Focusing on the 80 percent: Medical training to achieve competency in lifestyle counseling

Focusing on the 80 Percent: Medical Training to Achieve Competency in Lifestyle Counseling

According to the World Health Organization, an estimated 80 percent of all noncommunicable diseases could be prevented if just four lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation. Despite this, recent studies indicate that physicians conduct lifestyle counseling interventions in only 34 percent of all clinic visits, and the rate of counseling has decreased 10 percent between 1996-97 and 2007-08. 

“Improved population health is vital for society as well as for viable health care systems. Providers are uniquely positioned to encourage patients to adopt healthy lifestyle behaviors, but there is a significant gap between the need for effective lifestyle counseling and provider time and competency in behavior change,” said Patrick McBride, MD, MPH, professor, Cardiovascular Medicine.

The American Heart Association (AHA) recognizes the potential that lifestyle counseling holds to help reach the organization's 2020 goals1 for cardiovascular health promotion and disease reduction. The statement provides guidance in defining fundamentals in medical education and training needed for future physicians to be proficient in lifestyle medicine, focusing on nutrition, exercise and physical activity, and tobacco use, as well as behavioral sciences principles that underpin effective lifestyle counseling. Dr. McBride was a member of the writing committee.

In 2010, the AHA identified seven health metrics for cardiovascular health that reduce deaths from cardiovascular disease and stroke: nonsmoking, healthy weight, healthy diet, regular physical activity, and healthy levels of blood pressure, cholesterol, and glucose. Only 13 percent of US adults meet 5 of the criteria, and a mere 5 percent meet 6 of the criteria. 

And yet, progress in making curricular changes in US medical schools to support development of lifestyle counseling skills has been slow. The percentage of schools requiring a dedicated nutrition course dropped from 35 percent in 2000 to 18 percent in 2012. A survey of 72 schools indicated that only 6 percent of medical curricula had a core component or mandatory course that addressed exercise prescription. And a 2006-07 survey of medical schools indicated that the time allotment for prevention or health maintenance topics in the curricula averaged 23 hours of instruction over 4 years.

The position statement provides actionable recommendations for improvements in medical school, postgraduate, and continuing medical education. Behavioral and social sciences concepts are key to effective lifestyle counseling, and authors recommend the 5 A's algorithm for behavior change to encourage patients to adopt healthy behaviors: 

  1. Assess the risk behavior
  2. Advise change
  3. Agree on goals and an action plan via shared decision-making
  4. Assist with treatment
  5. Arrange follow-up

To illustrate the application of this algorithm, the position statement applies it to the areas of nutrition, physical activity, and tobacco use. The statement also provides detailed learning objectives for each topic and recommendations for curricular and pedagogical approaches.

“The writing committee recognizes that change of this magnitude will take time, but it is critical that the medical community not only embrace but lead this effort across the spectrum of medical education. The implications for health are profound. Given the importance of lifestyle, health professional schools must teach about nutrition, physical activity, weight loss, behavior change, healthy communities, and other aspects of healthy living,” said Dr. McBride.

Resources:

1) AHA 2020 goals are, by the year 2020, to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

 

Robyn Perrin, PhD