ABSTRACT
Background: Residency offers opportunities to address obesity-care knowledge gaps, but few curricula exist. We aimed to develop and rigorously test an obesity medicine curriculum for internal medicine (IM) residents. Methods: We conducted a prospective study comparing IM residents' obesity-care self-efficacy between a residency program receiving the curriculum (n=20) and a control program (n=19). From Feb-April 2020, we delivered a curriculum that combined online modules with live case-based discussions on guidelineconcordant obesity care (lifestyle, medications, surgery);enhanced with tools for documentation and patient communication. We determined residents' change in counseling self-efficacy on nutrition, behavior change, anti-obesity medications (AOM), and bariatric surgery on 4-point Likert scales at baseline and 5 months. We also assessed change in self-reported clinical practice habits. We used t-tests to compare mean change in outcomes both within and between groups. Results: Overall, 64% of residents were women and evenly distributed across post-graduate years. Curriculum residents had statistically significant within-group increases in all self-efficacy domains (nutrition 0.8;behavior 1.2;AOM 1.2;surgery 0.9 (p<0.01)) and statistically significant within-group increases in three practice habits (behavior 0.8, AOM 0.8, surgery 0.6 (p<0.02)). Relative to controls, curriculum residents had statistically significant improvements in all self-efficacy domains (between-group differences: nutrition 0.6 (p=0.02);behavior 0.8 (p<0.01);AOM 0.7 (p=0.03);surgery 0.5 (p=0.03)). We found no between-group differences in practice habits. Conclusions: A curriculum increased residents' obesity-care selfefficacy and produced improvements beyond those achieved with usual IM training. While curriculum residents reported increases in practice habits, the between-group changes were not statistically significant - possibly related to COVID19 disruptions. Future studies should determine effect on clinical practice.
ABSTRACT
BACKGROUND: Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. METHODS: A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. RESULTS: All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. DISCUSSION: A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.