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.

Introduction : Intravenous antibiotic therapy (IVAT) for CF acute pulmonary exacerbations (APE) can be delivered in hospital or in the community. This study aimed to compare physical activity in CF patients receiving hospital and community-delivered IVAT, as well as other health outcomes.Materials and Methods : This was a non-randomised parallel group prospective observational study. Hospitalised and community-treated CF adults receiving IVAT for APE were asked to wear ActiGraph® activity monitors, complete the habitual activity estimation scale (HAES), food diary, modified shuttle test (MST) and CFQ-R at the start and end of therapy. Nutritional and clinical outcomes were also compared between the cohorts. The primary outcomes was physical activity measured by the ActiGraph® activity monitors at the beginning and end of treatment in both cohorts. Results : Physical activity (measured and self-reported) was no different between the cohorts, with both hospitalised and community-treated subjects being generally sedentary. Body weight increased significantly in the hospitalised cohort, whereas no difference was seen in the community-treated cohort. FEV1 % predicted and FVC % predicted increased in community-treated subjects, whereas only FVC % predicted increased in hospitalised subjects. CFQ-R respiratory domain increased to a greater extent in community-treated subjects.Conclusion : CF adults receiving IVAT for APE, both in hospital and in the community, are generally sedentary and we found no difference in physical activity between the two groups. These findings suggests the need to further promote physical activity in suitable patients during APE where considered appropriate.

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