A Canadian survey of medical students and undergraduate deans on the management of patients living with obesity.

BACKGROUND: With over 26% of Canadian adults living with obesity, undergraduate medical education (UGME) should prepare medical students to manage this chronic disease. It is currently unknown how the management of patients living with obesity is taught within UGME curricula in Canada. This study (1) examined the knowledge and self-reported competence of final-year medical students in managing patients living with obesity, and (2) explored how this topic is taught within UGME curricula in Canada. METHODS: We distributed two online surveys: one to final-year medical students, and another to UGME deans at 9 English-speaking medical schools in Canada. The medical student survey assessed students' knowledge and self-reported competence in managing patients living with obesity. The dean's survey assessed how management of patients living with obesity is taught within the UGME curriculum. RESULTS: One hundred thirty-three (6.9%) and 180 (9.3%) out of 1936 eligible students completed the knowledge and self-reported competence parts of the survey, respectively. Mean knowledge score was 10.5 (2.1) out of 18. Students had greatest knowledge about etiology of obesity and goals of treatment, and poorest knowledge about physiology and maintenance of weight loss. Mean self-reported competence score was 2.5 (0.86) out of 4. Students felt most competent assessing diet for unhealthy behaviors and calculating body mass index. Five (56%) out of 9 deans completed the survey. A mean of 14.6 (5.0) curricular hours were spent on teaching management of patients living with obesity. Nutrition and bariatric surgery were most frequently covered topics, with education delivered most often via large-group sessions and clinical activities. CONCLUSIONS: Canadian medical students lack adequate knowledge and feel inadequately prepared to manage patients living with obesity. Changes to UGME curricula may help address this gap in education.

Undergraduate medical education interventions aimed at managing patients with obesity: A systematic review of educational effectiveness.

The growing obesity epidemic requires an evidence-based approach to management of patients with obesity. Two systematic reviews on obesity-management interventions in undergraduate medical education, both published in 2012, reported discrepant findings. This study aimed to build on previous research by identifying, systematically reviewing, and synthesizing current literature on the effectiveness of educational interventions aimed at teaching management of patients with obesity to medical students. A comprehensive search of seven databases was performed with no date or language restrictions. Database search identified 6462 studies; 5373 were screened against title and abstract, 156 full-text articles were retrieved, 31 met eligibility criteria, and 17 were included after critical appraisal of study methodology. Nine cohort-studies, three qualitative, two case-controls, two mixed-methods, and one randomized controlled trial were included. Findings supported the educational effectiveness of brief (<3 h) educational interventions, the value of video-clips to deliver content, and the importance of in-person teaching. Findings also demonstrated an increase in the number of studies describing educational interventions aimed at teaching management of patients with obesity to medical students. These results can be used by medical educators to inform the design of educationally effective curricula focused on the management of patients with obesity in undergraduate medical education.

The Role of Haptic Expectations in Reaching to Grasp: From Pantomime to Natural Grasps and Back Again.

When we reach to pick up an object, our actions are effortlessly informed by the object's spatial information, the position of our limbs, stored knowledge of the object's material properties, and what we want to do with the object. A substantial body of evidence suggests that grasps are under the control of "automatic, unconscious" sensorimotor modules housed in the "dorsal stream" of the posterior parietal cortex. Visual online feedback has a strong effect on the hand's in-flight grasp aperture. Previous work of ours exploited this effect to show that grasps are refractory to cued expectations for visual feedback. Nonetheless, when we reach out to pretend to grasp an object (pantomime grasp), our actions are performed with greater cognitive effort and they engage structures outside of the dorsal stream, including the ventral stream. Here we ask whether our previous finding would extend to cued expectations for haptic feedback. Our method involved a mirror apparatus that allowed participants to see a "virtual" target cylinder as a reflection in the mirror at the start of all trials. On "haptic feedback" trials, participants reached behind the mirror to grasp a size-matched cylinder, spatially coincident with the virtual one. On "no-haptic feedback" trials, participants reached behind the mirror and grasped into "thin air" because no cylinder was present. To manipulate haptic expectation, we organized the haptic conditions into blocked, alternating, and randomized schedules with and without verbal cues about the availability of haptic feedback. Replicating earlier work, we found the strongest haptic effects with the blocked schedules and the weakest effects in the randomized uncued schedule. Crucially, the haptic effects in the cued randomized schedule was intermediate. An analysis of the influence of the upcoming and immediately preceding haptic feedback condition in the cued and uncued random schedules showed that cuing the upcoming haptic condition shifted the haptic influence on grip aperture from the immediately preceding trial to the upcoming trial. These findings indicate that, unlike cues to the availability of visual feedback, participants take advantage of cues to the availability of haptic feedback, flexibly engaging pantomime, and natural modes of grasping to optimize the movement.