In this study, we identified important areas of focus for future curriculum development, implementation, and evaluation. Findings indicate that physicians across three specialties report inadequate obesity counseling skills, and the mean overall competency was low. Astonishingly, 1 in 5 physicians rated themselves as inadequately competent in every item, and almost 60% could not adequately use motivational interviewing to change behavior. These findings indicate a clear need for targeted evidenced-based curricula.
No significant difference in mean competency scores was found between residents and faculty. While this finding could indicate a limitation of our survey to distinguish between training levels, it more likely signifies that faculty education is needed, as number of years out of residency did not correlate to competency. Other studies have shown a general lack of training for both residents and faculty7,5
and that faculty development is a barrier to obesity education.18
Thus, faculty training must be incorporated into the curriculum to ensure its success.
This study validates the 5As model construct, leading to more trustworthy overall discipline-specific data upon which to develop obesity curricula likely to improve patient outcomes. Overall, physicians reported lower mean scores in ‘agree’ and ‘assist’ than for most of the other competencies, which reflects deficiencies in goal-setting and motivational interviewing—both teachable skills.19
Internists had lower competency in ‘arrange’ as compared to other specialties. Specifically, they had low perceived competency in recognizing and referring patients with eating disorders, collaborating with dieticians, and referring to community nutrition resources. These issues can be addressed in a targeted curriculum. IM residents also had lower perceived competency in ‘advise’ than faculty, which may indicate either that residents are less comfortable advising patients or that they have more need for didactic information regarding obesity risk and treatment options. Pediatricians reported higher competency than other specialties in some items (assessing diet, collaborating with dieticians, and referring to community nutrition resources); thus, these areas could be de-emphasized in their curriculum. Interestingly, pediatric faculty reported a lower percentage of obese patients losing weight than the other specialties despite the higher level of perceived competency.
Psychiatrists were less competent in ‘assess’ than other specialties. Supporting this finding is that psychiatrists reported significantly fewer obese patients than internists, although obesity is more prevalent in their population.20
Specifically, psychiatrists scored lowest on determining body mass index, ascertaining readiness to change, taking a targeted history and physical exam, and setting weight loss and physical activity goals with patients. These are all useful guides for curriculum development.
There are several limitations to this study. First, we relied on self-report rather than using direct methods (i.e., standardized tests, direct observation, and chart review) to test knowledge, skills, and patient outcomes. While studies have shown that physicians are poor at accurately evaluating their own skills,21
our findings are consistent with studies measuring physician performance.4,22,23
Second, the physicians surveyed were from one institution which may limit the generalizability of our findings. Counter to that is the fact that study participants practice in a variety of different public and private practice settings across three different specialties. Further, only 15% of NYU residents are graduates of NYUSoM, suggesting that obesity training is insufficient at other institutions as well.