Article Text

  1. M. J. Lineberry1,
  2. T. S. Caudill1,
  3. A. R. Hoellein1,
  4. J. F. Wilson1,
  5. S. A. Haist1
  1. 1University of Kentucky, Lexington, KY


Background Only about 20% of Americans consume the recommended proportions of fruits and vegetables and achieve the recommended level of physical activity. Also, only about 40% of patients report receiving dietary or exercise advice from their doctor. Therefore, nutrition and physical well-being (NPWB) knowledge and counseling skills should be part of the medical student curriculum. The purpose of this study is to determine the impact of a NPWB workshop (WS) using standardized patients (SP) on knowledge and clinical skills of third-year medical students.

Methods A 4-hour NPWB WS was developed as part of a new curriculum for a required third-year 4-week primary care internal medicine clerkship. The NPWB WS and three other novel WS were randomized for delivery to half of the rotational groups. The NPWB WS incorporates four SP cases representing different clinical challenges (exercise prescription, diabetic dietary counseling, stress reduction strategies, and low-carbohydrate diet counseling). A faculty preceptor facilitates group discussion of sensitive approaches to the problems. Participating students are also provided a 17-page NPWB reference. All students in every rotation group are assigned NPWB readings. At the end of the 4 weeks, all students take a 100-item written exam (seven NPWB questions) and nine-station SP exam (one NPWB station) including a post-SP encounter open-ended written exercise. Scores on the written exam NPWB items, NPWB SP checklist, and NPWB open-ended written exercise of workshop participants and nonparticipants were analyzed with simple means, standard deviations, and multiple regression approaches controlling for USMLE Step 1 scores and preventive care SP station checklist scores.

Results The NPWB WS was delivered to 6 of the 12 rotation groups during the 2004-2005 academic year. Forty-nine students participated in the workshop and 48 did not. Workshop participants performed significantly better than nonparticipants on the NPWB written exam items (5.7 6 1.0 vs 4.9 6 1.2, F = 13.9, p < .001) and the post-SP encounter written exercise (86.9% 6 6.7 vs 78.9% 6 5.8, F = 36, p < .001). There was no significant difference (p = .55) between the groups on the SP checklists.

Conclusions Students participating in a 4-hour SP workshop exhibit superior NPWB knowledge as assessed by open-ended and multiple-choice questions. NPWB attitudinal and supportive counseling skills are easily integrated into basic interviewing while practice with SPs assists in acquisition of knowledge.

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