Effect of Child Overweight/Obesity Didactic Session on Resident Confidence and Detection

Abstract

Objective . To evaluate the impact of an obesity didactic session for pediatric physicians on confidence in counseling and identified overweight/obesity and follow-up recommendations. Methods . Pediatric residents underwent training and completed pre/post online surveys evaluating confidence in obesity prevention and identification. A booster training occurred 1 year later. Pre-/post-training scores were compared using χ 2 or Fisher’s exact tests. Electronic medical records data for patients ≥3 years with BMI-for-age percentile ≥85 during 3 months prior/following the training/booster compared frequency of overweight/obesity identification and follow-up recommendations (≤3 months recommended vs longer) using logistic regression adjusting for age and overweight/obese status. Results . Post trainings, improvements in confidence to define/screen for obesity were observed, with a decline between trainings. Overweight/obese identification and follow-up time recommendations improved post-training (identification: 14.2% to 27.4%, adjusted odds ratio [aOR] = 3.16, 95% confidence interval [CI] = 1.54-6.51; follow-up: 48.9% to 58.9%, aOR = 1.63, 95% CI = 1.01-2.64), aOR = 1.77, 95% CI = 1.10-2.85, and identification remained stable/above pre-training rates both pre-/post-booster (25.8%, aOR = 3.14, 95% CI = 1.53-6.45; and 22.1%, aOR = 2.57, 95% CI = 1.25-5.30, respectively). Recommended follow-up time rates continued to rise when measured pre-booster (60.6%, aOR = 1.77, 95% CI = 1.10-2.85), then declined (46.0%, aOR = 0.95, 95% CI = 0.60-1.52). Conclusion . This didactic session improved resident confidence in defining/screening, identification of overweight/obesity and follow-up recommendations; however, rates of identification remained low. The successes of this intervention support similar didactic sessions in residency programs and identifies opportunities for improved resident/attending education.

Pediatric Residency Obesity and Overweight Training Curricula: A Systematic Review

“…Only 4 of the 11 studies looked, via chart review, at the effect of the obesity training sessions on EMR documentation. 15-17,20 These studies did find improved documentation of body mass index, nutrition and physical activity history, and nutrition and physical activity counseling. Two studies also noted an increase in frequency of follow-up appointments.…”

“…The trainings were mostly education-based, but 6 of the trainings included motivational interviewing techniques as well. 10,13,16,17,19,21 Many of the training sessions were an hour, 10,14,18 with the shortest training session being 15 minutes 15 and the longest training session being a half day in clinic with a nutritionist. 11 In only 2 studies did a small portion of the participants receive repeat training.…”

“…Two studies also noted an increase in frequency of follow-up appointments. 15,20 Only one study noted an increase in referrals to subspecialists and laboratory tests ordered if obesity was recognized. 20…”

“…Five of the studies were primarily pediatric residents, 13-15 3 included only family medicine residents, 16-18 and 3 were a combination of pediatric residents with other specialties (internal medicine, internal medicine/pediatrics, pediatrics/child psychiatry/psychiatry). 19-21 Four of the studies included attending physicians, 10,15,16,20 one of which included community physicians and not just faculty physicians. 10 Sample size ranged from 6 to 119 physician participants (Table 1).…”

“…10,14,15,18,20,21,23 Given this, an examination of training duration, specifically whether brief training sessions can sustain this efficacy and demonstrate reproducible benefits, is needed. Additionally, only 2 studies documented improvement in expected follow-up visits, 15,20 and none investigated the time frame and follow through for these visits to determine if closer evaluations and management took place as a result of these interventions. Finally, it is notable that few studies examine whether, after these trainings, there was correct identification of overweight/obesity based on standard criteria.…”