title: From the patient's perspective: the impact of training on resident physician's obesity counseling.
abstract: BACKGROUND
  It is uncertain whether training improves physicians' obesity counseling.
  
  
  OBJECTIVE
  To assess the impact of an obesity counseling curriculum for residents.
  
  
  METHODS
  A non-randomized, wait-list/control design.
  
  
  METHODS
  Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1-8 months post-intervention) 163 of the residents' obese patients were interviewed after their medical visits.
  
  
  METHODS
  A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients.
  
  
  METHODS
  Patient-report of physicians' use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics.
  
  
  RESULTS
  A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std beta = 0.18; R(2) change = 2.9%, P < 0.05).
  
  
  CONCLUSIONS
  Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account.
authors.affiliation: Division of General Internal Medicine, New York University School of Medicine, VA New York Harbor, 423 E 23rd Street, New York, NY 10010, USA. Melanie.jay@nyumc.org
authors.forename: Melanie
authors.initials: M
authors.lastname: Jay
authors.forename: Sheira
authors.initials: S
authors.lastname: Schlair
authors.forename: Rob
authors.initials: R
authors.lastname: Caldwell
authors.forename: Adina
authors.initials: A
authors.lastname: Kalet
authors.forename: Scott
authors.initials: S
authors.lastname: Sherman
authors.forename: Colleen
authors.initials: C
authors.lastname: Gillespie
mesh_terms: D000328:Adult; D003376:Counseling / Q000193:education* / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D015431:Weight Loss