Impact of a preventive medicine and nutrition curriculum for medical students

Abstract

Background

United States public health goals call for increased physician counseling about diet and exercise, but many medical schools lack adequate curriculum on these topics. At Harvard Medical School, second-year students take a preventive medicine and nutrition (PMN) course. This study evaluated the impact of this innovative curriculum on students' confidence about addressing patients' diet and exercise patterns and on their own health habits.

Methods

Students enrolled in the 2003 PMN course (N =137) completed a confidential 43-item written survey before and after the course. Surveys were completed by 134 students (98%) and 118 students (86%), respectively. The survey assessed students' diet and exercise habits and students' confidence in their ability to address diet and exercise with patients and family members.

Results

Students' confidence in their ability to assess and counsel about diet and exercise significantly improved after the course (all p <0.001). The course was also associated with a decrease in students' self-reported consumption of saturated fat (p =0.002) and trans fatty acids (p <0.001). Following the course, 72% of students perceived an improvement in their diet but only 18% perceived an improvement in exercise habits.

Conclusions

An innovative PMN course improved medical students' confidence in diet and exercise counseling and perceived dietary habits. Improving these mediators of physician counseling in medical students may translate into changes in their practice patterns.

Introduction

Diet and exercise are two modifiable health behaviors with the potential to prevent substantial morbidity and mortality.1 Physicians have the opportunity to help patients adopt healthier diet and exercise patterns but do not routinely do so.2 Barriers to counseling patients about health-related behaviors include physicians' lack of training in counseling skills and low self-efficacy.3, 4 Physicians with better personal health habits also report more preventive counseling.5, 6, 7

United States public health goals for 2010 call for increasing rates of physician counseling about nutrition and exercise.8 Medical schools need to teach these skills, and medical students believe that these topics should be included in their curricula.9 However, medical school curricula have been found to be deficient in content relating to nutrition and exercise.10, 11, 12 Medical students have reported being ill-prepared to counsel patients about diet and exercise and pessimistic about their ability to learn these skills.9, 13 In one study, medical students' perceptions of the importance of prevention was related to their own health habits,14 suggesting that a curriculum that addresses students' health habits might increase their interest in learning to counsel about these behaviors.

To improve the preventive medicine and nutrition teaching at Harvard Medical School (HMS), we implemented and evaluated an innovative course for second-year students. This study evaluates the impact of the course on students' diet and exercise patterns and on their self-efficacy for addressing these topics with patients.