| Incorporating performance improvement methods into a needs assessment: experience with a nutrition and exercise curriculum. | |
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MedLine Citation:
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PMID: 20737239 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal. OBJECTIVES: To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs. DESIGN AND PARTICIPANTS: One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents' baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling. MAIN MEASURES: The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported. KEY RESULTS: Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers. CONCLUSIONS: We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness. |
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Authors:
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Shelly-Ann Fluker; Ursula Whalen; Jason Schneider; Paul Cantey; Jada Bussey-Jones; Donald Brady; Joyce P Doyle |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of general internal medicine Volume: 25 Suppl 4 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-25 Completed Date: 2011-06-02 Revised Date: 2011-09-13 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: S627-33 Citation Subset: IM |
Affiliation:
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Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. shelly-ann.fluker@emory.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Competence Curriculum* Diet Directive Counseling Education, Medical, Graduate / methods Exercise* Feasibility Studies Health Knowledge, Attitudes, Practice Humans Internal Medicine / education* Motor Activity Needs Assessment* Nutrition Assessment Nutritional Status* Quality Improvement* Questionnaires |
| Comments/Corrections | |
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