Article Text

  1. T. S. Caudill1,
  2. A. R. Hoellein1,
  3. M. J. Lineberry1,
  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 40% of patients receive dietary or exercise advice from their doctor. Therefore, nutrition and physical well-being (NPWB) knowledge and counseling skills should be part of medical student curriculum. The purpose of this study is to determine the impact of a NPWB workshop (WS) using standardized patients (SPs) 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 WSs 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. 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 examination (seven NPWB questions) and a nine-station SP examination (one NPWB station), including a post-SP encounter open-ended written exercise. Written examination NPWB scores, NPWB SP checklist scores, and NPWB open-ended written scores of WS participants and nonparticipants were analyzed by means and multiple regression approaches solving for performance on a preventive medicine station and USMLE Step 1.

Results The NPWB WS was delivered to 12 of the 24 rotation groups during the 2004-2006 academic years. Ninety-four students participated in the WS and 92 did not. WS participants performed significantly better than nonparticipants on the post-SP encounter written exercise (4.7 ± 1.8 vs 2.8 ± 1.4, F = 60.5, p < .0001) and the NPWB written examination items (5.7 ± 1.0 vs 4.9 ± 1.2, F = 24.0, p < .001). There was a trend toward a significant difference on the NPWB-specific SP checklist items (23.8 ± 3.8 vs 22.4 ± 5.3, F = 3.4, p = .066).

Conclusions Students participating in a 4-hour SP WS exhibit superior NPWB knowledge as assessed by open-ended and multiple-choice questions, and there is a trend toward better clinical skills as assessed by an SP checklist.

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