Bmc family medicine residents

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Family Medicine

Family Medicine Sub-Internships and Electives

Telephone:    email:[email protected]

Location: BMC-Dowling 5 Room

SUB-INTERNSHIP IN FAMILY MEDICINE

i Title: Sub-internship in Family Medicine

Instructor: Talia Singer-Clark, M.D.

Interim Instructor (end of June):Lizzeth Alarcon, M.D.

Course Administrator: Latia Holmes – [email protected]
Location:   Menino Pavilion. Boston University Medical Center

Team:  Family Medicine Inpatient Service Team A or Team B
Students per Block: One per team
Period offered: Block

Orientation:  First day of the rotation

Overview

Students will work as interns with the family medicine inpatient team. They will care for a wide variety of patients from the HealthNet Rounder system, acting as the primary caregiver for their patients. They will have all the responsibilities of an intern, including daily management of their patients, new admissions, attending conferences and participating in daily teaching.

Due to COVID, the structure of the day has been adjusted to ensure physical distancing and optimize the safety of the student, other members of the medical team, and patients.

Location: Menino 7E

  • Team A: The Team A workroom is located in the hallway outside of the 7E unit (room ). Maximum capacity: Four people.
  • Team B: The Team B workroom is temporarily located in the 7E family room. Maximum capacity: Five people.
  • Swing space- Workroom down the hall on the right on 7E floor (room ). Maximum capacity: Three people.

 

Daily schedule:

Generally am to pm, 6 days per week. One day per week will be extended until 8pm to allow for an independent admission.

  • am: Chart pre-rounding on prior patients (swing space or medical school)
  • am: The student will touch base with the resident via phone call and double check if there are new patients assigned to the student for the day.
  • 7am: Team sign-out. The student will be in the swing space/medical school and join sign-out remotely via Zoom. The supervising resident will ensure the student is on the zoom call prior to starting sign out.
  • am Examine patients in person in Menino, check telemetry
  • am Rounds
  • If the team is doing table rounds, the student will join remotely from the swing space/medical school via Zoom and present patients via Zoom.
  • If the team is doing walk rounds, the student will join walk-rounds ensuring appropriate physical distancing. The sub-I will only go into their patients’ rooms with the attending and the supervising resident
  • After rounds, put in orders, talk to consultants, complete notes. The student will call supervising resident with any questions, and to ensure orders are co-signed in timely matter.
  • Noon conference Monday-Friday, the student will ask residents for most updated information and zoom conference details.
  • Afternoon- Follow up on tasks and complete notes, update sign out, and place morning labs. Complete an admission if the patient is expected to arrive before 5pm. Ideally, the student should do an admission once per week. If they haven’t, then they are expected to stay late once a week to complete an admission and staff with the evening attending.
  • Sign-out at 6pm. The student should call into sign out via Zoom.

 

Additional COVID Information

The student will:

  • Not provide care for any person confirmed to have COVID or be a person under investigation for COVID
  • Wear a surgical facemask and scrubs at all times when inside the hospital.
  • Wear a surgical mask, face shield, and gloves when physically interacting with a patient, and practice appropriate hand hygiene before and after each patient interaction.
  • Be able to call into a patient’s room if needed for follow up questions, afternoon check-ins, etc.
  • Practice physical distancing (6 feet apart) if meeting the team outside of a patient’s room in person.
  • In general, will not be in the same workroom area as the rest of medical team unless the number of people in the workroom allows for appropriate physical distancing (see limits under Location above).

Weekends

  • Students are expected to work three weekend days during the month, arranged in discussion with the senior resident. NOTE: students follow the holiday/vacation schedule of the team not of Boston University, speak with the team prior to making any travel arrangements.

Supervision

  • Students will be directly supervised by the 2nd or 3rd year resident in addition to the family medicine ward attending.
  • During the times of the day during which the student is working in a different space than the rest of the team, students will contact residents via page or phone call for patient care questions.
  • If after seeing their patients in-person (but before rounds), the student is worried about a patient being sick or unstable, they will immediately come to the work room to alert the supervising resident who will then evaluate the patient.

Education/Curriculum

  • The Sub-I student is expected to:
  • Be responsible for the care of their patients and should be the primary contact for the patient, consultants, and nursing. During the first week, the sub-I will care for two patients on the team and work up to four patients by the end of the month
  • Participate in all conferences/daily teaching.
  • Attend dedicated sub-I teaching organized by the course director twice per week via Zoom.
  • Organize two presentations on a pertinent topic for the rest of the team.
  • Complete one admission per week.
  • Complete two discharges per week.

Feedback

  • Students will ask for informal feedback during the course of the rotation from supervising residents and attendings.
  • Once per week (Thursdays), the outgoing attending will chat with the student and provide feedback about the past week working together.
  • The course director will meet with the sub-I student half way through the rotation to check in and review an H/P together. They will meet again at the end of the rotation.
  • The student can always email the course director if there are any concerns that come up during the rotation.

Objectives

  • Assess, formulate a differential diagnosis, and propose initial evaluation and management for patients with common acute illness presentations (U,R)
  • Demonstrate competency in advanced history-taking, communication, physical examination, and critical thinking skills (B, C, A)
  • Manage an acute exacerbation of a chronic illness for patients with common chronic diseases (U, C, R, S)
  • Develop an evidence-based plan to minimize future exacerbations of specific chronic conditions (U, R)
  • Discuss the principles of family medicine care as they apply to inpatient medicine (B, U, C, E, S)
  • Discuss the value of the provision of multidisciplinary team care to any health care system (U, S)

Evaluation:

  • Evaluation based on above goals and standard BU student evaluation (CSEF) completed by supervising resident and all FM inpatient attendings for the four-week rotation.
  • Summative evaluation will be completed by course instructor at the conclusion of the rotation

Guidelines for Absences

Students are reminded to maintain standards of professionalism, courtesy and common sense when scheduling residency interviews that take place during fourth year rotations.  Try to schedule interviews during vacation blocks whenever possible. In general, a student may, with advance permission from the rotation director, be away for no more than four days during the four-week rotation.

 

Please take note of the following guidelines:

  • Students must work a minimum of two continuous weeks with no absences in order to pass the rotation.
  • If a student is absent for more than four days, those missed days must be made up in order to pass the rotation. In some cases, a student may be required to repeat the rotation.
  • Students follow the holiday/vacation schedule of the team, not of Boston University. Speak with the rotation director prior to making any travel arrangements during the rotation.

 

 

ELECTIVES IN FAMILY MEDICINE

e Title: Advanced Ambulatory Family Medicine

Instructors:Sara Tepperberg, M.D., M.P.H., Heather Miselis, M.D., M.P.H. and Rachel Mott-Keis, M.D.

Administrative Contact:Latia Holmes – [email protected]  Telephone:

Locations: Two of three possible outpatient sites: Codman Square Health Center, South Boston Community Health Center, East Boston Neighborhood Health Center

Number of Students: One or Two Fourth Year Medical Student(s)-This is an elective for students considering residency in Family Medicine

Period to be offered: Blocks 11, 12 and 14 (one student per block) Block 13 (2 students)

Description of Elective:

Students who are entering the field of family medicine are the target for this elective.  Students will see ambulatory patients at one or two of the affiliated residency sites, including South Boston Community Health Center, East Boston Neighborhood Health Center and Codman Square Health Center. The student will work with a variety of Family Medicine residents and preceptors, and as such will not likely have opportunity for significant summative assessments and advanced accolades from faculty.   With appropriate supervision, students will be expected to have first contact with patients and to do the initial work-up.  Students will advance their skills in the diagnosis of the undifferentiated patient, and the assessment and management of acute and chronic problems which commonly present in family medicine. Instruction in patient education and preventive medicine in the family context will be emphasized. Students will participate in staff conferences and may attend rounds, conferences and lectures that are part of the BMC Family Medicine Residency Program.

This elective is also available through the Boston Medical Center Minority Recruitment Program.

EVALUATION

The student will be evaluated by the same BU School of Medicine assessment tool that is used for BU Family medicine clerks or by the elective evaluation supplied by their sponsoring institution.

 

Family Medicine ° Clinical Elective

Instructor:Elizabeth Ferrenz, M.D.

Administrative Contact:Latia Holmes – [email protected]([email protected])  Telephone:

Location: Boston Medical Center

Number of Students: Four-4th year BU medical students only

Period to be offered: Block 10

Description of Elective:

The Family Medicine 0 Clinical Elective is an opportunity for fourth year medical students to delve into the many roles of a family doctor.  This elective is designed for medical students strongly considering a career in Family Medicine who would like additional exposure to outpatient, inpatient, maternal child health and specialty care provided by family doctors.

The elective experience will take place at Boston Medical Center, at Family Medicine affiliated community health centers, and at the Ryan Center (Sports Medicine).

The student will have a clinical home throughout their rotation at a community health center.  Each student will be paired with a resident, and will participate in that resident’s continuity clinic 2 sessions/week on their inpatient and mom-baby weeks and 5 sessions/week on the outpatient week. These supervising residents will receive Resident as Teacher training and will get teaching support and mentoring during the rotation from Dr. Cohen-Osher.  The student will see a subset of patients on the resident’s schedule.  The clinical care provided by the student-resident pair will be supervised by the attending physician who is precepting in resident clinic.  The student will also work with additional clinicians at the community health center to understand the comprehensive services available for the care of patients such as integrated behavioral health and nutrition counseling.

The inpatient experience during the elective will include 2 weeks on the Family Medicine inpatient service caring for hospitalized adults.  During the week of nights, the student will work directly with the Family Medicine intern and attending physician to admit new patients and cross-cover patients on the Family Medicine resident teams.  During the week of days, the student will follow their own assigned patients with supervision from the resident team and attending physician.

The maternal child health week gives students a true Family Medicine-centered experience to include prenatal/perinatal care (including labor and delivery), inpatient postpartum care for women, as well as newborn nursery care for their infants.  The student will spend mornings on the postpartum floor caring for women and their infants- focusing on issues such as breastfeeding (including spending time with a lactation consultants), the newborn exam, routine postpartum care, maternal counseling and anticipatory guidance.

During the outpatient/specialties week the student will have an opportunity to tailor their clinical experiences to their individual interests.  All students will have the opportunity to spend clinical time with the Sports Medicine fellowship trained Family Medicine faculty and fellows.  Students will also be able to experience other areas of focus in Family Medicine such as integrative medicine, transitions of care, office based substance use treatment, geriatrics, and student health and these will be tailored (as much as possible) to the student’s clinical interests.

Inter-professional experiences are built-in to many components of this elective.  On the inpatient Family Medicine service there are board rounds twice daily where the MD team, nurses, and case management come together to discuss all patients. During the maternal child health week, there is daily communication with nursing and often with lactation consultants and social workers.  Our outpatient clinics have team care nursing and integrated behavioral health.

During the four-week rotation the student will select a topic of interest relevant to Family Medicine and prepare an oral presentation to be shared with Family Medicine residents and faculty which will be evaluated by the presentation coordinator.  This will happen in the 3rd or 4th week of the clerkship.

Maternal/Child Health

Instructor:Keri Sewell, M.D.

Administrative Contact: Latia Holmes – [email protected]  Telephone:

Location: Boston Medical Center

Number of Students Per Block: Selective Blocks, Please Inquire

Period to be offered: Blocks 9 – 19

Description of Elective:

This elective gives students a true family medicine-centered experience to include prenatal/perinatal care (including labor and delivery), inpatient postpartum care for women, as well as newborn nursery care for their infants. The student will spend mornings on the postpartum floor caring for women and their infants- you will focus on issues such as breastfeeding (including spending time with our lactation consultants), the newborn exam, routine postpartum care, maternal counseling and anticipatory guidance.  Afternoons will be spent either seeing primary care patients in clinic (including as many prenatal/pediatric visits as possible), or researching a maternal/child health topic of your choice to be presented at the end of the elective.  Students take call overnight on labor and delivery one night per week, allowing them an opportunity to be actively involved in deliveries and all aspects of labor and delivery care.  Each student chooses one weekend to work with the postpartum/nursery rounder to get more direct clinical experience.  Participation in this elective provides you with a wonderful opportunity to be an active and important team member with a lot of independence.  Students who will derive the most benefit from this rotation are self-motivated and active learners.

  Title: Latino Health Elective

Department of Family Medicine

Boston University School of Medicine

Course Director:Elizabeth Ferrenz

Email address:[email protected]

Administrative Contact:Latia Holmes

Email address:[email protected]

Clinical Faculty (may vary depending on availability each block):

Carol Singletary, Registered dietician, EBNHC

Dr. Sonia Ananthakrishnan, Endocrinology

Dr. Jose Betances, Pediatrics

Dr. Charles Bliss, Gastroenterology

Dr. Miriam Hoffman, Family Medicine

Dr. Jessica Levi, Pediatric Otolaryngology

Dr. Jose Romero, Neurology

Dr. Peter Smith, Chronic Disease Education and Management (CDEM), EBNHC

Number of Students: One fourth year medical student

Period to be offered: 4 weeks

Available Blocks: 14, 17, 18 and 19

Please note: Students must contact the course director before signing up for this elective to ensure that their level of Spanish proficiency will be adequate for a successful experience on this rotation.

DESCRIPTION OF ELECTIVE:

The Latino Health Elective is an opportunity for fourth year medical students to improve their ability to provide medical care in Spanish, to increase their understanding of Latino health issues and disparities, and to research a topic of relevance to the health of Latino communities.

The elective experience will take place at East Boston Neighborhood Health Center (EBNHC), Boston Medical Center, and Boston area community agencies. 

Students will participate in clinical sessions in Family Medicine and Chronic Disease Management at EBNHC.  Specialty clinical sessions will take place at BMC.  Students will be responsible for conducting history and physical examinations in Spanish and presenting their findings in standard oral presentation format in English. 

At community agencies, students will learn about outreach to the Latino community around issues of immigration, housing, education, and more.  Latino elder care will be explored with an adult day health program.

Selected readings will be provided to students to expand their knowledge of Latino communities in the United States and health disparities facing Latinos.  These readings will be reviewed independently and discussed with the course director.

During the four week rotation the student will select a topic of interest relevant to the Latino community and prepare an oral presentation to be shared in the final week. 

Students will be evaluated on the basis of their participation in clinical sessions and engagement with community agencies and independent readings.  The final presentation will be evaluated on the basis of relevance to Latino health and skills in oral presentation.

Latino Health Elective additional information

Title: Primary Care Sports Medicine

Instructor:Alysia L. Green, M.D.

Course Coordinator: Latia Holmes[email protected]

Telephone: 

Number of Students: One 4th year BU medical student

Period to be offered:   Blocks 12, 13, 14, 17, 18 and 19

LOCATIONS: Boston Medical Center, BU Ryan Center for Sports Medicine, BU Student Health Services, BU Athletic Training Room and various athletic fields/venues for event coverage

OBJECTIVE: To gain exposure and experience in the field of primary care sports medicine.

GOALS:

  • To improve history taking and physical examination skills
  • Development of a solid musculoskeletal examination
  • Development of a focused differential diagnosis based on history of injury and physical examination findings
  • Determining what further testing modalities are needed based on the differential diagnosis
  • Exposure to athletic training and rehabilitation of the injured athlete
  • Understanding the role of the team physician, student athlete and athletic trainer
  • Gaining game coverage experience

FACULTY:

Alysia L. Green, M.D.-Family Medicine/Primary Care Sports Medicine

Nathan Cardoos, M.D.- Family Medicine/Primary Care Sports Medicine

Douglas Comeau, D.O-Family Medicine/Primary Care Sports Medicine

Stephen Huang, M.D.-Family Medicine/Primary Care Sports Medicine

ADDITIONAL FACULTY:

Mark Laursen, Director of Athletic Training Services, Boston University

Jennifer Chadburn,, Assistant Director of Athletic Training Services, Boston University Primary Care Sports Medicine Fellow

Description of Elective:

The curriculum will include multiple experiences in primary care sports medicine. A sample of a weekly schedule of clinic time and other experiences would be the following:

-8 half days of Primary Care Sports Medicine

-1 full day in BMC orthopedics with Dr. Green in my non operative orthopedic clinic

-Wednesday Morning Sports Medicine Conference 7 am

-1/2 day BU Athletic Training Room physician clinic working one on one with one of the primary care sports medicine physician as they evaluate BU student athletes

-1/2 day of reading time

-Game coverage: will vary depending on the time of year and block but anticipate at least game coverage opportunities per week of the elective. Please note much of the game coverage occurs in the evening and/or the weekends so student needs to be aware they may have to work late and possibly on the weekends.

The student will have a mid-block evaluation of their achievement of the above stated goals, done by Alysia L Green M.D. with the written/verbal input of the other physicians and additional staff members. At the end of the rotation, the student will be responsible for presenting a recent journal article on a sports medicine topic at their final sports medicine conference.  They will further be evaluated throughout their rotation on their musculoskeletal examination skills.

Student will have to provide at least 30 days notice if they are going to drop the elective, otherwise it will not be allowed.

 

 

Family Medicine Boot Camp Elective

Course DirectorAmanda DeLoureiro MD, MPH Family Medicine

Course instructors –Additional clinical involvement of faculty and family medicine residents who participate in teaching the modules and SIM center.

Administrative Contacts –Latia Holmes – [email protected]

Office phone number

NUMBER OF STUDENTS

fourth year medical students

LENGTH OF ELECTIVE

2 weeks

AVAILABLE BLOCK

Block 19 A (3/21//3/22)

Description of Elective:

The Family Medicine Boot Camp Elective is an opportunity for fourth year students to directly prepare for their transition from medical school to an internship in Family Medicine. Faculty and residents will lead small-group activities and simulations to review core procedural skills. These sessions will focus on key categories of Family Medicine training, including outpatient care, inpatient adult and pediatric care, and inpatient obstetric care. 

The expected hours will be from 9 am to 5 pm on Monday through Friday. There will be no weekend activities. 

The course will be taught in Boston University School of Medicine (for case-based learning) and in the Boston University School of Medicine Simulation Center (for procedural sessions). There will be no direct patient contact.

 

Primary Care Elective at BU Student Health Services

Course Director: Aaliyah Y. Rizvi Shaikh, M.D.   email: [email protected]

Contact:Latia Holmes   email: [email protected]

Location: BU Student Health Services

NUMBER OF STUDENTS: 1

LENGTH OF ELECTIVE : 4 weeks

AVAILABLE BLOCKS

13, 19

Description:

The Primary Care elective at BU’s Student Health Services’ (SHS) Department of Primary Care (PC) provides students with an opportunity to engage in a university-based, outpatient primary care clinic serving a diverse domestic and global population. The MS4 will be part of a multi-disciplinary team and will participate in daily patient care. Simulating a primary care physician, they will be expected to conduct and document a thorough history, physical, assessment, differential, and plan. They will be assigned and guided by a physician and may have opportunities to rotate in other departments of SHS (Behavioral Medicine, Wellness, Sexual Assault Response & Prevention Center (SARP), and Athletic Training).

 

 

 

Sours: https://www.bumc.bu.edu/busm/education/registrars-office/third-and-fourth-year-scheduling/family-medicine/

Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey

  • Research article
  • Open Access
  • Published:

BMC Family Practicevolume 22, Article number:  () Cite this article

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Abstract

Background

U.S. physicians lack training in caring for patients with obesity. For family medicine, the newly developed Obesity Medicine Education Collaborative (OMEC) competencies provide an opportunity to compare current training with widely accepted standards. We aimed to evaluate the current state of obesity training in family medicine residency programs.

Methods

We conducted a study consisting of a cross-sectional survey of U.S. family medicine residency program leaders. A total of directors (including associate/assistant directors) from family medicine residency programs identified from the American Academy of Family Physicians public directory were invited via postal mail to complete an online survey in

Results

Seventy-seven program leaders completed surveys (16% response rate). Sixty-four percent of programs offered training on prevention of obesity and 83% provided training on management of patients with obesity; however, 39% of programs surveyed reported not teaching an approach to obesity management that integrates clinical and community systems as partners, or doing so very little. Topics such as behavioral aspects of obesity (52%), physical activity (44%), and nutritional aspects of obesity (36%) were the most widely covered (to a great extent) by residency programs. In contrast, very few programs extensively covered pharmacological treatment of obesity (10%) and weight stigma and discrimination (14%). Most respondents perceived obesity-related training as very important; 65% of the respondents indicated that expanding obesity education was a high or medium priority for their programs. Lack of room in the curriculum and lack of faculty expertise were reported as the greatest barriers to obesity education during residency. Only 21% of the respondents perceived their residents as very prepared to manage patients with obesity at the end of the residency training.

Conclusion

Family medicine residency programs are currently incorporating recommended teaching to address OMEC competencies to a variable degree, with some topic areas moderately well represented and others poorly represented such as pharmacotherapy and weight stigma. Very few program directors report their family medicine residents are adequately prepared to manage patients with obesity at the completion of their training. The OMEC competencies could serve as a basis for systematic obesity training in family medicine residency programs.

Peer Review reports

Background

Obesity is a serious public health problem in the United States (U.S.) affecting roughly 40% of American adults [1]. Obesity may cause, exacerbate, or accelerate numerous medical and psychosocial conditions including diabetes, heart disease, cancer, and depression and it also has profound economic consequences [2, 3]. The direct costs attributed to the medical complications of obesity have been estimated at $ billion annually [4]. Indirect costs, including lost productivity, have been estimated to be an additional $ trillion dollars [5]. Unfortunately, rates of obesity continue to climb [1].

Recent clinical guidelines reflect the recognition of a need to integrate obesity management in clinical care, and provide clear recommendations for medical care of patients with obesity [6, 7]. However, management of obesity has not been prioritized [8] or managed effectively in primary care settings [9,10,11]. In fact, despite high prevalence rates, fewer than 5% of primary care visits in were dedicated to obesity based on the National Ambulatory Medical Care Survey [12]. In addition to lack of sufficient clinic time and inconsistent reimbursement for obesity related codes [13], other reasons why primary care physicians may not effectively address obesity include discomfort discussing obesity with patients [14] and limited exposure to obesity as part of formal education in both medical school and residency. Studies have shown that less than one-third of medical schools meet the minimum recommended hours of nutrition education [15] and there is limited coverage of obesity-related topics in internal medicine programs [16] or medical licensing exams [17].

Successfully tackling the obesity epidemic requires a multi-faceted approach that includes innovative new treatments, changes in public health policy, improved public awareness of the causes and consequences of obesity, and improved provider education and training. In , the Obesity Medicine Education Collaborative (OMEC) formulated a set of 32 obesity-related competencies for medical students, trainees, and professionals engaged in the diagnosis, evaluation, counseling, and treatment of patients with obesity [18]. This complemented an earlier effort by the Provider Training and Education Workgroup of the Integrated Clinical and Social Systems for the Prevention and Management of Obesity Innovation Collaborative which had created obesity competencies for inter-professional education [19]. These competencies have been endorsed by a number of professional organizations including the American Academy of Family Physicians (AAFP) and the Society of Teachers of Family Medicine (STFM). Family physicians are in an ideal position to care for patients with obesity because obesity is often a lifelong, relapsing condition for which a meaningful long-term relationship with a healthcare provider is appropriate [20].

Our objective was to obtain a baseline assessment documenting current training on the management of obesity incorporated in family medicine programs, which components are included, and the consistency of this training with the recently published OMEC competencies. Ultimately our goal for this research is to serve as a benchmark against which to examine incorporation of the OMEC competencies in future assessments. The aim of this study is to: 1) describe the proportion of family medicine residency programs with training programs for care of patients with obesity, 2) examine whether family medicine residents are adequately prepared to manage patients with obesity at the end of their training, and 3) describe the extent to which the OMEC competences are currently addressed in family medicine residency programs.

Methods

Study design

We surveyed leaders of family medicine residency programs in the U.S. between October 23 and December 7, Invitations were sent by postal mail and surveys were completed online. Although more than one leader in some programs was identified, only one respondent was permitted from each residency program to ensure consistent data and representation across institutions. The study was reviewed by the Columbia University Institutional Review Board and was found to qualify for exempt status (IRB-AAAS; ).

Participants

We identified potential study participants through a multi-step process. Using the AAFP public directory [21], we selected all family medicine residency programs listed. Based on addresses in the AAFP directory of residency programs and after excluding the two institutions from which the only identified contacts participated in the pilot testing, we mailed invitations to program leaders including directors, associate directors, and assistant directors that we could identify using publicly available information including residency program websites. The mailed package included a letter specifying the study sponsor (Novo Nordisk) and academic collaborators (Columbia University Mailman School of Public Health and the Bariatric and Metabolic Institute at the Cleveland Clinic), study objectives, participation requirements, web link and instructions for completing the online survey, and a prepaid incentive of $65 in the form of a check to thank participants for their time. A second postal mailing, along with several rounds of follow-up faxes and emails, were used to remind non-responders to participate. To qualify, respondents were required to be at least somewhat familiar with “the Accreditation Council for Graduate Medical Education’s (ACGME’s) learning objectives and requirements for family medicine” to ensure survey responses were based on sufficient knowledge of their residency program.

Survey instrument

The online survey was based on the OMEC competencies and comprised 47 questions related to obesity education, including multiple choice, scalar, and numeric text questions. Respondents were asked to assess the degree to which their residency program curricula address core obesity competencies on a 4-point Likert scale (“great extent”, “some extent”, “very little extent”, and “not at all”). Survey questions included the nature and setting of obesity training in the curriculum, opportunities for clinical rotations in obesity, as well as expectations, priorities, and barriers regarding expansion of obesity education.

We based the family medicine survey on a similar survey of medical schools [22] and internal medicine residency programs [16]. To emphasize unique aspects of family medicine, the survey was adapted, through an iterative process, to include questions related to the prevention of obesity (in addition to its management), the extent to which programs integrate clinical and community systems as partners in obesity management, the degree to which patient-centered communication is emphasized, and the level of participation of other disciplines as part of the “medical home” team. See Additional file 1 for the survey questions.

Prior to fielding the survey, a family residency faculty member reviewed and suggested modifications to the instrument. The resulting instrument was then pilot-tested with four family medicine residency program directors via telephone and a web-based platform for their assessment of the face validity of the survey. We made minor wording changes to the survey based on feedback from the pilot to improve clarity and relevance.

Statistical analysis

We used descriptive statistics to summarize respondents, programs, and responses. Univariate comparisons of responses by key independent variables were completed using Spearman’s rank correlation test. All statistical analyses were completed using SPSS v. 24 (IBM, Armonk, NY). Results were considered statistically significant if the p-value < 

Results

Characteristics of respondents and family medicine residency programs

Leaders of 77 programs completed the survey including 56 program directors and 21 other residency leaders (of a total of programs approached; 16% response rate). Respondents completed the survey in a median of 12 min. All respondents were involved in teaching/training residents and had been in their current role for a mean of 7 years. Eighty-eight percent of the programs were associated with medical schools (i.e., medical school-based, -administrated, or -affiliated) and 12% were community-based, non-affiliated programs (Table 1).

Full size table

Obesity in the family medicine residency curriculum

Most respondents reported that their residency programs offered formal or organized training on obesity topics: 49 (64%) programs on prevention of obesity and 64 (83%) programs on management of patients with obesity. Fifty-two percent of all the surveyed programs offered surgical clinical rotation opportunities and 43% had non-surgical rotations in obesity. In addition to clinical faculty, residents from 69 programs (90% of total programs surveyed) had opportunities to work with other healthcare providers who cared for patients with obesity, although the nature of this work was not defined in the survey nor was the extent to which residents participated in these opportunities. Nearly all (99%) respondents reported that other clinical disciplines participated in medical home teams and inpatient rounds, including nursing (79%), social work (75%), psychology (58%), nutrition (42%), pharmacy (30%), and physical therapy (25%).

Although 49% of programs reported teaching an approach to obesity management that integrates clinical and community systems as partners to “some extent”; only 12% indicated doing so to a “great extent”, 27% “very little”, and 12% reported not teaching this approach at all. Furthermore, only 47% of participants reported that their programs emphasized to a “great extent” the use of patient-centered communication when working with patients with obesity, while 12% indicated their program emphasized this very little or not at all.

Figure 1 summarizes the extent of coverage of core obesity competencies during the family medicine residency program. There were notable differences in coverage across topic areas. Among the core topics on obesity included in the survey, only behavioral aspects of obesity were covered to a great extent by slightly more than half of the programs. Nutrition aspects of obesity and physical activity were covered to a great extent in 36% and 44% of programs, respectively. The topic of weight stigma and discrimination were covered to a much lesser extent. Teaching was provided primarily in supervised outpatient clinics and dedicated seminars.

Coverage of Obesity Competencies in Family Medicine Residency Programs. Some competencies have been shortened for presentation; responses of “some extent” not shown

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Physical exam skills specific to assessing patients with obesity were reported to be covered at least to some extent in the majority of programs; however, additional assessment tools (metabolic testing, body composition analyses) were covered very little or not at all by half of the programs. Teaching of this component was primarily in an outpatient clinic setting.

Treatment of obesity was generally not extensively covered. Surgical treatment was more commonly addressed than was pharmacological treatment. Only 10% of programs reported covering the latter to “great extent” – over one-third reported no or very little coverage. These topics were taught primarily in outpatient precepting clinics and dedicated seminars of respondents’ programs.

Finally, competencies related to the etiology and pathophysiology of obesity were the least addressed in the curriculum, with more than half of the programs covering those topics to a very little extent and at least 10% not covering them at all; both topics were typically taught in dedicated seminars. The extent to which etiologic aspects of obesity were included in the curricula was highly correlated with the extent to which physiologic (hormonal) aspects of obesity were covered (r = ; p < ).

Perception of preparedness in managing patients with obesity

Most respondents (program leaders) (87%) perceived themselves as “very prepared” to diagnose obesity. Approximately 55% and 38% felt that they were “very prepared” to give physical activity advice and nutritional advice for obesity management, respectively (Fig. 2). In contrast, only 17% of respondents described themselves as “very prepared” to prescribe pharmacotherapy for obesity management and 8% felt that they were “not at all prepared”. Interestingly, respondent’s perception of their preparedness for prescribing pharmacotherapy was significantly correlated with the perceived degree of importance of pharmacotherapy in obesity education (r = ; p < ), as well as to the extent that pharmacotherapy is included in the residency program curriculum (r = ; p < ).

Respondents’ Personal Preparedness for Managing Patients with Obesity

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When asked about the preparation level of their residents at the end of the residency program, only 21% of the respondents felt that the residents were “very prepared” to treat patients with obesity. Slightly more than half (53%) reported that their residents were “fairly prepared”, and the remainder perceived their residents as only “somewhat prepared” (25%) or “not at all prepared” (1%). Resident preparation was significantly correlated with the degree of preparation the respondents (i.e., program directors) had for giving nutritional advice (r = ; p < ).

Perceived importance of obesity-related education

When asked about the importance of education on specific obesity-related topics, most respondents (58%–88%) rated nearly all as “very important” (Fig. 3); the two exceptions were comfort with obesity pharmacotherapy and coding and billing for an obesity encounter, which were rated as “very important” by only roughly one-third of the respondents.

Importance of Obesity-Related Topics for Education

Full size image

We inquired about incorporating obesity education into the curriculum: three-quarters (75%) of respondents thought it should be offered as both a separate discipline and as part of education related to the management of other related medical conditions; only 4% felt obesity education should be taught solely as a separate discipline and 21% felt it should only be incorporated as portions of teaching in conjunction with management of other conditions. Recognition of the importance of including obesity education in family medicine residency training was consistent with respondents’ estimates of the high mean prevalence of overweight (39%) and obesity (32%) in the patient populations served by their residents.

Prioritizing obesity education in family medicine residency curriculum

Almost two-thirds of respondents indicated that expanding obesity education was a high (10%) or medium (55%) priority for their programs; of these programs, 34% had plans to update (either incorporate or expand) the obesity curriculum within 1 year and 50% within 1–2 years. The top challenges related to integrating obesity education during residency were lack of room in the curriculum and lack of faculty expertise in obesity; these challenges were perceived as large or moderate barriers by 56% and 44% of the respondents, respectively. In contrast, fewer than 21% of respondents reported lack of faculty or resident interest and financial considerations as significant barriers.

Discussion

We sought to evaluate the current state of obesity education in family medicine residency program curricula and to gauge its alignment with the OMEC competencies. Our analysis can help identify priorities for future obesity education.

We found that the OMEC competencies are addressed to some extent in U.S. family medicine residency programs, but coverage varies widely by topic, with greater emphasis on areas such as behavioral, physical, and nutritional aspects of obesity and much less attention given to the clinical assessment and treatment of patients with obesity. Additionally, although most programs offered formal training on topics related to prevention and management of obesity, the actual didactic and clinical time devoted specifically to management of patients with obesity was limited. Thus, it is not surprising that only one-fifth of program leaders rated their residents as being very prepared to manage patients with obesity at the end of training. These findings underscore the need for improving obesity-related training during family medicine residency.

The few studies that have examined obesity in residency curricula have focused on internal medicine [23,24,25] or pediatrics [26]. A survey of Ohio medical residents (family, internal, and obstetrics and gynecology) found low levels of knowledge about obesity and counseling practices as well as low levels of perceived self-efficacy to effectively counsel their patients on obesity, nutrition, and physical activity [27]; this survey also revealed little provision of training in residency programs to support obesity management [28]. To our knowledge, this is the first study to survey family medicine residency leaders on the state of obesity education in their programs.

Despite the identified gaps in training related to management of patients with obesity during family medicine residency, the vast majority of program leaders in our study recognize the importance of providing obesity education and the challenges that arise with expanding such education. Graduate medical education has appropriately evolved to include and promote other topics relevant to primary patient care, such as opioid use and dependence [29]. Management of patients with obesity, however, still appears to be a relatively low priority. Although a lack of room in the curricula is reported as a major barrier by program leaders, the lower prioritization of obesity may also be due to other factors such as stigma against patients with obesity in the healthcare community [30].

Most programs are devoting considerable time to education about obesity. Rather than addressing the challenge of expanding time for obesity education, improvement may simply result from better aligning current training with the systematically developed OMEC competencies [18]. For example, less time could be devoted to understanding surgical procedures and more time to addressing stigma and its impact. One of the core initiatives of The Strategies to Overcome and Prevent (STOP) Obesity Alliance, a multi-organization collaboration dedicated to addressing policies, treatment, research, and education, is “Curating the Obesity Care Competencies” [31]. The goal of this STOP project is to support the implementation of the OMEC-developed obesity competencies by curating a collection of curricular material and tools for use by organizations to facilitate obesity education and training such as the Weight Can’t Wait Guide [32] as well as to develop a curricular case series highlighting successful competency integration strategies.

Our survey results suggest several opportunities for improving education about management of patients with obesity within existing structures. Lack of faculty with obesity expertise can be addressed by either leveraging existing multidisciplinary team members such as pharmacists to expand education on pharmacotherapy, as done in other chronic disease models, or using external resources, such as shared curricula from institutions already excelling in obesity education or widely available web-based CME (Continuing Medical Education) training sessions. Examples of CME include those developed by The Endocrine Society [33, 34], the Obesity Medicine Association [35] the Obesity Society [36] and the American Association of Clinical Endocrinology (AACE) [37]. Other available resources include online resources and webinars such as those offered by UConn Rudd Center for Food Policy & Obesity [38], the AACE Nutrition and Obesity Resource Center [39], and The Obesity Medicine Association [40, 41], Additionally, interactive training sessions, such as those developed by the American Heart Association [42], can be incorporated during clinical rotations to provide residents with specific skills that can be applied within busy, ambulatory care settings in which most will practice as primary care providers. Opportunities for training include patient-centric communication, counseling skills, and strategies to assess readiness and self-efficacy for behavior change [43]. Additionally, teaching integration of clinical and community partners could facilitate patient compliance and could similarly leverage the high prevalence of multidisciplinary members such as social work and nursing. Ultimately, development and endorsement of obesity education for family medicine residency programs by AAFP and STFM could have the greatest impact on the implementation of consistent training related to the treatment and management of obesity.

As our study is a baseline assessment, it could be repeated in the future once programs have been able to incorporate the OMEC competencies, in order to assess the progress of education and the impact of increased training on obesity management in U.S. family medicine residency programs. Initial examination of the impact of incorporating the OMEC competencies suggests that such incorporation will be well received. A recent study of a Midwest family medicine program assessing a new half-day teaching session based on the competencies demonstrated a positive impact on residents’ approach in managing obesity with more than 80% of residents surveyed after the session reporting that the content at least moderately impacted how they approached obesity management; comfort in working with patients with obesity and perception of their own biases improved significantly from baseline to immediately after the intervention and were sustained 15 months later [44].

Limitations

The study has several limitations including a small sample size, as only 16% of family medicine residency programs responded to the survey, despite attempts to maximize response rates utilizing a variety of methods. This could be due to competing with the many other demands on residency program leaders’ time, or it could be indicative of low interest in the topic of obesity education. The sample size limited the number of subgroup analyses that could be conducted. Additionally, participation among certain groups was absent or limited, including military family medicine residency programs and programs located in New England, the Pacific Northwest, Appalachia, and parts of the South. Although these limitations may constrain generalizability of the results, the sample distribution served by responding programs was similar to that of invited programs with respect to types of institutions with which the programs are affiliated, populations served, and U.S. geographic region. These facts may support generalizability in this context.

Respondents appeared to be candid in their survey responses. Responder bias would likely have resulted in a larger percentage of programs which are more adequately addressing obesity in their curricula, or, conversely, fewer programs reporting inadequately addressing education of the condition; instead, our data show significant room for improvement. We acknowledge that respondents’ assessment of their curricula is likely to be subjective. Results are nonetheless informative and relevant for understanding obesity education related challenges faced by family medicine residency programs. The questionnaire was developed by researchers with extensive experience in survey design and medical residency training even though the survey was not formally validated, and response and other biases are possible. Obesity education can take multiple forms including informal or self-directed learning; this type of learning was not assessed in our study.

Conclusions

Despite being in a unique position to provide obesity care, most recently trained family medicine physicians are likely not adequately prepared to manage patients with obesity. Training related to prevention and management of patients with obesity appears suboptimal in a large portion of family medicine residency programs. Although most family medicine residency programs surveyed cover some elements of obesity education to an extent, in a wide variety of settings, most of the OMEC obesity-related competencies are not yet adequately addressed. Our survey results point to several opportunities for leveraging existing resources to incorporate the current OMEC competencies. Such opportunities can contribute to improving the quality of family medicine residency education in obesity.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

United States

Obesity Medicine Education Collaborative

American Academy of Family Physicians

Society of Teachers of Family Medicine

Accreditation Council for Graduate Medical Education

Standard deviation

Strategies to Overcome and Prevent Obesity

Continuing Medical Education

American Association of Clinical Endocrinology

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Acknowledgements

The authors would like to thank Maria Castro Bacca of Columbia University, Mailman School of Public Health for her analytical support, and Rebecca Hahn and Daniela Geba of KJT Group, Inc. for their medical writing assistance and support, which was funded by Novo Nordisk, Inc.

Funding

This study was funded by Novo Nordisk, Inc. which financed the development of the study design, third-party blinded data collection, analysis, and interpretation of data as well as writing support of the manuscript. An employee of Novo Nordisk, Inc., Dr. Smolarz, co-designed the study and had a role in the analysis and interpretation of the data. The funding body had no additional role in the design of the study or the collection, analysis, and interpretation of the data.

Author information

Author notes
  1. Manuela Orjuela-Grimm and W. Scott Butsch are co-primary authors.

Affiliations

  1. Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA

    Manuela Orjuela-Grimm & Silvia Bhatt-Carreño

  2. Departments of Surgery and Internal Medicine and Geriatrics, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    W. Scott Butsch

  3. Novo Nordisk Inc., Plainsboro Township, NJ, USA

    B. Gabriel Smolarz

  4. Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA

    Goutham Rao

Contributions

MOG, WSB, BGS designed the study, developed the study materials, provided input into the data analyses, and contributed to writing the manuscript. SBC and GR provided input into the data analyses and contributed to writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to B. Gabriel Smolarz.

Ethics declarations

Ethics approval and consent to participate

Ethical approval has been exempted by Columbia University Institutional Review Board, August 16, , reference number IRB-AAAS Prior to completing surveys, respondents provided informed consent electronically, i.e., by selecting “yes” to the question “Do you consent to these terms and wish to continue with the following survey on obesity medicine education?”.

Consent for publication

Not applicable.

Competing interests

Dr. Orjuela-Grimm has no conflicts of interest to disclose.

Dr. Butsch is a health consultant for Novo Nordisk Inc. and on an advisory board for Rhythm Pharmaceuticals, Inc.

Ms. Bhatt-Carreño has no conflicts of interest to disclose.

Dr. Smolarz is an employee of Novo Nordisk and owns stock in Novo Nordisk.

Dr. Rao has no conflicts of interest to disclose.

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Supplementary Information

Additional file 1.

Family Medicine Residency Curriculum Survey. Questions from survey conducted among family medicine residency directors.

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Orjuela-Grimm, M., Butsch, W.S., Bhatt-Carreño, S. et al. Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey. BMC Fam Pract22, (). https://doi.org//sy

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Keywords

  • Obesity
  • Education
  • Internship and residency
  • Family practice
  • Graduate medical education
  • Primary health care
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