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Starting an Obesity Medicine Track for Internal Medicine Residents 

26 days ago

Medical Education: Part III

Starting an Obesity Medicine Track for Internal Medicine Residents

Dr. Shafer (rshafer2@northwell.edu) is a General Internal Medicine and Obesity Fellow at the Zucker School of Medicine at Hofstra/Northwell. Dr. Rajkumar (jrajkumar1@northwell.edu) is an assistant clinical professor in the Department of Internal Medicine, Section of Obesity Medicine, at the Zucker School of Medicine at Hofstra/Northwell. Dr. Ehrlich (jehrlich@northwell.edu) is the associate program director at the Hofstra/Northwell Internal Medicine Residency Program and the medical director of the Northwell Health Medicine Specialties at Glen Oaks. Dr. Kane (jkane1@northwell.edu) is the director of the Northwell Health Center for Weight Management and the chief of obesity medicine at Hofstra/Northwell.

Obesity is a major healthcare issue in the United States, affecting nearly 40% of the US adult population,1 with healthcare costs estimated at $147 billion annually.2 Additionally, obesity is a risk factor for diseases such as metabolic syndrome, diabetes, chronic kidney disease, nonalcoholic fatty liver disease, and many cancers.3 Despite these facts, many physicians feel unprepared to treat patients with obesity.1 Despite national guidelines for primary care physicians stressing the importance of treating obesity, only one-third of patients with obesity report receiving weight counseling.2 Clinical knowledge is one of the major barriers to physicians evaluating and managing patients with obesity.2 Physicians report receiving inadequate training in weight counseling and having insufficient knowledge of the tools involved in treating obesity.2 Physicians that are trained in obesity screening, evaluation and counseling in residency are more likely to initiate conversations about diet and exercise with patients who are overweight or obese.2 Specifically, physicians express increased comfort in treating patients with obesity after receiving educational training and direct clinical implementation with oversight about the pharmacological and surgical treatment of obesity.4

Although there are obesity medicine learning experiences in medical schools5 and obesity medicine clinical tracks in family medicine (University of Pittsburgh Medical Center McKeesport) and pediatric medicine (Mount Carmel) residencies, there are currently no obesity tracks within internal medicine residency programs that offer a longitudinal clinical experience to evaluate and manage patients with obesity. Our aim is to fill this gap by developing a longitudinal two-year obesity medicine experience within the Northwell Internal Medicine Program at Hofstra to train residents in the multidisciplinary and comprehensive management of obesity. This track expands on a previous one-year clinical obesity medicine experience offered in the program with the addition of teaching, educational and research activities.

The aim of creating this track is for residents to feel confident in their ability to evaluate and assess patients with obesity and treat these patients through a multimodal approach, which includes nutritional guidance, behavioral therapy, physical activity, and treatment with pharmacology or surgery.

Obesity Medicine Track

We believe there is a tremendous need to train internal medicine residents through a longitudinal clinical experience that provides the skills to properly assess, diagnose, and counsel patients on the comprehensive management of obesity using a multimodal approach. The longitudinal two-year clinical and educational obesity medicine track, embedded within the ambulatory experience, provides categorical internal medicine residents with opportunities to practice obesity medicine by evaluating and managing patients and to participate in teaching, educational, and research activities related to obesity medicine.

The main goals of the track include the following:

  1. Recognizing the complex nature of obesity and why it requires a multimodal approach for treatment.
  2. Performing a weight history and dietary assessment.
  3. Learning to counsel patients with obesity about different treatment modalities.
  4. Completing an academic project promoting obesity medicine research and/or education.

First Year of Track

First-year categorical internal medicine residents apply to participate in this track in the spring of their first year of residency with a short essay about their interest in studying and practicing obesity medicine. Beginning in their second year of residency, the track consists of five second-year residents, as our program’s residents are split up into five firms.

The first-year track activities are similar to the one-year clinical obesity medicine experience offered in the program. Residents participate in half-day clinical sessions evaluating and treating patients with obesity. These sessions take place once a week during their respective ambulatory clinic cycle, which occurs every five weeks. The sessions begin with a 30 minute-didactic led by the obesity medicine fellow. Topics covered include foundational areas in the management of patients with obesity such as nutrition, physical activity, pharmacology, bariatric surgery, eating disorders, and endocrine disorders. Interactive case-based questions are included at the end of each didactic.

Following the didactic sessions, the residents evaluate and manage patients with obesity under the guidance of both the obesity medicine attending and fellow. Residents receive experience counseling patients about nutrition and physical activity, as well as prescribing weight loss medications. They also gain experience in coordinating with multidisciplinary members and having continuity with the patients they assess and evaluate throughout the year.

Second Year of Track

The second year of the track expands on the previous clinical experience offered in our program by providing opportunities for the residents to implement a significant educational or research project. Residents also apply the educational concepts taught in the first year by the fellows and act as “teachers” for incoming track members. The goal of expanding on the previous experience by implementing this track is to give the residents the opportunity to utilize the skills learned in the first year of the track to contribute significantly to obesity medicine education and research.

  • Teaching: Residents take part in a “Resident as Teacher” activity, in which they lead one of the didactics for the first-year track members in their respective firm.
  • Academic Project: In the first year of track, track members will identify an educational or research project that they will implement in the second year of their track. Each resident will be assigned an obesity medicine specialist within the Center for Weight Management as a mentor for their project.
  • Reflection: At the end of the track, residents will submit a reflective piece on a specific patient experience and/or their experience in the track as a whole.

We plan to evaluate this track through surveys that residents fill out before and after the track. Surveys will assess their comfort and confidence in the assessment and management of patients with obesity, and their attitudes and beliefs about obesity. The surveys also contain knowledge-based questions about foundational topics within obesity management.

At the beginning and end of the first year in the track, residents will be observed in a clinical encounter. Faculty observers will be scoring residents with an observer checklist that focuses on gathering a comprehensive weight history and performing a dietary and physical activity assessment. This assessment will provide constructive feedback to the residents, as well as information about their progress in the track.

Physicians have the opportunity to play a major role in addressing the obesity epidemic through counseling and managing patients for weight loss and understanding when it is appropriate to refer patients to weight loss programs.4 Despite the importance of these skills, physicians still feel unprepared to treat patients with obesity1 and do not feel as though they have received adequate training in obesity medicine management.2 Educational training along with direct clinical experience is a strategy to mitigate this discrepancy. Therefore, we created this track for residents to feel confident in their ability to evaluate and assess patients with obesity and treat these patients through a multimodal approach. Additionally, the track provides an opportunity for the residents to apply the knowledge gained to contribute significantly to obesity medicine education and research. The goal of this experience is to train residents who will go into their respective specialties with an understanding of the complexity of obesity as a chronic disease and be provided with the appropriate tools to better manage it.

References

  1. Butsch WS, Kushner RF, Alford S, et al. Low priority of obesity education leads to lack of medical students’ preparedness to effectively treat patients with obesity: Results from the U.S. medical school obesity education curriculum benchmark study. BMC Med Educ. 2020;20(1):23. Published January 28, 2020.

  2. Bleich SN, Bennett WL, Gudzune KA, et al. National survey of US primary care physicians’ perspectives about causes of obesity and solutions to improve care. BMJ Open. 2012;2(6):e001871. Published December 20, 2012.

  3. Kushner R. Taking a weight history–Using mnemonics to learn a missing skill in medical education. MedEdPublish. 2017; 6(4):46.

  4. Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res. 2003;11(10):1168-1177.

  5. Wilechansky R, Burgermaster M, Jones D, et al. Obesity, diet, and exercise education for the primary care clerkship using an articulate storyline 2 e-learning module. MedEdPORTAL. 2016;12:10497. Published November 10, 2016.


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