Effect of didactic lectures on obesity documentation and counseling among internal medicine residents.

BACKGROUND: Screening adult patients for obesity and offering appropriate counseling and treatment for weight loss is recommended. However, many healthcare providers feel ill-equipped to address this topic. OBJECTIVE: We examined whether didactic presentations lead to increased obesity documentation and counseling among internal medicine (IM) residents. METHODS: We reviewed medical records of patients seen at the IM Resident Continuity Clinic during April 2015. Residents were provided feedback at two didactic presentations during May 2015. To examine the effect of this intervention, we repeated medical record review during June 2015. For both reviews, we abstracted patient-specific (i.e., age, body mass index [BMI], race, sex, and number of comorbid diagnoses) and resident-specific (i.e., sex and training level) data as well as evidence of obesity documentation and counseling. We used logistic regression models to examine the effect of intervention on obesity documentation and counseling, adjusting for patient- and resident-specific variables. RESULTS: Of the 278 patients with BMI≥30 kg/m(2), 139 were seen before and 139 after the intervention. Intervention had no effect on obesity documentation or counseling with or without adjustment for confounding variables (both P>0.05). In adjusted post-hoc analyses, each additional comorbidity increased the odds of obesity documentation by 8% (OR=1.08; 95% CI=1.05-1.11; P<0.001). In addition, as compared to postgraduate year (PGY) 1 residents, PGY-3 residents were 56% (OR=0.44; 95% CI=0.21-0.95; P=0.03) less likely to counsel obese patients. CONCLUSIONS: Obesity is inadequately addressed in primary care settings, and didactic presentations were unable to increase obesity documentation or weight loss counseling. Future research to identify effective interventions is needed.

Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.

IMPORTANCE: There is an increasing demand for a limited number of pigmented lesion clinic (PLC) visits at dermatology centers. OBJECTIVE: To determine the proportion of visits to PLCs that are more frequent ("additional screening") than the recommended ("standard") follow-up schedule and to determine if certain patient characteristics correlate with the demand for these visits. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical chart review of all PLC visits at an academic dermatology center from October 2010 to January 2012. A total of 609 patients associated with 1756 visits were identified. Of these, 25 patients associated with 26 visits were excluded owing to lack of melanoma diagnosis or risk factors, leaving 584 patients and 1730 visits. Diagnoses of these patients included in situ and invasive melanoma, dysplastic nevi, Spitz nevi, atypical nevus syndrome, family history of melanoma only, and other risk factors. The mean (SD) age was 48 (16) years, and 235 (40.2%) of the patients were male. MAIN OUTCOMES AND MEASURES: The proportion of additional screening visits compared with standard visits. Standard visits were defined as occurring at the following frequencies: annually for mildly dysplastic nevi, Spitz nevi, or solely family history of melanoma; biannually for the first year, then annually thereafter for moderately dysplastic nevi or atypical nevus syndrome; biannually for up to 3 years, then annually thereafter for severely dysplastic nevi or melanomas in situ; every 3 months for 2 years, biannually for the following 2 years, then annually thereafter for invasive melanoma. RESULTS: A total of 1400 visits (80.9%) were standard, 257 (14.9%) were for additional screening, and 73 (4.2%) were "problem focused." Thirty percent of patients had at least 1 additional screening visit. The distribution of diagnoses among standard vs additional screening visits differed significantly, with "family history only" and "other risk factors" taking up a larger percentage of standard visits (15.1%) than the percentage of additional screening visits (8.9%), and all other diagnoses being better represented among additional screening visits (P = .04). No particular patient characteristic described those who sought additional screening visits. CONCLUSIONS AND RELEVANCE: A substantial proportion of additional screening PLC visits exist and are desired by all patients with pigmented lesions. We propose alternative clinic models, such as diagnosis-specific, adjunctive fee-for-additional-service, and teledermatology clinics to meet patient needs while creating resources to expand PLC visits.

Incorporating Scientific Publishing into an Undergraduate Neuroscience Course: A Case Study Using IMPULSE.

The journal IMPULSE offers undergraduates worldwide the opportunity to publish research and serve as peer reviewers for the submissions of others. Undergraduate faculty have recognized the journal's value in engaging students working in their labs in the publication process. However, integration of scientific publication into an undergraduate laboratory classroom setting has been lacking. We report here on a course at Ursinus College where 20 students taking Molecular Neurobiology were required to submit manuscripts to IMPULSE. The syllabus allowed for the laboratory research to coincide with the background research and writing of the manuscript. Students completed their projects on the impact of drugs on the Daphnia magna nervous system while producing manuscripts ready for submission by week 7 of the course. Findings from a survey completed by the students and perceptions of the faculty member teaching the course indicated that students spent much more time writing, were more focused on completing the assays, completed the assays with larger data sets, were more engaged in learning the scientific concepts and were more thorough with their revisions of the paper knowing that it might be published. Further, the professor found she was more thorough in critiquing students' papers knowing they would be externally reviewed. Incorporating journal submission into the course stimulated an in depth writing experience and allowed for a deeper exploration of the topic than students would have experienced otherwise. This case study provides evidence that IMPULSE can be successfully used as a means of incorporating scientific publication into an undergraduate laboratory science course. This approach to teaching undergraduate neuroscience allows for a larger number of students to have hands-on research and scientific publishing experience than would be possible with the current model of a few students in a faculty member's laboratory. This report illustrates that IMPULSE can be incorporated as an integral part of an academic curriculum with positive outcomes on student engagement and performance.