Alexander H. Buell, BS, Jennifer Rockfeld, MD, Frank H. Netter MD School of Medicine
Lifestyle medicine (LM) is a growing field that aims to address the root cause of chronic disease through lifestyle interventions in the areas of nutrition, physical activity, stress management, and other behavior modification. Much of the discipline's success is dependent upon training new medical professionals in the tenants of lifestyle medicine. At the Frank H. Netter MD School of Medicine, students receive curriculum dedicated to this topic, as well as training in motivational interviewing and behavioral change theory. This study aimed at characterizing students' self-reported knowledge, skills, and attitudes towards LM. We hypothesized that students' knowledge of LM and competence in prescribing lifestyle interventions would increase as they progressed through medical school.
We performed a cross-sectional study to compare students' familiarity with lifestyle medicine, self-reported competence in prescribing exercise and dietary interventions, and their attitudes towards this field across all four years of school. We utilized a survey created by Dr. Mark Fraies, PhD (Texas A&M) for distribution to several medical schools across the country. It was sent electronically to all medical students at the Frank H. Netter MD SOM in January 2018 (n=375). Students were not compensated for their participation in the study. Competence and attitudes were assessed on a 1-6 Likert Scale. The study was approved by the IRB and all responses were anonymous.
There were 82 completed surveys (34.1% M1, 32.9% M2, 12.2% M3, 20.7% M4). Overall, 76% of students reported good or excellent knowledge in the field of LM. There was an incremental increase in competence in LM skills from first year to fourth year (3.17 (M1), 3.45 (M2), 4.00 (M3), 4.37 (M4), p<0.001). Specifically, students' competence in physical examination to clear for an exercise program and determination of max heart rate increased from year one to four (p<0.001.) 96.4% of M1s and 96.3% of M2s were familiar with lifestyle medicine whereas 60% of M3s and 52.3% of M4s were familiar with the field. 93% of students across all four years wanted more curricular time dedicated to lifestyle medicine.
As students progress through medical school, their self-reported competence in exercise and dietary prescription increases. However, it appears that their familiarity with LM decreases. Given that all four classes received the same LM curriculum, this may be due to the lower response rate in the third and fourth year students or the fact that the curriculum takes place in the classroom and may not be re-emphasized in the clinical settings. It is clear that students across all years of medical school want more curricular time dedicated to lifestyle medicine and more research is needed on how best to integrate this content into all four years of their medical training.
ACKNOWLEGEMENTS: Dr. Richard Feinn, PHD for his work on the statistical analysis Dr. Mark Fraies, PHD for the use of his survey
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