Assisting primary care teams and patients in a culturally diverse periphery: impact on medical students' future career choices.

BACKGROUND: Medical students can assist in reducing healthcare disparities and promote health equity by engaging with rural communities and gaining insights into their unique healthcare needs. A two-arm student-delivered program was designed and implemented during COVID-19 in a social-geographic peripheral area to assist clinics with complex chronic and/or socially disadvantaged patients and improve preventive behavior in townships through home visits delivering community kits. METHODS: We conducted a pre-post design study which included weekly structured medical student reports and monthly structured telephone interviews with clinic directors and municipal partners. Students completed pre-post program survey on their knowledge, skills, and capabilities to address chronic patients from diverse cultural backgrounds (n = 73). The Wilcoxon-Signed-Rank test for related samples was used to determine differences. RESULTS: Following the program, the knowledge and awareness levels of students about working in the community (P < 0.001) and their knowledge of common chronic diseases were significantly improved (Mean Difference (MD) = 0.31; p < 0.001). The program significantly increased students' interest to integrate into community care alongside a hospital (P = 0.012). Thematic analysis of student reports revealed improved insight into the role of primary care. Clinic directors (90%) were highly satisfied and reported that students became an integral part of the clinics' teams. CONCLUSIONS: Integrating medical students into the community through primary-care clinics and home visits in diverse communities, exposed students to the interwoven effect of clinical and social determinants on health and improve their knowledge of common chronic diseases. Participation in the program encouraged students to consider a career in community care.

Mapping lifestyle medicine in undergraduate medical education: a lever for enhancing the curriculum.

BACKGROUND: In 2017, the Bipartisan Policy Center called for inclusion of lifestyle medicine (LM) in undergraduate medical education. Recognizing the requirement that lifestyle medicine should be an integral and integrated part of the curriculum, we undertook an in-depth mapping process to determine the extent of LM teaching at our Faculty, staff perceptions and the impact on medical students. METHODS: The study utilized mixed methodology. In Phase 1 (Mapping) structured analysis of course syllabi were conducted followed by observation of teaching sessions throughout the pre-clinical and clinical years, recording content, the degree of coverage, and time allocated to LM Medicine. In Phase 2 (Impact and perceptions), students' attitudes and confidence in LM counselling were ascertained by questionnaire (scale 1-4) on completion of second and fourth year of studies. Interviews were conducted with course coordinators. RESULTS: Phase 1: Students received 58 hours of LM teaching, 49 hours pre-clinical and 9 clinical; 42 hours were dedicated to theoretical knowledge and 16 hours to teaching practical skills related to lifestyle behavior change. Nutrition received the most attention (18 hours), alcohol, sleep, smoking and sexuality the least. On completion of the internal medicine rotation, students (n = 48) agreed that LM guidance should be part of the physician's role and that patients expected their physicians to be role models (mean ± sd; 3.4 ± 0.7). Students were fairly confident about providing general LM counselling (3.3 ± 1.1); but less so for exercise (3.0 ± 1.2), nutrition (2.7 ± 1.1), stress (2.5 ± 1.0), sleep (2.2 ± 1.2), and sexuality (2.1 ± 1.2). Staff recognized the importance of LM but reported time limitations and the need to bring in external experts to teach LM as challenges. CONCLUSIONS: Real-time mapping of teaching is a valuable way to ascertain teaching in practice. Based on our mapping process, redesign of curricula is needed to integrate more competency-based, experiential teaching, particularly in the clinical years.

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.

Preferences and barriers to the utilization of primary health care by sick physicians: a nationwide survey.

BACKGROUND: Physicians are often dissatisfied with their own medical care. Self-prescribing is common despite established guidelines that discourage this practice. From a pilot study, we know primary care physicians' (PCP) preferences, but we lack information regarding other specialties and work places. OBJECTIVES: The goal of this study was to examine whether physicians are satisfied with their personal primary care and how this could be improved. METHODS: We distributed an electronic survey to all physicians registered with the Israeli Medical Association. The questionnaire examined satisfaction with medical care, preferences for using formal care versus informal care, self-prescribing and barriers to using formal care. RESULTS: Two thousand three hundred and five out of 24 360 invited physicians responded. Fifty-six per cent of the respondents were satisfied with their personal primary care. Fifty-two per cent reported initiating self-treatment with a medication during the last year. Five and four per cent initiated treatment with a benzodiazepine and an antidepressant, respectively, during the last year. This was despite the fact that most physicians did not feel competent to treat themselves. Having a personal PCP was correlated with both a desire to use formal care and self-referral to formal care in practice. Regression analysis showed that the highest odds ratio (OR) for experiencing a large gap between desired and actual care were for physicians who had no personal PCP (OR = 1.92). CONCLUSIONS: Physicians frequently engage in self-treatment and in informal medical care. Whether the root cause is the health care system structure that does not meet their needs or the convenience of self-treatment is not known.

Lifestyle Medicine Around the World: Lifestyle Medicine in Israel.

In 2015, the Centers for Disease Control in the United States declared that 7 of 10 deaths per year are caused by chronic diseases; in Israel, the situation is consistent with this assessment. Healthy Israel 2020, an Israeli Ministry of Health initiative, places physicians at the forefront of health promotion and preventive medicine. In 2012, the Israeli Society of Lifestyle Medicine (ISLM) was established under the auspices of the Israel Association for Family Physicians. This decision was taken because we, the authors, wanted to promote change in the primary care services through the recruitment of key leaders for implementation of lifestyle medicine (LM), including improved attitudes, knowledge, motivation, and skills of primary care physicians and health providers. Today, the ISLM is an active member of the Israeli Medical Association, promoting educational activities, physician's health, and well-being initiatives; developing tools for health-promoting clinics; and more. Our future plans are to incorporate LM as an integral part of daily practice in all sectors of the medical profession in Israel. This is challenging, but we see this as the only way to effectively combat the noncommunicable disease epidemic.

A nationwide assessment of lifestyle medicine counseling: knowledge, attitudes, and confidence of Israeli senior family medicine residents.

BACKGROUND: Non-communicable diseases are the leading causes of death, largely due to the last century's often-unhealthy lifestyles. Family medicine (FM) and other physicians can improve patients' lifestyle behaviors, yet FM residency programs in Israel and other countries do not uniformly deliver lifestyle medicine (LM) training. The readiness of FM residents to counsel on lifestyle issues is not known. The purpose of this study is to assess knowledge, attitudes, and confidence levels of senior Israeli FM residents regarding LM counseling, and to evaluate the influence of LM training and personal health behaviors on residents' LM knowledge, attitudes, and confidence. METHODS: From May to June 2017, we surveyed all senior Israeli FM residents regarding their knowledge, attitudes, confidence, and personal health behaviors. We compared health behaviors, attitudes, and confidence in counselling between: 1) trained residents vs. untrained residents; 2) physically active residents vs. not physically active residents; 3) residents with a BMI < 25 vs. those with a BMI > 25; and 4) residents who eat a Mediterranean diet vs. those who do not. RESULTS: A total of 169 senior Israeli FM residents were surveyed, and 143 completed the survey, a response rate of 84.6%. Senior FM residents said they considered LM counseling to be an integral part of their role and an effective tool by which to improve a patient's health. Yet, their knowledge of LM and their confidence in delivering LM counseling are low. Compared with untrained residents (n = 84), LM-trained residents (n = 55) had higher knowledge scores (30.9% vs. 13.1%, p = 0.016) and were more confident in their ability to impact their patients' behaviors (53.7% vs. 34.5%, p = 0.004). Residents' positive personal health behaviors correlated with a higher level of confidence to provide LM counseling. CONCLUSIONS: FM physicians can play a key role in the management of patients with chronic diseases. Israeli FM residents consider counseling patients about a healthy lifestyle to be an integral part of their work, but do not feel well prepared to do so. Dedicated LM training and resident's personal health promotion may improve critically important levels of LM counseling and patient outcomes, and this training should therefore become a higher priority.

Health-related behaviours and perceptions among physicians: results from a cross-sectional study in Israel.

OBJECTIVES: Physicians' demanding work conditions may reduce the time and energy required for maintaining healthy lifestyles. This study examined health-related behaviours, perceived health status and emotional stress among physicians, and analysed the effects of personal and work characteristics on these endpoints. DESIGN: A cross-sectional study using a digital questionnaire. SETTING AND PARTICIPANTS: All 25 590 physicians who were members of the Israeli Medical Association in 2015 were invited to participate by email. Of 14 694 who opened the e-mail, 4832 (32.9%) responded. OUTCOME MEASURES: Survey topics included physical activity (PA), nutrition and eating habits, smoking, sleep, perceived health status and emotional stress, body mass index (BMI) and contact with a regular physician, as well as personal and work characteristics. Univariate and multivariate analyses were performed. RESULTS: Of the 4832 respondents, 21% reported poor or fair health status, 36% felt considerable emotional stress, 57% were overweight or obese (according to BMI≥25 kg/m2), 71% did not meet the recommended PA level, 79% did not meet a composite measure of healthy nutrition, 8% were current smokers, 25% slept 5 hours or less and 57% did not have a regular physician. Residents and hospital physicians reported significantly less healthy lifestyles, lower perceived health status and higher stress levels, compared with senior and community physicians. Multivariate analysis demonstrated that being female (OR=0.74, 95% CI=0.64 to 0.85), younger (0.69, 0.64 to 0.74), having poor nutrition (0.66, 0.55 to 0.78), not meeting PA targets (0.68, 0.57 to 0.82), inadequate sleep (0.54, 0.40 to 0.56) and perceived poor health status (0.48, 0.40 to 0.56) were significantly associated with high stress levels (p<0.001). CONCLUSIONS: The unfavourable health behaviours reported among Israeli physicians may have negative effects on their health and well-being. An intervention program to help physicians to adopt a healthier lifestyle is urgently needed.

Leading Healthy Lives: Lifestyle Medicine for Medical Students.

Background. Doctors have a special role in helping patients make lifestyle changes, and they are more credible and effective if they are role models. Yet few medical schools have incorporated lifestyle medicine into their curricula. We ascertained the influence of a lifestyle medicine curriculum during the first year of medical school. Methods. The curriculum, involving 140 students, consisted of one intensive day at medical school entry and 16 hours of teaching 8 months later. It addressed students' own lifestyle choices and topics related to lifestyle medicine. A survey was delivered at the beginning and end of the academic year. Results. A total of 114 students completed the first survey and 64 the second. They rated the course highly for personal and professional value. At baseline, students exhibited lifestyle behaviors typical for young adults and showed an appreciation of the physician's role in lifestyle change. However, over time they showed a significant reduction in quality of lifestyle, with increased stress, weight gain, and fast food consumption and less exercise. Conclusions. Although lifestyle medicine knowledge is valued by medical students, a 24-hour intensive lifestyle medicine curriculum delivered over 3 days appears to be ineffective in preventing worsening lifestyle behaviors over the course of the year. This is especially concerning as physicians are unlikely to provide effective guidance if they cannot sustain healthy behaviors themselves.

Lifestyle medicine course for family medicine residents: preliminary assessment of the impact on knowledge, attitudes, self-efficacy and personal health.

PURPOSE: The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. METHODS: Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. CONCLUSIONS: A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme.

NextGenU.org's Free, Globally Available Online Training in Lifestyle Medicine.

NextGenU.org now uniquely offers a free, accredited, globally-available online training in Lifestyle Medicine. Courses such as Lifestyle Medicine for Primary Care Physicians, Prevention and Treatment of Alcohol Use Disorders/Tobacco Use, Substance Use Disorder Screening, Public Health Nutrition, and more are competency-based and include knowledge transfer, a web-based global peer community of practice, and local, skills-based mentorships. Trainings use existing, expert-created resources from governments, universities, and medical specialty societies thus ensuring their quality and simultaneously making them free of costs, advertisement, and geographic barriers. To offer free credits for these courses, NextGenU.org partners with universities and professional societies. NextGenU.org's comprehensive Lifestyle Medicine Curriculum will launch in early 2017.

Family physicians prescribing lifestyle medicine: feasibility of a national training programme.

BACKGROUND: The actual causes of the preponderance of non-communicable chronic diseases are related to unhealthy behaviours, such as poor nutrition, physical inactivity and tobacco use. Our goal was to evaluate the feasibility of training in lifestyle medicine (LM) for family physicians, which could be included in 'Healthy Israel 2020', a national initiative created to enhance the health of Israelis. METHODS: Twenty-six providers participated in a 1-year certificate of completion in LM. A control group included 21 providers who participated in a similar musculoskeletal training programme. Pre/post data were collected in both groups of participants' attitudes and self-efficacy to prescribe LM and personal health behaviours. Mid/post feedback was collected in the study group participants. RESULTS: Physicians in the LM training represented a nationwide distribution and attended >80% of the programmes' meetings. They reported positive outcomes in most areas after the intervention compared with baseline. Five variables reached statistical significance: potential to motivate patients to improve exercise behaviours (p<0.05), confidence in one's knowledge about LM (p=0.01) and counselling (p<0.01), particularly related to exercise (p=0.02) and smoking cessation (p<0.05). The control group demonstrated one significant change: potential to motivate patients to change behaviours to lose weight (p<0.05). CONCLUSIONS: A training programme in LM appears feasible and could have a positive impact on interested family physicians' attitudes and confidence in prescribing LM. Thus, 'Healthy Israel 2020' and other programmes worldwide, which aim to improve health behaviours and decrease the impact of chronic diseases, might consider including family physicians training.