Major Finding: In July 2009, only 50% of charts at one site had percent BMI calculated. This figure grew to 85% by June 2010.
Data Source: A 1-year pilot study of pediatric and family physician residents at five residency programs testing their knowledge about pediatric obesity.
Disclosures: The Anthem Blue Cross and Blue Shield Foundation funds the Fit for Residents project. Dr. Slusser said she owns stock in Amgen, Bristol-Myers Squibb, Merck, and Novo Nordisk.
DENVER – Pediatric and family physician residents' knowledge about pediatric obesity significantly improved at five residency programs that adopted a new curriculum, a 1-year pilot study has shown.
Resident attitudes about prevention, management, referral, and advocacy improved as well, although the changes were not statistically significant.
The training made a difference clinically. Greater attention to interpretation of body mass index (BMI) measurements, nutrition, and physical activity was noted through periodic chart reviews for participants in the “Fit for Residents” training, Dr. Wendy Slusser said at the meeting.
In July 2009, for example, only 50% of charts at one site had percent BMI calculated. This figure grew to 85% by June 2010. “Luckily, once [residents] really started calculating BMI, they were doing it correctly as well. That was a nice thing to see,” Dr. Slusser said.
The training was a mix of online, didactic, and experiential learning. “They did some teaching to the residents … and then around midstudy, they developed a stamp that they included on their charts that triggered the resident to not only calculate and plot the BMI, but to interpret it,” Dr. Slusser said.
Initially, a panel of expert physicians developed a childhood overweight prevention and management curriculum. Their aim was to better arm future clinicians with the skills necessary to combat obesity in children and adolescents, said Dr. Slusser, a pediatrician and medical director of the UCLA Fit for Healthy Weight program. The Fit for Residents program is a collaboration among the American Academy of Pediatrics, the American Academy of Family Physicians, and the University of California, Los Angeles. The Fit for Residents training adopts a chronic care model and was designed to be similar to a successful AAP breastfeeding residency curriculum, Dr. Slusser said.
Residents completed a baseline survey about their knowledge and attitudes regarding pediatric obesity. Then the residents at the additional training sites received a 2-day, in-person orientation to the curriculum that included training in motivational interviewing and quality improvement. They also participated in group problem solving. UCLA faculty made monthly telephone calls to key residency faculty once a month on an individual basis and once quarterly as a group call.
Dr. Slusser and her colleagues gauged the efficacy of the project by comparing resident responses to surveys before and after the initiative. The investigators also reviewed 20 charts once a month at each of the 10 residency programs to determine changes in clinical practice.
Resident knowledge about pediatric obesity did change significantly at the five residency programs with the new curriculum. In contrast, no significant change was observed at the five comparison sites.
Very few practices documented that physicians asked patients about physical activity, Dr. Slusser said. However, one program with paper charts added a lifestyle log that made residents much more likely to assess physical activity, she added.
A meeting attendee asked about implementation of the curriculum at sites with paper versus electronic medical records (EMRs). Two of the sites had EMRs, Dr. Slusser replied. Improvements in resident knowledge and attitudes did not differ between sites with different record types, but programs with EMRs adopted changes faster and more efficiently than paper-based sites.
The 10 pediatric and family physician residency programs studied were in California. The five primary care residency programs that added the new curriculum were Children's Hospital and Research Center Oakland, Contra Costa Family Practice, White Memorial Pediatrics and Family Medicine, Harbor-UCLA Pediatrics, and Scripps Family Practice.
The next step is to complete data analysis and to refine the curriculum and tools based on the 1-year experience, Dr. Slusser said. “We next hope to engage residency programs at the national level.”
Resident knowledge about pediatric obesity did change significantly at the programs with the new curriculum.
Source DR. SLUSSER