To our knowledge, this is the first study to examine comfort, frequency, prior education, and effectiveness of diabetic dietary counseling in a sample of IM residents. When comparing dietary counseling with other aspects of diabetes care, comfort with and frequency of dietary counseling were low. Although most residents did not have prior education in this area, those who did were more comfortable with diabetic dietary counseling. While prior education was not significantly associated with increased counseling frequency, comfort and perceived effectiveness with diabetic dietary counseling were associated with more frequent diabetic dietary counseling. The low levels of comfort with and frequency of diabetic dietary counseling in this study are consistent with the rates of general dietary counseling in other studies of physicians and residents6,8–11
Dietary counseling is an important component of counseling for many chronic diseases, particularly diabetes12
. However, less than a third of residents reported prior education in chronic disease counseling. Efforts to improve resident dietary counseling will need to integrate dietary counseling training into residency curricula.
It is important to understand why prior education was not associated with increased frequency of diabetic dietary counseling. Although lack of time or appropriate resources11,13,14
may be causes, another explanation may be that educational efforts have not addressed physicians’ low perceived effectiveness with dietary counseling. To reform these perceptions, it is important to educate physicians that physician advice can prompt patients to improve their diet15–17
. Beyond standard nutritional education, residents also need tangible skills that translate directly to the clinical setting and a forum in which to practice their skills to boost their confidence in delivering dietary counseling. Further studies to evaluate the effects of such educational interventions on comfort and frequency of counseling are also needed.
There are limitations to this study. First, this study sample draws from IM residents at a single institutional site and may not be generalizable to all residents. Second, we used self-reported counseling frequency. Given that physicians often overestimate the frequency of preventive service delivery18,19
, it is likely that counseling rates are even lower than reported. Third, because prior education was not strictly defined, residents may have interpreted it differently. Lastly, the impact of prior education on comfort level was observational, which prohibits causal inferences.
In summary, comfort with and frequency of diabetic dietary counseling remain low among IM residents. The majority of residents do not receive education in chronic disease counseling. However, more frequent diabetic dietary counseling was noted among residents who reported greater comfort or effectiveness with dietary counseling. Given these results, IM residency programs may wish to modify their curricula to include dietary counseling. Successful curricula should place emphasis on both knowledge and boosting physicians’ low perceived effectiveness.