An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy?

Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents' (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.

Medical student self-efficacy, knowledge and communication in adolescent medicine.

OBJECTIVE: To evaluate student self-efficacy, knowledge and communication with teen issues and learning activities. METHODS: Data were collected during the 8-week pediatric rotation for third-year medical students at a local children's hospital. Students completed a self-efficacy instrument at the beginning and end of the rotation; knowledge and communication skills were evaluated during standardized patient cases as part of the objective structured clinical examination. Self-efficacy, knowledge and communication frequencies were described with descriptive statistics; differences between groups were also evaluated utilizing two-sample t-tests. RESULTS: Self-efficacy levels of both groups increased by the end of the pediatric rotation, but students in the two-lecture group displayed significantly higher self-efficacy in confidentiality with adolescents (t(35)=-2.543, p=0.02); interviewing adolescents, assessing risk, sexually transmitted infection risk and prevention counseling, contraception counseling were higher with marginal significance. No significant differences were found between groups for communication; assessing sexually transmitted infection risk was marginally significant for knowledge application during the clinical exam. CONCLUSIONS: Medical student self-efficacy appears to change over time with effects from different learning methods; this higher self-efficacy may increase future comfort and willingness to work with this high-risk, high-needs group throughout a medical career.

Binge eating in obese adolescents: emotional and behavioral characteristics and impact on health-related quality of life.

PURPOSE: This study explored binge eating among an adolescent obese population to ascertain the prevalence of bingeing, the relationship between binge eating and body mass index (BMI), and to evaluate significant relationships between binge eating, emotional/behavioral functioning, and health-related quality of life. METHODS: Participants included 102 overweight adolescents aged 12-17 years presenting to a multidisciplinary outpatient obesity clinic. Data obtained included height, weight, and self-report questionnaire data on emotional and behavioral functioning. RESULTS: Binge eating prevalence included 33% moderate to severe binge eating. Binge eating was significantly positively related to BMI and depression, negative mood, feelings of ineffectiveness, negative self-esteem and significantly negatively related to somatic complaints and all aspects of health-related quality of life. Important demographic differences emerged with regard to the impact of binge eating on health-related quality of life with Caucasians, females, and older groups experiencing more pervasive impact. CONCLUSIONS: This research suggests that bingeing behaviors have pervasive and important implications for health-related quality of life for obese adolescents.

Adolescent health care and the trainee: roles of self-efficacy, standardized patients, and an adolescent medicine rotation.

PURPOSE: Pediatric residents often cite a lack of confidence with adolescents owing to minimal exposure during training. Self-efficacy has been evaluated in a general context but not in relation to perception of knowledge and communication skill. Study objectives were to evaluate resident self-efficacy during a month-long adolescent rotation and to assess knowledge and communication skills in their relationship to self-efficacy. METHODS: Data were collected as part of the adolescent medicine rotation for pediatric residents at a local children's hospital. Residents completed 2 standardized patient cases at the beginning of the rotation and a self-efficacy instrument before/after the cases and at the end of the rotation. The study assessed trends in self-efficacy using repeated-measures analysis of variance and χ tests to examine relationships between self-efficacy and knowledge as well as communication in preventative and sexually transmitted infection adolescent health. RESULTS: Resident (n = 44) self-efficacy levels significantly changed over all time points and were significantly related to knowledge and communication levels. Although self-efficacy levels decreased immediately after the standardized patient cases, all self-efficacy items were significantly higher at the end of the rotation. Residents confident or very confident in general health topics were deficient in asking basic history items and residents confident or very confident in high-risk topics often did not actually assess these areas with patients. CONCLUSIONS: Residents' personal assessments on paper may differ from actual clinical interactions. Standardized patient cases expose resident strengths and weaknesses with adolescents, and a month-long adolescent rotation allows for repetitive experiences with special adolescent health care topics with associated increase in self-efficacy, knowledge application, and communication skill.

Eating disorders in Arkansas: trends observed over fourteen years.

OBJECTIVE: The purpose of this study was to explore trends among patients presenting to an outpatient multidisciplinary child and adolescent eating disorders program over a period of fourteen years (1997-2010). METHODS: An Institutional Review Board (IRB) approved chart review was performed on demographic, physical and psychological data collected at intake on 507 patients who presented to the eating disorders program during the target time period. Gender, age, ethnicity, diagnosis, weight, Body Mass Index (BMI), bone density and Resting Energy Expenditure (REE) are among some of the variables collected. RESULTS: Diagnoses include Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS). Gender representation included 472 females, 35 males with increased male representation noted across years; age ranged from 5 to 21 with younger ages increasingly represented across years; ethnicity included Caucasian, African American, Hispanic, Asian and Other with increased minority representation noted across years; BMI 12.0 to 36.9 with lower BMIs noted in more recent years; REE results (n = 441) ranged from 60 to 153% with the lower percent results noted within the last five years. CONCLUSIONS: Observed trends are consistent with expectations and support trends noted in existing literature and illustrate eating disorders as progressively more nondiscriminatory with regard to age, gender, and ethnicity. Severity of illness may be trending towards worse at the time of initial evaluation indicating that patients are being identified and/or are presenting for treatment after symptoms have become significant.

Eating disorders in a rural state: two adolescent cases: a Hispanic male and a Korean female.

PURPOSE: The objective is to increase knowledge on eating disorder presentation and prevalence across age, gender and ethnicity. METHODS: Two adolescent ethnic minority cases diagnostically evaluated and treated at a multidisciplinary pediatric eating disorders specialty clinic in a rural state. RESULTS: A 14-year-old Hispanic male presented with a history of a 22-pound weight loss over brief period, food restriction, over-exercising, excessive fears regarding weight. A 14-year-old Korean female presented with a history of a 22-pound weight loss over brief period, severe food restriction, over-exercising, excessive fears regarding weight. CONCLUSIONS: It is important for professionals to increase their knowledge base and to become more comprehensively informed about eating disorders and to recognize that eating disorders are progressively becoming less discriminatory, impacting individuals across age, ethnicity, gender and socioeconomic status.

The use of a parent support group in the outpatient treatment of children and adolescents with eating disorders.

Our objective was to measure parents' level of satisfaction and perceived benefits gained from participating in a parent support group as part of an outpatient treatment program. We mailed surveys to 261 parent/guardian participants. Results reflected high satisfaction with the support group. Parents indicated that it assisted them in understanding eating disorders symptoms and treatment and supporting their child struggling with an eating disorder. Additionally, the group was a source of emotional support. Results suggest that inclusion of a parent support group in the outpatient treatment of children and adolescents with eating disorders has important implications for parents.