VCOM Carolinas Research Day 2023

Educational Reports

Evaluation of Medical Student’s Confidence To Provide Patient -Centered Nutrition Interventions Gabriel Ward OMS- III; Eli Hopkins OMS-III; Alyssa DeMutis OMS-III; Merwan Faraj OMS-IV; Annie Nguyen, OMS-IV; JuliSu DiMucci-Ward, PhD, MPH, RDN, CDE, LD; Amber Stroupe, DO Edward Via College of Osteopathic Medicine – Carolinas Campus Abstract Results Conclusions Abstract # EDUC-2

Context: Non-communicable diseases (NCDs) have significant health and economic costs nationally across all age groups. Chronic diseases are complex and best treated with a multifaceted approach that must include diet and lifestyle education. An abundance of research indicates when physicians lack confidence in their ability to address diet and lifestyle education in a timely manner, they may fail to address it at all. Medical schools are incorporating more nutrition education in their curriculum; however, students need to learn the practical application for their patient care plans. The goal of the Food and Nutrition as Medicine (FANAM) course was to enhance preclinical students’ teaching skills at the patient -clinician interface. The core elements of interviewing, culinary skills, and heritage diet awareness are key. The purpose of this QI/QA study was to determine if students with preclinical training in practical evidenced-based nutrition and culinary skills have increased confidence applying the tenets of osteopathy to individualize nutrition care plans addressing NCDs for patients with multiple diverse heritages. Objective: Appraise student knowledge of course objectives and their confidence implementing evidence-based nutrition recommendations before and after completing the FANAM course. Methods: Non-randomly selected students (N=54) were enrolled in this course over 2 years and completed 7 apprenticeship modules, each incorporating application of clinical knowledge and hands on learning. This QI/QA study specifically addressed student knowledge of course objectives and their confidence implementing evidence-based nutrition recommendations before and after completing the FANAM course. 5-point Likert surveys were utilized with pre- and post-course evaluations to assess the overall course. Additionally, in the first year, pre- and post-module surveys were used to develop the curriculum. Results: Qualitative assessments showed that all students believed further education on nutrition the standard curriculum was necessary. Quantitative assessment of the surveys showed between the 2 years that the course was offered, student confidence in providing effective nutritional and lifestyle modification counseling increased by 58.8%. Students in the second year reported on average 4% higher satisfaction with each module's delivery of the set objectives. Conclusion: Over the 2 first classes, students have reported increased confidence addressing nutrition and lifestyle habits when forming integrative patient care plans. Given our results core, we will enhance the core topic areas with more practical real-life scenarios requiring proficiency in culinary skills, communication, patient readiness, counseling, food scarcity, and community resources. Future research needs to determine the net amount of objective knowledge gain and retention in future practice. worked in 9 small groups. Students applied to participate in the course and were selected by a committee. Inclusion criteria were a strong interest in utilizing the osteopathic tenets to gain both physical and communication skills to adequately teach patients about personalized nutrition. FANAM was implemented, and the QI/QA surveys evaluated the effectiveness of the student doctor’s training. The QI/QA surveys rated students’ level of understanding/confidence with a Likert scale from 1 through 5. 1 “minor understanding,” 2 a little bit, 3 “competent,” 4 a foundation, 5 “expert level.” Likert scale items were strongly recommended in literature to capture qualitative concepts including confidence, competency, and satisfaction [10]. In the 2 academic years, the pre- and post-course evaluations were used to assess the overall course by calculating a mean score for all students. An evaluation of each individual module was utilized in both academic years; however, in the first year pre- and post- module surveys were used to develop the curriculum. In the second year, only post-module surveys were used to refine individual module objectives in future years. The class mean score was calculated from student responses respective of each category. The same method was used to analyze the collective confidence of the students pre- and post-course. The osteopathic significance of an apprenticeship approach to NCDs prevention trains clinicians to initiate patient education and to collaborate with community support systems. Methods This Quality Improvement/Quality Assessment (QI/QA) addressed student knowledge of course objectives and their confidence implementing evidence-based nutrition recommendations before and after completing the FANAM course. 54 non-randomly selected students were enrolled in the course, 20 students in the first year, who worked in 6 small groups, and 34 students in the second year, who

Non-randomly selected students (N=54) were enrolled in this course over 2 years. These students applied to participate and were selected by a committee. Qualitative assessments showed that all students believed further education on nutrition beyond the standard curriculum was necessary. Quantitative assessment of the surveys showed between the 2 years that the course was offered, student confidence in providing effective nutritional and lifestyle modification counseling increased by 58.8%, demonstrating the value of additional medical nutritional therapy education compared to the standard curriculum. The response rate of the post-course survey for the second year of the course was 94.1%, above the national average of 44.1% [11] for survey completion. Furthermore, students in the second year reported on average 4% higher satisfaction with each module's delivery of the set objectives when compared to the first-year results, indicating success in fine tuning of each module’s content between the first and second years the course was offered.

FANAM's goal was to bring practical real-life scenarios requiring proficiency in culinary skills, communication, patient readiness, counseling, food scarcity, and community resources. The 2 classes have reported increased confidence in addressing nutrition and lifestyle habits when forming integrative patient care plans. A recurring theme of the modules was a concise didactic portion leaving more time to cook and interact with the guest speakers or practice communication exercises. Using that feedback, we plan to expand the hands-on portion of our class and have our guest speakers emphasize real-world scenarios throughout a given module. Future classes will take a pre- and post-assessment covering the core topic areas: nutrition, mindfulness, lifestyle choices, medicine, and patient care plans to obtain an objective measure of knowledge change. A limitation of this study was survey participation rate. We had a 77-100% response rate that would fluctuate per month, as a result of varying academic demands and the fluctuations of the COVID-19 pandemic. On a positive note, the survey participation rate we obtained was greater than “the average response rate of 44.1 percent” [11]. A second limitation was selection bias as the study participants were already interested in nutrition and more likely to implement nutrition in future patient care. Lastly, recall bias may have occurred with the surveys, as participants submitted their post-module survey from the night of the module up to several weeks later, thus, the recollection rating could be altered. To account for these biases, the pre-survey could be given to all medical students to gather a baseline and post-survey could only be accepted the last night of the course. Long term research needs to determine the amount of knowledge that will be carried into their future practices.

References

Table 1. Comparison of confidence ratings before and after each class

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Table 2. Comparison of

confidence ratings before and after the course

Acknowledgments We would like to express our gratitude to Drs. Tooke-Rawlins and Cannon for their support in the development of this pilot elective. Also, all the professional and clinical staff that provide instruction.

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