"At the End of the Day it's Their choice": An Exploratory Qualitative Study of Pregnancy Options Counseling.

This study's purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.

Creation and beta testing of a "choose your own adventure" digital simulation to reinforce motivational interviewing skills in genetic counseling.

Standardized patients and/or role-playing are commonly used for practicing genetic counseling (GC) skills. Use of digital simulation, incorporating gamification elements, would require fewer resources to sustain than standardized patients. This manuscript reports steps taken and the lessons learned from creating a digital "Choose your own adventure" simulation in which students select preferred dialog for a genetic counselor who is seeing an adult patient to discuss genetic testing for the known pathogenic variant that caused familial adenomatous polyposis (FAP) in their father. The case has three endings, one of which is attained by selecting options that are mostly consistent with motivational interviewing counseling techniques. We conducted a preliminary evaluation of our beta version among nine GC students and one educator using a survey to assess acceptability and appropriateness as well as to elicit open-ended feedback. All participants agreed or strongly agreed with statements indicating the case was acceptable, appropriate, and fun. Users particularly appreciated the immediate feedback given throughout the case simulation. Many users wanted more options to select from and listed various other recommendations, including several which would require substantial resources to implement.

Virtual counselling of tobacco cessation during the COVID-19 pandemic: A qualitative study on the experiences and perceptions of Malaysian dental undergraduates and their patients.

INTRODUCTION: When dental institutions had to close down during the Movement Control Order (MCO) implementation due to the COVID-19 pandemic, dental students were faced with delays in completing their tobacco cessation schedule. An alternative was to allow students to conduct virtual counselling (VC) for smoking cessation for their patients to address their clinical requirements. This study aimed to explore Malaysian dental undergraduates' and patients' experiences undergoing smoking cessation counselling through virtual platforms. MATERIALS AND METHODS: The study consisted of qualitative, semi-structured Focus Group Discussions (for students, n = 23) and in-depth interviews (for patients, n = 9); to phenomenologically describe the perceptions of participants involved in the VC. Each session was recorded with the participants' permission. The recorded session was transcribed verbatim and thematically analysed using the qualitative data analysis software, NVivo™. RESULTS: The major themes that emerged were: (1) General opinions and experiences, (2) Content of VCs, (3) Remote access to counselling, (4) Patient-clinician relationships, (5) Technical issues, (6) Changes after VCs, and (7) Future application. Most students and patients were quite comfortable with VC as it is convenient, allowing students to be creative and avoid the hassle of transport and traffic. However, some of the students felt that it lacked the personal touch and guidance from lecturers who would normally be present during physical class. CONCLUSION: Virtual counselling enables remote access to counselling, but it is also subjected to some limitations, especially regarding lack of clinical assessments, human touch and internet issues. Though participants were optimistic about adapting it in the future, multiple factors must be considered. Ultimately, the behavioural change will depend on the patient's motivation in making a difference.

Group meditation, addressing stigma, and "mental health days": Recommendations for integrating self-awareness practices into genetic counseling graduate programs.

Genetic counseling graduate programs provide a rigorous curriculum comprised of coursework encompassing counseling and medical genetics, fieldwork, and research experience. Students face similar emotional and mental demands as practicing genetic counselors while also experiencing stressors commonly associated with graduate study. Increased self-awareness may help combat these stressors. This mixed-methods study surveyed 154 genetic counseling graduate students to determine the types of self-awareness practices they would like to have included in their graduate training and surveyed 11 program faculty regarding the feasibility of implementing these practices. The students' most preferred practices were self-reflection (n = 73, 47.4%), support from peers, colleagues, and/or supervisors (n = 71, 46.1%), and mental health counseling (n = 71, 46.1%). Analysis of responses to open-ended questions capturing students' recommendations for programs yielded six recurrent themes: (1) Consistent, Structured Practice with Accountability, (2) Emphasis on Mental Health, (3) Practical Techniques, (4) Access to Resources, (5) Encouragement and Support, and (6) Barriers to Implementation. Many students suggested that programs should incorporate repetitive exercises that could be implemented on a schedule with an emphasis on consistency (Theme 1). Students also emphasized the importance of providing exposure to multiple examples of self-awareness practices, so they could find an approach that was most beneficial on an individual basis (Theme 3). These findings were shared with program faculty via a presentation at the Association for Genetic Counseling Program Directors annual meeting, and attendees were subsequently surveyed regarding self-awareness practices currently integrated into their curriculum, as well as the feasibility and likelihood of integrating new practices. Program faculty respondents indicated that most of the recommended practices were included in their curriculum already or would be feasible and likely to incorporate. These results provide insight into the attitudes of genetic counseling students toward structured practice in self-awareness and how genetic counseling graduate programs might integrate such practices into the curriculum.

Creation and initial validation of a genetic counseling supervisory self-efficacy scale.

Fieldwork supervision is the "signature pedagogy" for training genetic counseling students, ensuring that students have the experience necessary to become minimally competent genetic counselors. According to the National Society of Genetic Counselors 2022 Professional Status Survey, roughly 40% of genetic counselors serve as supervisors for genetic counseling graduate students. Despite fieldwork supervision being essential for training, there are currently no validated supervision skill assessment tools for genetic counseling fieldwork supervisors to use for professional development. While a self-efficacy scale for genetic counselors currently exists, a comprehensive self-efficacy scale for genetic counseling supervision skills does not. The purpose of the study was to develop and validate a genetic counseling supervisory self-efficacy scale (GCSSES). This study was comparative, quantitative, and cross-sectional, with data collected via an online questionnaire which assessed supervision self-efficacy (95 items), derived from 154 published GC supervision competencies, demographics (5), experience (9), and supervisory development (18), using the Psychotherapy Supervisory Development Scale (PSDS). A total of 119 board-certified genetic counselors completed the survey. Factor analysis eliminated 40 items due to insufficient factor loading, and item-item correlation eliminated one item with elevated inter-item correlation, leaving 54 items on the finalized GCSSES. Exploratory factor analysis derived four GCSSES factors, which accounted for 65% of the variance in the scale: (a) Goal Setting, Feedback, and Evaluation; (b) Complex Aspects of Supervision; (c) Conflict Resolution; and (d) Working Alliance. Preliminary analyses show the GCSSES has high reliability and internal consistency (Cronbach's alpha = 0.99). Positive correlations between experience variables and supervisory self-efficacy were identified. A 54 item GCSSES was developed by this study. The GCSSES may serve as a tool for genetic counseling supervisors and graduate programs to assess skills, monitor professional development, and target training. A genetic counseling supervisory self-efficacy scale can also be used in future studies regarding training of genetic counseling supervisors.

Connecting improvisational exercises and pharmacy communication skills: A how-to guide.

BACKGROUND AND PURPOSE: Medical improvisation (improv) is increasingly being used to teach physicians, nurses, and other caregivers how to better communicate with patients and other members of the healthcare team. This article describes how improvisational activities were incorporated within an existing pharmacy practice lab course and how to implement improv games targeting specific communication skills. EDUCATIONAL ACTIVITY AND SETTING: Three hours of improvisational activities were incorporated into a semester-long pharmacy practice lab course. Partner games such as "the mirror" and group games such as "out-of-order story" were played and connected to communication skills related to counseling or taking a patient's history. Additional activities were introduced targeting specific areas of weakness identified in a formative assessment. FINDINGS: A survey was used to assess student perceptions of the improv activities. Students were largely able to connect the skills learned in improv to pharmacy, and some provided examples of how they were already implementing these skills in practice. SUMMARY: This article provides a user manual so that faculty with little to no improv experience can include these activities in their communications courses.

"There's no real roadmap that I know of": Experiences of transgender and nonbinary graduate students in counseling psychology programs.

Minimal research has examined the experiences of transgender and nonbinary (TNB) people in graduate school with no studies to date examining the experiences of TNB students in psychology graduate programs. The purpose of this study was to utilize a critical-ideological paradigm to identify recruitment, retention, and attrition factors for TNB people in counseling psychology (CP) programs with the aim of providing specific recommendations to CP programs. Individual interviews (between 35 and 70 min) were conducted with a sample of 16 TNB graduate students, aged 23-37-years old (M = 26.9, SD = 3.84), in masters (n = 6) and doctoral (n = 10) CP programs. Participants were nonbinary (n = 13) and trans men (n = 3), the majority were White (n = 10), and all were sexual minorities. Participants were recruited online through email listservs and on social media posts on Facebook and Twitter. Reflexive thematic analysis revealed themes related to challenges experienced in CP programs (systemic/structural challenges, interpersonal challenges, individual/internal challenges) and strengths of or recommendations for CP programs (transaffirming resources/policies, supporting TNB competence and expertise, being a TNB accomplice). Several unique subthemes emerged across the seven themes. Findings may be applied by CP programs to more effectively recruit and retain TNB people, and collectively contribute to an increasing number of TNB people within this field. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexuality training in counseling psychology: A mixed-methods study of student perspectives.

Counseling psychologists are a cogent fit to lead the movement toward a sex-positive professional psychology (Burnes et al., 2017a). Though centralizing training in human sexuality (HS; Mollen & Abbott, 2021) and sexual and reproductive health (Grzanka & Frantell, 2017) is congruent with counseling psychologists' values, training programs rarely require or integrate comprehensive sexuality training for their students (Mollen et al., 2020). We employed a critical mixed-methods design in the interest of centering the missing voices of doctoral-level graduate students in counseling psychology in the discussion of the importance of human sexuality competence for counseling psychologists. Using focus groups to ascertain students' perspectives on their human sexuality training (HST) in counseling psychology, responses yielded five themes: (a) HST is integral to counseling psychology training, (b) few opportunities to gain human sexuality competence, (c) inconsistent training and self-directed learning, (d) varying levels of human sexuality comfort and competence, and (e) desire for integration of HST. Survey responses suggested students were trained on the vast majority of human sexuality topics at low levels, consistent with prior studies surveying training directors in counseling psychology and at internship training sites (Abbott et al., 2021; Mollen et al., 2020). Taken together, results suggested students see HST as aligned with the social justice emphasis in counseling psychology but found their current training was inconsistent, incidental rather than intentional, and lacked depth. Recommendations, contextualized within counseling psychology values, are offered to increase opportunities for and strengthen HST in counseling psychology training programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Q Methodology Investigation of School Counselors' Beliefs and Feelings in Reporting Suspected Child Sexual Abuse.

School counselors can be influenced by a wide variety of beliefs and emotions when reporting suspected child sexual abuse (CSA) including worry, fear, sadness, depression, helplessness, anger, and distrust of child protective services. These beliefs and emotions can keep school counselors from reporting suspected CSA despite their duties as mandated reporters. We sought to uncover patterns of school counselors' (N = 85) shared beliefs and emotions that can impact their decision making in reporting suspected CSA. Q methodology allowed us to reveal common profiles of school counselors' viewpoints on reporting CSA to inform school counseling practice and training. Our data analysis revealed two profiles representing distinct patterns of school counselor viewpoints: worry about consequences and knowledge gap. School counselors in the worry about consequences factor felt that the potential negative consequences of their reports for the child and themselves impacted their reporting process. School counselors in the knowledge gap factor believed their lack of knowledge of signs of CSA, school procedures, and school counseling ethical codes influenced their reporting of CSA. School counselors should reflect on their beliefs and emotions that may prevent reporting, communicate and collaborate with child protective services, and seek support and mentorship as necessary.

Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations.

Genetic counselors (GCs) have traditionally been trained to adopt a position of equipoise or clinical neutrality. They provide information, answer questions, address barriers, and engage in shared decision-making, but generally, they do not prescribe a genetic test. Historically, GCs have generally been trained not to persuade the ambivalent or resistant patient. More recently, however, there has been discussion regarding when a greater degree of persuasion or directionality may be appropriate within genetic counseling (GC) and what role MI may play in this process. The role for "persuasive GC" is based on the premise that some genetic tests provide actionable information that would clearly benefit patients and families by impacting treatment or surveillance. For other tests, the benefits are less clear as they do not directly impact patient care or the benefits may be more subjective in nature, driven by patient values or psychological needs. For the former, we propose that GCs may adopt a more persuasive clinical approach while for the latter, a more traditional equipoise stance may be more appropriate. We suggest that motivational interviewing (MI) could serve as a unifying counseling model that allows GCs to handle both persuasive and equipoise encounters. For clearly beneficial tests, while directional, the MI encounter can still be non-directive, autonomy-supportive, and patient-centered. MI can also be adapted for equipoise situations, for example, placing less emphasis on eliciting and strengthening change talk as that is more a behavior change strategy than a shared decision-making strategy. The core principles and strategies of MI, such as autonomy support, evocation, open questions, reflective listening, and affirmation would apply to both persuasive and equipoise encounters. Key issues that merit discussion include how best to train GCs both during their initial and post-graduate education.

Only Human: Mental-Health Difficulties Among Clinical, Counseling, and School Psychology Faculty and Trainees.

How common are mental-health difficulties among applied psychologists? This question is paradoxically neglected, perhaps because disclosure and discussion of these experiences remain taboo within the field. This study documented high rates of mental-health difficulties (both diagnosed and undiagnosed) among faculty, graduate students, and others affiliated with accredited doctoral and internship programs in clinical, counseling, and school psychology. More than 80% of respondents (n = 1,395 of 1,692) reported a lifetime history mental-health difficulties, and nearly half (48%) reported a diagnosed mental disorder. Among those with diagnosed and undiagnosed mental-health difficulties, the most common reported concerns were depression, generalized anxiety disorder, and suicidal thoughts or behaviors. Participants who reported diagnosed mental disorders endorsed, on average, more specific mental-health difficulties and were more likely to report current difficulties than were undiagnosed participants. Graduate students were more likely to endorse both diagnosed and undiagnosed mental-health difficulties than were faculty, and they were more likely to report ongoing difficulties. Overall, rates of mental disorders within clinical, counseling, and school-psychology faculty and trainees were similar to or greater than those observed in the general population. We discuss the implications of these results and suggest specific directions for future research on this heretofore neglected topic.

Medical student lifestyle counselling for non-communicable disease: impact on students' competence and patients' health behaviors.

BACKGROUND: Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many doctors feel unskilled and medical schools lack its inclusion in their curricula. The impact of a novel elective lifestyle course is described, where students provided 3 months' coaching to at-risk patients. METHODS: Students' attitudes, competence and lifestyle were assessed pre- and post the 18-month course. Patients' health measures and behaviors were measured. Student and patient views were ascertained. RESULTS: Nineteen students, 13 controls, and 29 patients participated. Perception of physicians' importance as lifestyle consultants increased in coaching students (mean ± SD 3.7 ± 0.4 vs. 3.2 ± 0.5; p = 0.05). Self-perceived competence remained high in coaching students (6.7 ± 1.8 vs. 6.7 ± 1.2; p = 0.66). Controls' competence increased but did not attain coaching students' levels (3.6 ± 2.1 vs. 5.5 ± 1.9; p = 0.009). Focus groups of students confirmed self-perceived acquisition of skills. More patients exercised (38% vs. 82.7%; p = 0.001); spent more time in physical activity (median mins/week + IQR) 25 + [0.180] vs. 120 + [45,300]; p = 0.039), and avoided less desirable foods, such as unhealthy snacks, sweets and drinks. LDL cholesterol showed declining trend. Patients highlighted students' empathy and attentiveness; satisfaction was extremely high. CONCLUSIONS: The course successfully enhanced students' counselling skills, with beneficial effects for patients. This model for teaching experience-based lifestyle medicine has potential policy implications in terms of promoting effective lifestyle counselling by future physicians.

Teaching brief motivational interviewing to medical students using a pedagogical framework.

OBJECTIVE: Medical schools are charged with assisting medical students to acquire the confidence, knowledge and skills for behavior change conversations in primary healthcare. The present study evaluated teaching brief motivational interviewing (MI) to pre-clinical medical students. METHODS: Forty-six students participated in an educational intervention premised on the Learn, See, Practice, Prove, Do, Maintain pedagogical framework, comprising 2 × 2-h lectures, a 2-h role-play triad session, and 3 × 2-h small group simulated patient encounters supported by scaffolding strategies. Measures of brief MI knowledge (MI Knowledge and Attitudes Test & Multiple-Choice Knowledge Test) and confidence (MI Confidence Scale) were taken at baseline, post-training, and 3-month follow-up, and skills (Behavior Change Counseling Index) were assessed at three intervals during simulated patient encounters. RESULTS: Students who received brief MI training improved in knowledge and confidence from baseline to post-training and gains remained at 3-months. Brief MI skills improved across the simulation sessions. CONCLUSION: Pre-clinical medical students can attain knowledge, confidence and skills in brief MI after participation in a short intervention and improvements are sustainable. PRACTICE IMPLICATIONS: Our results support the use of an evidence-based pedagogical framework for teaching brief MI in pre-clinical years of medical curricula and our scaffolding strategy affords promise.

Nutrition education incorporation into mainstream primary school curriculum in Ghana: Stakeholders' sources of nutrition information and perceived barriers.

INTRODUCTION: Nutrition literacy has been cited as a crucial life skill. Nutrition education as a primary school subject has been treated inconsequentially when compared to other subjects. We investigated an aspect of the current state of nutrition education in Ghana by engaging stakeholders about their sources of nutrition information and the perceived barriers in implementing nutrition education in mainstream primary schools. METHODS: Three hundred and fifty one (351) primary school children, 121 homebased caregivers, six schoolteachers, two headteachers, two Ghana Education Service (GES) officials, and six school cooks were involved in the study. Surveys were used to collect data on nutrition information acquisition behaviors and to record perceived barriers. Key Informant Interviews were conducted among GES officials, headteachers, schoolteachers and school cooks, while Focus Group Discussions were used among homebased caregivers and children to gather qualitative information. RESULTS: Only 36.3% of the primary school children had heard about nutrition, and 71% of those got nutrition information from their family members. About 70% of homebased caregivers had heard or seen nutrition messages, and their source of nutrition information was predominantly traditional media. Schoolteachers mostly received their nutrition information from non-governmental organizations and the Internet, while most of the school cooks stated their main source of nutrition information was hospital visits. Perceived barriers included schoolteachers' knowledge insufficiency, and lack of resources to adequately deliver nutrition education. Lack of a clear policy appeared to be an additional barrier. CONCLUSION: The barriers to the implementation of nutrition education in the mainstream curriculum at the primary school level that were identified in this study can be resolved by: providing schoolteachers with learning opportunities and adequate nutrition education resources for practical delivery, having specific national policy framework, and including family members and school cooks in the nutrition education knowledge and information dissemination process.

Improving Quality of PrEP Counseling for Adolescent Girls and Young Women in Kenya With Standardized Patient Actors: A Dose-Response Analysis.

BACKGROUND: Health care worker (HCW) training using standardized patient actors (SPs) is an evidence-based approach for improving patient-provider interactions. We evaluated whether SP training among HCWs in Western Kenya improved the quality of pre-exposure prophylaxis (PrEP) counseling for adolescent girls and young women (AGYW). METHODS: We conducted a 2-day SP training intervention among HCWs providing PrEP counseling for AGYW. Six trained SPs role played one encounter each with HCWs following scripts depicting common PrEP-seeking scenarios. SPs used checklists to report and discuss domains of adherence to national PrEP guidelines, communication, and interpersonal skills using validated scales after each encounter. HCWs presented to each case in a random order. Overall and domain-specific mean score percentages were compared between the first and subsequent case encounters using generalized linear models, clustering by HCWs. RESULTS: During 564 training cases among 94 HCWs, the overall mean quality of PrEP counseling score was 83.1 (SD: 10.1); scores improved over the course of the 6 encounters (P < 0.001). Compared with the first case encounter, the mean scores for the fourth were significantly higher (79.1 vs. 85.9, P < 0.001). The mean scores plateaued from the fourth to the sixth case (85.2). Although HCWs demonstrated high baseline communication (95.3) and interpersonal skills (83.7), adherence to PrEP guidelines at baseline was suboptimal (57.6). By the fourth case, scores increased significantly (P < 0.001) for all domains. CONCLUSIONS: SP training improved PrEP counseling overall and in domains of interpersonal skills, use of guidelines, and communication with AGYW and could be useful in efforts to improve the quality of PrEP counseling for AGYW.

Validation of the Suicide Counseling Skills Inventory.

Background: The self-report measures used in evaluations of the Applied Suicide Intervention Skills Training (ASIST) program have tended not to detect an improvement in a broad range of suicide counseling skills from pre- to posttraining or among trainees with better skills at pretraining. Aims: The purpose of this study was to develop and validate the Suicide Counseling Skills Inventory (SCSI), which included ten brief counselor-client scenarios and three counselor responses to each scenario. Method: Data were collected from several samples to develop and evaluate the SCSI. Trainee scores were subtracted from criterion expert scores to create discrepancy scores. Results: The SCSI detected an improvement in skills from pre- to posttraining across samples, including among trainees with better skills at pretraining. Internal consistency and test-retest reliability were good. Limitations: The results may not generalize across different training models. Conclusion: Trainee scores were more like expert scores at posttraining. The SCSI may be useful in evaluating suicide counseling competency.

Use of Motivational Interviewing Techniques by Student Volunteers to Reduce Substance Use in Coyote Clinic Patients.

INTRODUCTION: Nationally, free clinics report 18.5% of clients have a substance use disorder but few clinics have treatment resources on site. In 2014, 63,000 people in South Dakota needed but did not receive treatment for substance abuse. The Coyote Clinic (CC), a student-run free clinic, focuses on acute problems, making it difficult to manage and follow-up on long-term substance abuse disorders. Motivational interviewing (MI) is a style of counseling that has shown efficacy in producing change in behavior among patients who suffer from substance abuse in just one session. METHODS: A MI instructional session was given to all third-year medical students with a pre- and post-course survey to determine understanding and its application. For 21 weeks in the CC, a survey about substance use and willingness to change behavior was distributed to patients before and after the student interview. Student volunteers also responded to a post-clinic survey about their use of MI during the patient visit. RESULTS: Students showed a 17% increase in confidence in discussing substance use with patients and a 47% increase in confidence in applying MI techniques after the instructional session. At CC, 54.5% of patients reported substance use and 16.7% of those patients responded that they would consider quitting in the next month after the student interview. In the post-clinic survey, students rated an average of 4.21 out of 5 on comfort level in discussing excessive substance use. CONCLUSION: MI training expanded student volunteers' insight into treatment of substance use disorders and increased students' confidence when advising patients about substance abuse. Patients showed more willingness to change substance abuse behaviors after their student interviews. This project helps address substance use in student-run free clinics with limited resources and minimal follow up.

Advanced virtual mentoring of dentists in oral cancer screening and tobacco cessation - An interventional study.

Context: Oral cancer is the third common cancer in India. Its mortality can be reduced through early detection and tobacco cessation ideally by dentists owing to their forte of work. Aim: This study was conducted to discuss effectiveness of an advanced tele-mentoring programme in oral cancer screening and tobacco cessation for dentists across India. Settings and Design: Online, interventional study. Methods and Material: The 14-week long training programme with 52 participants/spokes from across India had weekly hour-long online sessions comprising of an expert-led didactic and case discussions by spokes. Online evaluation (pre- and post-training, post-session), weekly and post-one-year feedback were conducted. Successful spokes attended a hands-on workshop subsequently. Statistical Analysis Used: One and independent sample t-tests determined the significance of the evaluation scores of the participants. Findings on attitudes and practice-related questions are presented as simple percentages. Results: A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was observed. Many participants started these services at their clinics, thereby reducing further referrals, and were also motivated to spread community awareness about the same. Conclusion: This tele-mentoring programme, based on the novel Extension for Community Healthcare Outcomes model, is the first oral cancer screening training programme for dentists. This model-comprising of expert didacts, case discussions, and significant spoke-expert interaction-is a promising best-practices tool for reducing the disparity in knowledge and skills regarding oral cancer prevention among dentists across different locations. This would enable these most appropriate healthcare providers to contribute toward the overall goal of oral cancer prevention.

Impact of an Expansion of a Clinical Nutrition Curriculum on Pre-Clerkship Medical Students' Perception of Their Knowledge and Skills Related to Performing a Nutritional Assessment.

Learning how to provide nutritional counseling to patients should start early in undergraduate medical education to improve the knowledge, comfort, and confidence of physicians. Two nutrition workshops were developed for first-year medical students. The first workshop, co-led by physicians and registered dieticians, focused on obtaining nutrition assessments. The second workshop focused on the appropriate dietary counseling of patients with chronic kidney disease and cardiovascular risk. We surveyed students before workshop 1, after workshop 1, and after workshop 2 to assess their perceptions of the value of physician nutrition knowledge and counseling skills as well as their own comfort in the area of nutritional knowledge, assessment, and counseling. We found a significant improvement in their self-assessed level of knowledge regarding counseling patients, in their comfort in completing a nutritional assessment, and in their confidence in advising a patient about nutrition by the end of the first workshop. By the time of the second workshop five months later, students continued to report a high level of knowledge, comfort, and confidence. The implementation of clinical nutrition workshops with a focus on assessment, management, and counseling was found to be effective in increasing student's self-assessed level of knowledge as well as their confidence and comfort in advising patients on nutrition. Our findings further support the previous assertion that clinical nutrition education can be successfully integrated into the pre-clerkship medical school curriculum.

Effectiveness of a nurse-led, face-to-face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions.

Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self-care. We designed a two-group quasi-experimental time series trial to examine the effectiveness of a nurse-led, face-to-face, individually-tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self-efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse-led individually-tailored HC intervention involving 4-6 face-to-face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p = .006). However, this improvement was not maintained at follow-up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short-term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation.