University of Massachusetts Medical School
MSWeight: Medical Students Learning Weight Management Counseling Skills
Medical educators designed the MSWeight curriculum to teach weight management counseling to future physicians and address the muffled discussion about obesity in U.S. health education and healthcare. The MSWeight curriculum is designed to give students repeated and sequential exposure to weight management counseling curricula over the course of the first three years of medical school. OSCEs and self-reported assessments are being used to compare the results of MSWeight to the current medical curricula.
Most physicians report limited skills or training to provide weight management counseling. In response, Drs. Judith Ockene and Rashelle Brown Hayes designed the MSWeight curriculum for Weight Management Counseling in Medical Schools. They are currently leading a randomized controlled trial across 3,311 students in collaboration with the National Cancer Institute and 9 highly selective U.S. medical schools that compares the efficacy of multi-modal educational intervention (MSWeight) versus traditional methods of instruction on weight management counseling. The MSWeight curriculum applies evidence-based educational and psychological theories that challenge the standards currently in place and focuses on determining what method provides the most effective counseling skills for addressing the increased prevalence of obesity. Once completed, results from this innovative program have the potential to change the way future doctors acknowledge and address weight management counseling.
This work is supported by NIH and the National Cancer Institute (5R01CA194787).
MS Weight MME Curriculum
Whereas traditional medical education may include topics related to the treatment of weight management and obesity as well as sporadic stand-alone lectures or small group discussions conducted separately or as a part of a patient interviewing or behavioral course, the multi-modal MSWeight program consists of a tested web-based curriculum, a series of interactive counseling practice opportunities with observation and feedback, video demonstrations, a formative web-based objective structured clinical exam (OSCE), and a school weight management counseling (WMC) social media Facebook page.
The MSWeight intervention targets student individual factors (WMC knowledge, obesity bias, WMC observed skills, and WMC perceived skills and self-efficacy), interpersonal factors between faculty and student (modeling and provision of WMC feedback), and institutional factors (exposure to WMC curriculum, including clinical experiences) to support WMC skill building for medical students. The intervention is modeled on the protocol used for diet, alcohol, and smoking behavior change interventions, using patient-centered counseling integrated into the 5As framework (Ask, Advise, Assess, Assist, and Arrange) as well as incorporating content from the 2013 AHA/ACC/TOS obesity guidelines.
Web-Course “MSWeight: Building Weight Management Counseling Skills”
Experts in behavioral health, medical practice and nutrition reviewed existing online courses such as New Lifestyle and Nutrition in Medicine for teaching weight management counseling and other selected resources as a guide for selecting key goals for the web-based didactic component of the intervention. The web-course included 14 modules that range from epidemiology of overweight/obesity and the role of the physician in weight management counseling to providing tools that physicians can use to partner with patients to make dietary and physical activity behavior changes. Since obesity bias is prevalent in society and can be present during a medical student-physician-patient interaction, the web-course incorporated content to raise awareness about obesity bias and increase knowledge for effectively counseling patients with obesity.
To facilitate the web-course completion, the course was self-paced. Each module was designed to be completed by students in approximately 15 minutes with an overall time commitment of 4 hours. Medical education deans and course directors agreed to include the course in the first year curriculum and to record course completion among their students. At the end of the web-course, students completed a short quiz. Upon completion of the quiz students received a certificate of completion. The web-course was promoted as a prerequisite for the role play exercise.
Role Play Exercise
The goal of the role play exercise was to provide students with hands-on practice conducting WMC. The one-hour session was facilitated by school faculty instructors and included a brief video demonstration of a physician-patient encounter for WMC that incorporates the 5As framework followed by a brief discussion of the video and WMC challenges such as initiating the conversation about weight management and goal setting. Subsequent to the discussion, students broke into dyads and practiced two physician-patient encounters.
The WebPatientEncounter provided students with WMC skills practice during the second year. In this intervention, students interact with a standardized patient (SP) with obesity in a formative WebPatientEncounter, using a video-conferencing system developed and administered by investigators at Drexel University College of Medicine – in alignment with the OSCE checklist. It provides a two-way video that can be recorded and stored. After a 15-minute encounter the SPs (hired and trained by Drexel University) guided the student through the structured OSCE WMC behavior checklist, noting behaviors and communication skills the student successfully implemented and those the student could have employed for a more effective encounter. The SP provided feedback by playing back relevant parts of the encounter to show the student what they did. Students could access their interview for continued reflection. Total time with the SP was 40 minutes; staff at Drexel University along with staff at each MME institution scheduled student/SP meetings.
Enhanced Clerkship and Faculty Development
Clinical preceptors are in the position to teach, model, provide practice opportunities, give constructive feedback to students during the clerkship experience, and can have a positive impact on students’ clinical skills development. However, the educational level, experience, and skill level of the academic detailers varies between schools. Clerkship directors delivered the intervention because investigators were concerned that academic detailers are not on the front line with preceptors or medical students and may not adequately teach them WMC. The clerkship directors worked with the UMass team to develop preceptor faculty development materials, designing the educational session to be brief (30 minutes) to enhance preceptor engagement.
Clerkship directors facilitated the group educational session for the preceptors. Preceptors were strongly encouraged to: (1) conduct WMC with their patients for students to observe, as modeling is an effective training technique and (2) actively observe students with patients and give critical feedback related to their WMC skills. The clerkship directors’ educational program for preceptors included principles of patient engagement and use of the 5As and patient-centered counseling for WMC. For off-site preceptors, a recorded session was sent out electronically. Preceptors and medical students received pocket guides to reinforce intervention concepts. Through use of a checklist, preceptors and medical students verified that the medical student was observed and given feedback on their WMC skills. The checklist was then forwarded to the study coordinator at the site. Materials were provided in multiple formats, including one easy to access by smartphone.
Structure of the Study
Students in this randomized controlled trial learn through either traditional education or MSWeight. The efficacy of each approach is measured after completion of the third year by an OSCE, which is already in place as the standard evaluation of medical students’ skills. The secondary method of measuring efficacy is through self-report. The participating medical students assess their own skills in the 5As: Ask, Advise, Assess, Assist, and Arrange. This longitudinal assessment is replicated after the first and third year of school.
Seven components of clinical teaching were measured by student’s level of agreement to how well their preceptor performed the following behaviors during their most recent clerkship:
- provided clear instruction on ways to deliver WMC to patients
- provided feedback on the student’s weight management counseling
- modeled ways to provide weight management counseling
- outlined clear objectives for weight management counseling, such as the number of patients with overweight or obesity with whom one should interact
- responded to questions about weight management counseling
- served as excellent role models to help their patients lose weight
- emphasized the need for a team approach to help patients lose weight.
Also included were two questions to assess office systems/environmental cues:
- the presence of a place in the preceptor’s record that reminded physicians to discuss weight
- whether there were educational materials for patients about weight management prominently displayed in the preceptor’s office
A weight management counseling Preceptor Score was created by summing the nine preceptor-related responses for each student. The scores for the students’ exposure to weight management counseling precepting ranged from a low score of nine to a high score of 36 points.
Student level of agreement with nine questions regarding their clerkship experience related to weight management counseling
[FM = family medicine clerkships; IM = internal medicine clerkships; OB = obstetrics and gynecology clerkships]