Behavior Change Counseling Curricula for Medical Trainees: A Systematic Review

Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA 94143-0120, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 05/2012; 87(7):956-68. DOI: 10.1097/ACM.0b013e31825837be
Source: PubMed

ABSTRACT Unhealthy behaviors contribute to half of U.S. deaths. However, physicians lack sufficient skill in counseling patients to change behaviors. Characterizing effective published curricular interventions for behavior change counseling for medical trainees would inform educators toward improved training.
The authors conducted a systematic literature search of studies published between 1965 and 2011 evaluating curricula on behavior change counseling for medical trainees. Included studies described behavior change counseling, teaching interventions for medical trainees, and assessment of interventions. The authors extracted eligible articles, rated outcomes for learners and patients using Kirkpatrick's hierarchy, and determined study quality.
Of 2,788 identified citations, 109 met inclusion criteria. Most studies were performed in the United States (98), 93 at a single institution, and 81 in primary care settings. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). Although most studies did not include theoretical frameworks, 39 used the Transtheoretical Model of Change. Sixty-two studies involved eight or fewer hours of curricular time, and 51 spanned four or fewer weeks. The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings.
Existing literature suggests that trainees learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within actual clinical practice settings. Multiinstitutional medical education research on methods of teaching behavior change counseling that influence patients' health outcomes are needed to ensure trainees' clinical competence and improve patient care.

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Available from: Jason Milton Satterfield, Sep 26, 2015
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    • "For example, medical training that provides opportunities for students to develop and maintain regular PA behavior is likely to increase frequency of PA counseling in practice, as it has been found that, similar to practicing physicians, those students who are personally active are more likely to counsel (24). Second, the most effective general health behavior counseling curricula have included a combination of didactics and clinical practice experiences within either simulated or real clinical settings (19, 21). In addition, conceptual frameworks and counseling models that illuminate the complexity of behavior change have been incorporated into the most apparently successful programs (19–21). "
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    ABSTRACT: Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.
    Medical Education Online 07/2014; 19:24325. DOI:10.3402/meo.v19.24325 · 1.27 Impact Factor
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    • "As discussed above, our educational intervention that consisted of a single lecture on nicotine dependence was associated with higher knowledge levels one year after the intervention. A combination of educational and interactive training during medical school improves knowledge, attitude, and counselling skills on tobacco cessation and behavioural change [28, 29]. Role-playing and interaction with patients are equally effective and both represent more powerful learning tools than web-based learning with or without a teaching lecture [30]. "
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    ABSTRACT: Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects ("Score 1"), and effectiveness of cessation treatments ("Score 2"). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived.
    04/2014; 2014(3):321657. DOI:10.1155/2014/321657
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    • "A similar trend is found among medical students, where healthy personal practices are found to equate with engagement in preventive counseling and appreciation of importance of this role as part of their professional responsibility [6]. A combination of didactic and interactive training during medical school can improve knowledge, attitude, and counseling skills regarding tobacco cessation and other forms of behavioral change [7,8]. There is very limited information about the prevalence of smoking among Canadian medical school students and their perceived level of education and preparedness to address tobacco use with their patients [9]. "
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    ABSTRACT: Background Little is known about the knowledge and attitudes towards tobacco use among medical students in Canada. Our objectives were to estimate the prevalence of tobacco use among medical students, assess their perceived level of education about tobacco addiction management and their preparedness to address tobacco use with their future patients. Methods A cross-sectional online survey was administered to University of Alberta undergraduate medical school trainees. The 32-question survey addressed student demographics, tobacco use, knowledge and attitudes around tobacco and waterpipe smoking, tobacco education received in medical school, as well as knowledge and competency regarding tobacco cessation interventions. Results Of 681 polled students, 301 completed the survey. Current (defined as “use within the last 30 days”) cigarette, cigar/cigarillo and waterpipe smoking prevalence was 3.3%, 6% and 6%, respectively. One third of the respondents had ever smoked a cigarette, but 41% had tried cigars/cigarillos and 40% had smoked a waterpipe at some time in the past. Students reported moderate levels of education on a variety of tobacco-related subjects but were well-informed on the role of tobacco in disease causation. The majority of students in their final two years of training felt competent to provide tobacco cessation interventions, but only 10% definitively agreed that they had received enough training in this area. Conclusions Waterpipe exposure/current use was surprisingly high among this sample of medical students, a population well educated about the role of tobacco in disease causation. The majority of respondents appeared to be adequately prepared to manage tobacco addiction but education could be improved, particularly training in behavioral modification techniques used in tobacco use cessation.
    Tobacco Induced Diseases 04/2013; 11(1):9. DOI:10.1186/1617-9625-11-9 · 1.50 Impact Factor
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