A Canadian survey of medical students and undergraduate deans on the management of patients living with obesity

Abstract

Background: With over 26% of Canadian adults living with obesity, undergraduate medical education (UGME) should prepare medical students to manage this chronic disease. It is currently unknown how the management of patients living with obesity is taught within UGME curricula in Canada. This study (1) examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity, and (2) explored how this topic is taught within UGME curricula in Canada.

Methods: We distributed two online surveys: one to final-year medical students, and another to UGME deans at 9 English-speaking medical schools in Canada. The medical student survey assessed students' knowledge and self-reported competence in managing patients living with obesity. The dean's survey assessed how management of patients living with obesity is taught within the UGME curriculum.

Results: One hundred thirty-three (6.9%) and 180 (9.3%) out of 1936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Mean knowledge score was 10.5 (2.1) out of 18. Students had greatest knowledge about etiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviors and calculating body mass index. Five (56%) out of 9 deans completed the survey. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities.

Conclusions: Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity. Changes to UGME curricula may help address this gap in education.

Keywords: Curriculum; Medical education; Medical student; Obesity; Survey.

Fig. 1

Medical student knowledge of obesity management scores by individual question, grouped by knowledge domain (n = 133). Questions adapted from Obesity Knowledge among Final-Year medical Students in Norway, by Martins and Norsett-Carr (2017) [26]

Fig. 2

Medical student knowledge of obesity management scores averaged by knowledge domain (n = 133). Questions adapted from Obesity Knowledge among Final-Year medical Students in Norway, by Martins and Norsett-Carr (2017) [26]

Fig. 3

Medical Student Self-Assessed Competencies (n = 180). Question begins with “I can…” followed by the stem below. Some stems have been condensed for presentation here. The full survey may be found in Additional file 4. Q1: Use 24-hour recall, food record, or food frequency to obtain diet history; Q2: Determine body mass index (BMI); Q3: Assess diet for unhealthy behaviours associated with obesity; Q4: Ascertain each patient’s readiness and ability to work on weight loss; Q5: Recognize and screen for common psychosocial comorbidities in those with obesity; Q6: Perform targeted history and physical examination to identify common obesity-related comorbidities; Q7: Discuss risks associated with obesity; Q8: Respond to a patient’s questions regarding treatment options; Q9: Assess level of physical activity and provide guidance; Q10: Assist in goal setting related to permanent lifestyle changes; Q11: Prescribe plan for exercise / physical activity; Q12: Use motivational interviewing to change behaviour; Q13: Provide counselling intervention regarding weight loss; Q14: Recognize and refer patients with eating disorders; Q15: Collaborate with and refer to allied health