Teaching medical students to help patients manage their weight, quit smoking

UMMS testing curriculum to ensure future doctors address major health threats

By Sandra Gray

UMass Medical School Communications

December 17, 2015
  Judith K. Ockene, PhD, MEd, MA
  Judith K. Ockene, PhD, MEd, MA

Losing weight and quitting tobacco are two of the best ways to improve health. But ask Americans if their primary care providers have discussed either topic with them, and most will likely say no.

“More than two-thirds of adults are currently overweight or obese, putting them at increased risk for diabetes, heart and vascular disease, and cancer,” said Judith K. Ockene, PhD, MEd, MA. “Providing physicians-in-training with the skills needed to help patients who are overweight or obese manage their weight is a critical step in addressing this growing clinical and public health epidemic.”

With a new five-year, $4 million grant from the National Cancer Institute, Dr. Ockene, the Barbara Helen Smith Chair in Preventive and Behavioral Medicine, professor of medicine and chief of the Division of Preventive and Behavioral Medicine, and co-principal investigator Rashelle Hayes, PhD, along with colleagues at UMass Medical School, will conduct a randomized controlled trial with 10 medical schools to compare the effectiveness of an enhanced curriculum, called MSWeight, to traditional education for weight management counseling skills.

“It is recommended by the U.S. Preventive Services Task Force and the American Association of Medical Colleges, among other organizations, that physicians intervene and provide weight management counseling to obese or overweight patients, but they report limited skill training to do so,” said Ockene.

Medical schools currently offer few opportunities for students to learn about weight management counseling. 

“In response to this gap, we developed a comprehensive, integrated, and competency-based curriculum called MSWeight (Medical Students Learning Weight Management Counseling Skills). It is designed to help medical students develop weight management counseling skills,” said Dr. Hayes, assistant professor of medicine. “Using learning theories, the enhanced medical education for weight management places an emphasis on continuous hands-on practice and varied learning opportunities.”

Starting in the first year and continuing into the third year, MSWeight will include a web-based curriculum with faculty-led discussions; interactive counseling practice sessions online and in the classroom; a school study Facebook page; and an enhanced family medicine or internal medicine clerkship where preceptors also will learn to use weight management counseling skills in order to model, observe, and further train the medical students. MSWeight will  address sensitive topics that make talking about weight difficult, including co-morbid psychological challenges such as depression, and obesity bias, which is an inclination for health care providers to form unreasonable judgments based on a person’s weight.  

“Our goal is to not only enhance weight management counseling skills, but also increase obesity treatment knowledge and improve attitudes on the importance and potential ease of helping patients manage their weight,” said Hayes.

Refined with extensive input from patients and medical students, the MSWeight curriculum and pilot is based on the success of Ockene and Hayes’ MSQuit study testing methods for teaching medical students how to address tobacco cessation with patients. Also funded by the National Cancer Institute, MSQuit was conducted at most of the same 10 medical schools, which will be the sites for MSWeight. Published online by the Journal of General Internal Medicine,Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial”found that students who had enhanced training reported greater confidence in their ability to counsel patients about tobacco dependence behaviors compared to students who received traditional education.

Ockene noted that MSWeight and MSQuit reflect developmental work conducted over three decades regarding how to counsel patients to make health behavior changes..  

“Opportunities to use patient-centered counseling and to elicit the patient’s specific values by asking the right questions can help the clinician motivate the patient to make that important health change,” Hayes added. “Once the patient is ready to make a change, taking the time to work with the patient to address barriers to change is important. Often this will include a conversation to refer some patients to other health professional experts such as a nutritionist, behavioral health clinician, or psychologist.”

“We thought smoking was hard, but weight management may be harder,” said Ockene. “We’re excited to tackle the challenge of this major health issue.”

Related links on UMassMedNow:
New guidelines established to help primary care physicians treat obese patients
Judith Ockene named Distinguished Scientist by Society of Behavioral Medicine
Division of Preventive and Behavioral Medicine marks 30 years of preventing disease, improving health
Clinicians urged to help patients improve diet, exercise and healthy behaviors: Ockene plays key role in new advisory from American Heart Association
Drs. Glew, Grisso, Irwin and Ockene receive 2013 Chancellor’s Medals for distinction

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