Semi-structured face-to-face interviews were conducted with 22 practice nurses in Lambeth, Southwark and Lewisham in South London. Interviews were digitally recorded and transcribed. Key themes were identified following coding of the data. Findings Factors that positively affected nurses' role adequacy and legitimacy were: their belief that obesity management was part of their chronic disease management and health promotion remit; their confidence in their own communication skills and ability to build rapport with patients; having attended training and being supported to take extra time for obesity management. Factors negatively affecting their role legitimacy and adequacy were: their low awareness and use of guidance; lack of knowledge of referral options; limited knowledge and use of non-medical and non-persuasive approaches; perceived lack of expertise in motivating patients, as well as in nutrition, child obesity and assessment; belief that there were some contexts in which it was more appropriate to raise the issue than others; lack of culturally appropriate materials and language barriers; belief that they had limited impact on outcome and that the patient is responsible for lack of success. Other factors negatively affecting their role adequacy and legitimacy included their ambivalence about the effectiveness of the interventions offered; perceived lack of priority for obesity management within practices; lack of time; workload and lack of clarity on protocols and roles within the practice.
Enabling tomorrow's doctors to address obesity in a GP consultation: an action research project Obesity is a leading risk factor for morbidity and mortality, however guidelines for prevention and management are relatively recently established, and little is known about what needs to be in place to put these into practice.This research provides an insight into how senior medical students consult with obese patients in general practice, the range of their learning needs, and the impact of various educational strategies that aim to bring their practice closer to current evidence-based guidelines.It centres on a series of compulsory but formative reflective case studies written by final year students at one large medical school on their GP rotation as they consult independently with obese patients with 'next room' GP tutor support.Analysis of these case studies was used to inform a three-year educational action research project. By systematically identifying and addressing learning needs, including barriers and enablers to best practice, we have demonstrated how senior medical students, and their GP tutors, can acquire the role legitimacy and role competency required for effective practice.Keywords: obesity, medical education, behaviour change, health promotion, primary care, general practice Status Box What is already knownOur clinical and educational response to obesity is less well developed than our response to other risk factors for morbidity such as smoking. There are difficulties translating behavioural change and obesity guidelines into practice, and teaching tends to be inconsistent and vicarious with little understanding of the learning needs of students or how teaching translates into clinical practice. What this work addsThis paper gives insights into real-life encounters with obese patients providing a rich understanding of the learning needs of senior medical students. An action research methodology has been used to test approaches to addressing these needs, which have been tested in the clinical context. Suggestions for future work and researchA follow-up study looking at patient experiences and outcomes of consultations led by healthcare professionals trained using these approaches is needed.
Behaviour change teaching successfully improved students' knowledge of and confidence regarding PA promotion. These improvements are a step forward and may increase the rates and success of physician PA counselling in the future.
Despite the economic, environmental and patient-related imperatives to prepare medical students to become health promoting doctors, health promotion remains relatively deprioritised in medical curricula. This paper uses an in-depth case study of a health promotion curriculum implementation at a large UK medical school to provide insights into the experiences of teachers and learners across a range of topics, pedagogies, and teaching & assessment modalities. Topics included smoking cessation, behavioural change approaches to obesity, exercise prescribing, social prescribing, maternal and child health, public and global health; with pedagogies ranging from e-learning to practice-based project work. Qualitative methods including focus groups, analysis of reflective learning submissions, and evaluation data are used to illuminate motivations, frustrations, practicalities, successes and limiting factors. Over this three year implementation, a range of challenges have been highlighted including: how adequately to prepare and support clinical teachers; the need to establish relevance and importance to strategic learners; the need for experiential learning in clinical environments to support classroom-based activities; and the need to rebalance competing aspects of the curriculum. Conclusions are drawn about heterogeneous deep learning over standardised surface learning, and the impacts, both positive and negative, of different assessment modalities on these types of learning.
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