrition counseling, and 17% of seniors reported that they frequently counseled their patients about nutrition. Students who consumed more fruit and vegetables, believed that they would be more credible if they ate a healthy diet, were not Asian or white, or intended to specialize in primary care counseled patients about nutrition more frequently. Medical students consumed an average of 3.0 fruit and vegetable servings/d, which declined over time. CONCLUSIONS: The perceived relevance of nutrition counseling by US medical students declined throughout medical school, and students infrequently counseled their patients about nutrition. Interventions may be warranted to improve the professional nutritional practices of medical students.     

Factors that Influence Physicians’ and Medical Students’ Confidence in Counseling Patients About Physical Activity

Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians’ and medical students’ confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students’ patient populations.     

Future Doctors' Perceptions about Incorporating Nutrition into Standard Care Practice

Objective: The increasing prevalence of chronic disease has been largely attributed to long-term poor nutrition and lifestyle choices. This study investigates the attitudes of our future physicians toward nutrition and the likelihood of incorporating nutrition principles into current treatment protocols.Methods: Setting: The setting of this study was an Australian university medical school. Subjects: Subjects including year 1–4 students (n = 928) in a 4-year medical bachelor, bachelor of surgery (MBBS) degree program. Students were invited to participate in a questionnaire based on an existing instrument, the Nutrition in Patient Care Attitude (NIPC) Questionnaire, to investigate their attitudes toward nutrition in health care practices.Results: Respondents indicated that “high risk patients should be routinely counseled on nutrition” (87%), “nutrition counseling should be routine practice” (70%), and “routine nutritional assessment and counseling should occur in general practice” (57%). However, despite overall student support of nutritional counseling (70%) and assessment (86%), students were reluctant to perform actual dietary assessments, with only 38% indicating that asking for a food diary or other measure of dietary intake was important.Conclusion: These findings demonstrate that future physicians are aware of the importance of considering nutrition counseling and assessment. However, students are unlikely to adequately integrate relevant nutritional information into their treatment protocols, evidenced by their limited use of a basic nutritional assessment. This is potentially the result of a lack of formal nutrition education within their basic training.     

Assessment of health issues and concerns of Israeli seventh graders during school physician examinations: a pilot study

BACKGROUND: The AMA Guidelines for Adolescent Preventive Services (GAPS) recommends annual medical evaluations during adolescence, emphasizing screening and counseling regarding psychosocial issues. In Israel, seventh graders undergo medical examinations within the school health services, focusing on the detection of physical conditions. We addressed the psychosocial issues of these students by introducing an expanded school physician evaluation. METHODS: Twelve school physicians performed structured expanded health evaluations for seventh graders in 11 schools. Each student completed a questionnaire (checklist) with 22 health topics "about which s/he may want to receive information." The physician then carried out a biomedical and psychosocial evaluation, physical examination, and offered counseling to the student. RESULTS: Two hundred and seventy-eight students were examined. The questionnaire required 1-2 minutes, and the physician's evaluation 20-25 minutes. Health behaviors revealed included: currently dieting (28%), no physical activity after school (35%), ever smoked cigarettes (3%), ever smoked a water pipe (9%), used alcoholic beverages (6%), and does not always use front (22%) or rear (55%) seat belt. Nine percent rated their mood as being less than 7 (on a scale from 1 to 10). The leading topics about which the students requested information were height (50%), acne (42%), weight (38%), nutrition/diet (37%), physical activity (35%), and menstrual period (29% of the girls). The physicians counseled the students on an average of 3.6 topics per visit. CONCLUSIONS: An expanded school physician examination identifies students with psychosocial problems otherwise undetected during standard physical examinations, and provides the opportunity to address their personal concerns.     

Preventive care attitudes of medical students

Presently developing attitudes of future physicians towards preventive medicine will likely provide either a major impetus for or barriers to the inclusion of preventive medicine content in medical school curricula and in other formats of physician education. In turn, attitudes about preventive care and its role in medical practice will continue to have a large influence on how much disease prevention and health promotion emphasis physicians provide in their practices. Consequently, it becomes important to study how medical students' attitudes evolve during the process of medical education. Furthermore, to the extent that we can better understand how desired attitudes can be developed and nurtured, the practice of preventive medicine may become more purposeful. Beginning and third-year medical students were surveyed with a 100-item questionnaire designed to assess their attitudes regarding: the relative importance of 20 specific preventive services to the practice of medicine and the adequacy of preclinical coursework for preparing them to offer preventive care in medical practice. The confidence of third year students' in the ability of primary care physicians to provide these specific services was also assessed. Preventive care service areas about which third-year students expressed high confidence in the ability of physicians to provide were: immunizations, health screening physicals, blood pressure control, cancer detection education, family planning, health counseling/education, and sexually transmitted disease prevention. Services that students had low confidence in the ability of physicians to provide were: smoking cessation, nutrition counseling/education and weight reduction.(ABSTRACT TRUNCATED AT 250 WORDS)     

What's in store for medical students? Awareness and utilization of expert nutrition guidelines among medical school preceptors

BACKGROUND: Instruction of physicians and other health professionals in medical nutrition sciences is among the expert recommendations to promote population health and reduce risks for cancer and other major causes of morbidity and mortality in the population. However, formal training in nutrition in United States medical schools is still lacking compared to the gains in basic and applied medical nutrition sciences. We sought to understand the awareness and current utilization of expert nutrition recommendations and practice guidelines among medical student faculty preceptors. METHODS: We surveyed the teaching faculty who precept for first-, second-, and third-year medical students in two required courses at Boston University. The instrument queried preceptor awareness and current utilization of expert nutrition recommendations, nutritional management practice guidelines, as well as faculty-student interactions regarding patient nutritional education and counseling. RESULTS: Of 187 faculty surveyed, 139 (74%) responded. Faculty reported using 2.3 expert guideline sources (N = 111; SD = 1.8; range = 0-8) but 83% had considered only one or no sources or did not remember what guidelines they had used. Eighty-four percent of preceptors expected students to routinely discuss nutritional practices with patients and/or their families; however, less than half of preceptors routinely provided feedback to students on patient nutritional education or counseling strategies. CONCLUSION: Our findings suggest gaps in faculty awareness and utilization of expert nutrition recommendations and practice guidelines relating to cancer and other chronic disease-risk reduction and population health promotion, underscoring the need for improvements in faculty and medical student training in basic and applied medical nutrition sciences.     

Weight gain prevention: identifying theory-based targets for health behavior change in young adults

Young adults attending college are more vulnerable to weight gain than the general population. We sought to identify health behavior change targets related to weight management in college students. Based on the Social Cognitive Theory model for health behavior change, we investigated the health-related lifestyle behaviors and physiological characteristics of this population. Forty-three college students (18.3+/-0.1 years) completed a series of quantitative assessments (eg, body weight and composition, cardiorespiratory fitness, and diet and activity habits) and structured qualitative assessments (ie, structured interview or focus group). Participants were predominantly normal weight (mean body mass index 22.2+/-0.4) and fit (maximal oxygen consumption 50.5+/-1.5 mL/kg/minute). However, healthful eating and physical activity were not considered high priorities, despite having ample free time, high exercise self-efficacy, positive outcome expectations for exercise, and a desire to exercise more. Participants reported that regularly engaging in exercise was difficult. This may have been due to poor planning/time management, satisfaction with body image, lack of accountability, and feelings of laziness. Dietary patterns generally met recommendations but were low in fruits, vegetables, and whole grains. Social support for exercise and healthful dietary habits were important factors associated with health behaviors. Students reported a decline in exercise and dietary habits relative to high school, which may have contributed to college weight gain. Our results suggest that this population may not have adequate self-regulatory skills, such as planning and self-monitoring, to maintain healthful behaviors in the college environment. Food and nutrition professionals working with young adults attending college may use these findings to guide the behavioral therapy component of their weight management medical nutrition therapy goals and outcomes.     

Impact of Repeated Health Behavior Counseling on Women Portraying an Overweight Standardized Patient

ObjectiveTo investigate the influence of participation in a health behavior counseling (HBC) case by examining standardized patients' real-life attitudes and behaviors toward nutrition and physical activity habits.MethodsFocus group sessions were held with 10 standardized patients who regularly participated in the HBC case. Emergent themes were identified using grounded theory data analysis.ResultsStandardized patients reported how participation with role playing in the HBC case prompted personal lifestyle changes. Changes occurred through increased awareness and motivation to make adjustments to health habits, such as exercise and improved food choices.Conclusions and ImplicationsThe HBC model can be an effective method for helping patients to recognize the need to take action and implement positive lifestyle changes.     

Perceptions of adolescents involved in promoting lower-fat foods in schools: associations with level of involvement

This article describes perceptions of adolescents involved in peer-led school-based nutrition promotions encouraging lower-fat food purchases and assesses the differences by level of student involvement. Surveys were administered at schools. Data were collected from 397 high school students from 10 Minnesota schools randomized to the intervention condition of the Trying Alternative Cafeteria Options in Schools study. Students were categorized as highly involved (n=54) or less involved (n=343) based on their level of involvement in promotional activity implementation. Chi 2 tests were conducted to measure the differences between highly-involved and less-involved students in perceptions and attitudes about lower-fat foods. Highly-involved students were significantly more likely than less-involved students to report more healthful eating behaviors and positive attitudes toward lower-fat foods. Student involvement in nutrition interventions should be integrated into programs aimed at increasing healthful food choices among adolescents.     

某医科大学不同专业学生营养知识态度和饮食行为调查

目的了解某医科大学不同专业学生的营养知识、态度和饮食行为,为有针对性地开展营养教育提供科学依据。方法采用自行设计的营养知识、态度、饮食行为调查问卷,随机抽取某医科大学不同专业学生682人。结果医学相关专业大学生在营养知识最高达86%、态度最高达86%和饮食行为53.25%,均比非医学相关专业高。所有大学生对营养知识掌握均较好、营养态度积极程度较高,但是在饮食行为方面较差。结论医科大学生营养知识普遍缺乏,应加强营养教育,提高营养知识和态度,促进其改变不良的饮食行为,促进健康。     

Determinants of health-promoting lifestyle behaviors in rural older women

The purpose of this study was to: (a) describe the health-promoting lifestyle behaviors and attempts at change among 102 community-dwelling rural women aged 65 and older, and (b) determine the extent to which personal influences (demographics, definition of health, and perceived health status) and contextual influences (sources of health information and provider counseling) explain health-promoting lifestyle behaviors and attempts at change among those women. They scored highest on frequency of nutrition behaviors and lowest on frequency of physical activity behaviors. They had attempted change in from zero to five areas of health-promoting lifestyle within the past year. Multiple regression analyses revealed that younger age, living with other(s), defining health as wellness, better perceived mental health, more sources of health information and provider counseling were significantly associated with health-promoting lifestyle behaviors. Only younger age and more sources of health information were significantly associated with attempts at change. These findings provide information that is relevant in designing interventions to enhance health-promoting lifestyle behaviors among rural older women.     

Physicians' attitudes toward preventive care services: a seven-year prospective cohort study.

We report results of a seven-year prospective cohort study of physicians' attitudes about and intentions to provide 27 preventive care services in their future practices. Respondents in the cohort were surveyed three times: first, during orientation to medical school; second, during their third year of medical school; and finally, following completion of their third-year of residency training. The majority of preventive care services were viewed as more important to clinical practice in primary care than in non-primary care specialties. Positive attitudes toward preventive care services generally persisted among both primary and non-primary care physicians. Respondents expressed only fair to medium levels of confidence in the ability of physicians in their specialty areas to provide any of the preventive services examined. Respondents reported low levels of confidence in the ability of primary care physicians to provide nutritional counseling, though they ranked it as important. Respondents were fairly or moderately confident in the ability of primary care physicians to provide counseling about smoking cessation, health, AIDS education, and substance abuse. Participants ranked smoking cessation counseling, health counseling, AIDS education, cancer detection education, and substance abuse counseling and education as very important. In general, physicians were less likely to plan on providing preventive services than they were to expect their residency programs to prepare most or all to provide the services. Findings document the need to prepare physicians better to provide preventive services.     

Gesundheitsverhalten und Lebensstil – Risiken von Medizinstudierenden

Background

Little is known about medical students’ health-related lifestyle in Germany. But it seems important to know about this regarding the function of future doctors as health coaches. Thus students should learn more about health risks by analysing their own state of health and health-related lifestyle.

Methods

In 2008/2009 a cross-sectional study was conducted among 880 medical students in their 3rd to 6th academic year at Halle medical school by using a standardized questionnaire. Validated instruments of the 24-item questionnaire consisted e.g. of the fast alcohol screening test (FAST) and the lifestyle satisfaction fraction of the German Health Survey (BGS).

Results

Risk factors (alcohol and tobacco consumption, physical activity, BMI) were distributed constantly over academic years. The rate of non-smokers was 80%, and the level of tobacco consumption increased with higher academic year among smokers. The FAST showed that men have a considerable risk for alcohol-related disturbances (42% high-risk proportion). Data regarding physical activity scores showed that only half of women are at least minimally active in sports. The risk behaviour of male smokers showed that they are more dissatisfied with their health situation than female non-smokers. Students with a higher measure of physical activity are more satisfied with their life circumstances.

Conclusion

The duration of medical education itself has no detectable health promoting effect. Considerable gender differences concerning tobacco and alcohol consumption and physical activity were observed. The need for gender-specific interventions becomes clear. The high portion of risky alcohol consumption patterns among male students shows need for action. Students should learn more about their own health risks in order to become better health coaches or at least improve their own lifestyle.     

Personal and professional nutrition-related practices of US female physicians

BACKGROUND: The extent to which female physicians personally and clinically adhere to dietary recommendations is unknown and has implications for patients. OBJECTIVES: We aimed to identify US female physicians' personal and professional nutrition- and weight-related habits and to identify which, if any, of their personal habits predicted their clinical practices. DESIGN: Our sample included the 4501 respondents to the Women Physicians' Health Study, a large, cross-sectional, questionnaire-based study of the health behaviors and counseling practices of US female physicians. RESULTS: Forty-three percent of physicians performed nutrition counseling, and 50% performed weight counseling with patients at least yearly. Forty-six percent thought that discussing nutrition was highly relevant to their practices, 47% thought the same about discussing weight, and 21% stated that they had received extensive related training. Primary care physicians, obstetricians-gynecologists, pediatricians, vegetarians, and those with a personal history of obesity were more likely to provide nutrition and weight counseling to patients. Female physicians report regularly performing more nutrition and weight counseling than they do most other types of prevention-related counseling. Female physicians report relatively healthy diet-related habits, and these personal habits are related to their likelihood to counsel their patients about nutrition and weight. CONCLUSIONS: Nutrition and weight-related issues are important to female physicians in both their personal and professional lives, and these 2 spheres influence each other.     

Health care reform as perceived by first year medical students

Our study objective was to evaluate the attitudes of first year medical students toward the health care system using a self administered questionnaire to all first year medical students at the medical schools in the University of California system. Of 631 students surveyed, 94% comleted the instrument. Students were asked about their attitudes toward and familiarity with concepts in health services, access to care, and managed care. Our findings indicated that most students were unfamiliar with concepts related to health services. Students were concerned about access to care; sixty-six percent of students favor a national health insurance plan. A majority of students supported allowing patients access to the current health care system regardless of the cost or utility of a medical test or procedure. Thirty-nine percent felt that rationing health care in any form (transplants, access to the intensive care unit, etc.) is contrary to the way medicine should be practiced. 72% felt that practicing physicians had a major responsibility to help reduce health care costs. When asked about specific changes intended to control health costs, students identified reform of medical malpractice system (63%) and increased spending on preventive health (60%) as the two proposals most likely to be effective. Students generally held negative attitudes toward managed care organizations; only 10% would chose to receive their care in HMOs. We conclude that first year medical students generally have little understanding of the health care system. Despite this, they hold strong opinions about access to care, managed care organizations and strategies intended to reduce health care spending. It is up to medical educators to find creative methods of introducing these content areas into an already bulging curriculum.Funds for this study were generously provided by the L.K. Whittier Foundation. Samuel A. Skootsky's salary was in part supported by Southern California Edison.     

Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners

Background. Previous surveys have shown that there is a disparity between physicians′ beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of nutrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the delivery of nutrition counseling by primary care physicians. Methods. A random-sample-mailed questionnaire was sent to 2,250 primary care physicians selected from the AMA masterfile from general practice, internal medicine, and pediatrics, representing self-employed, group, hospital, and HMO practices. Participants were stratified by age, gender, geographical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patients receiving dietary counseling and to identify barriers to the delivery of nutrition counseling. Results. A 49% response rate (n = 1,103) was obtained. Results are presented for the 1,030 physicians (70% private practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer min discussing dietary changes. Despite this pattern, nearly three-quarters of respondents feel that dietary counseling is important and is the responsibility of the physician. Ranking of perceived barriers to delivery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling training, lack of knowledge, inadequate reimbursement, and low physician confidence. Conclusions. This survey suggests that multiple barriers exist that prevent the primary care practitioner from providing dietary counseling. A multifaceted approach will be needed to change physician counseling behavior.     

Infant Safe Sleep: A Survey of the Knowledge,Attitudes, and Behaviors of Obstetric Physicians

Obstetricians may be a pregnant woman’s primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians’ knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio. Surveys were sent to all licensed physicians included in the registry of the State Medical Board of Ohio with “obstetrics,” “obstetrics and gynecology,” or “maternal and fetal medicine” as their primary specialty (n?=?1771). The response rate was 30%, with 418 physicians included in the analysis. Many participants were knowledgeable about infant safe sleep recommendations; however, only 55% indicated that it was important for obstetric physicians to discuss Sudden Infant Death Syndrome and/or infant safe sleep with prenatal patients. Many participants (70%) perceived barriers to providing infant safe sleep education, however most (82%) indicated interest in doing so. Participants’ knowledge and attitudes were significant predictors of whether they discuss this topic with patients. Obstetric physicians can influence the infant safe sleep decisions that women make. Improving obstetricians’ knowledge and attitudes about infant safe sleep and supporting physicians who wish to provide education on this topic may help to ensure that women are receiving frequent and consistent infant safe sleep messaging throughout the prenatal period.