Commentary on: "Physical activity education in the undergraduate curricula of all UK medical schools. Are tomorrow's doctors equipped to follow clinical guidelines?".

Abstract

A recent survey of medical schools in the UK has revealed a wide ranging level of teaching in physical activity promotion, but was reported as sparse overall.1 Physical inactivity causes an estimated 6–10% of major non-communicable diseases globally including type 2 diabetes mellitus, coronary heart disease, and certain types of cancer.2 In the UK, a third of the adult population do not meet the recommended levels of physical activity outlined by the Department of Health.3 The House of Lords Select Committee Science and Technology's July 2012 report on sport and exercise science and medicine refers to building on the Olympic legacy of London 2012 to improve a nation's health. It highlighted a lack of awareness and appropriate training for health professionals on the benefits of exercise based treatments.4 With increasing levels of obesity and sedentary lifestyles, Weiler et al. raise the question whether doctors’ training truly reflects the needs of this changing nation's demographic.1 Weiler et al. employed a telephone survey and questioned all 31 medical schools in the UK. This revealed that five medical schools did not include any specific teaching in physical activity. Of the 12 that quantified the hours spent teaching physical activity, this was only 4.2 hours in the entire curriculum. Only 15 medical schools taught the Chief Medical Officer's recommendations for physical activity. Despite these results, the study remains limited by the difficulty in quantifying the hours spent teaching physical activity; only 12 schools were able to so. Physical activity teaching was often “integrated” or “difficult to assess”.1 The study does not account for the integration of physical activity teaching into other specialities; cardiology, respiratory, physiology, endocrine, or GP/community care. The study does not address whether students are competent to promote physical activity without structured education. However, students’ perceptions of competence may poorly reflect objectively measured competence thus reinforcing the need for education and structured assessment.5 In highlighting a general paucity of physical activity teaching, this supports similar data from American and Canadian medical school curricula.6,7 There are a number of reasons for change. First, the education of physical activity promotion to students is specifically recommended by the Royal College of Physicians (RCP),8,9 as well as the Select Committee on Science and Technology.4 Additionally, recommendations for patient physical activity are embedded into 39 national guidelines of wide-range clinical conditions, including 23 National Institute for Clinical Excellence (NICE) guidelines.10 However, despite these recommendations, the current curriculum outlined by the General Medical Council (GMC) does not require medical schools to provide teaching in exercise/preventative medicine.11 Second, physical activity promotion by health professionals is an effective means of increasing physical activity uptake.12 Medical students need to acquire the basic knowledge, confidence, and skills to promote physical activity. Education in providing advice, risk stratification, promoting behavioural change, and exercise physiology might be included. Given the impact of physical inactivity on health,2 increased integration of physical activity teaching into medical curricula would target health needs of the patient, but also adhere to Government, NICE, and RCP recommendations. However, there remain many barriers to change. The true need for additional physical activity teaching is not well established. Management of patients is being increasingly integrated between all members of the multidisciplinary team. Specialised professionals such as dieticians, occupational therapists, physiotherapists, and rehabilitation specialists mean that the responsibility for physical activity of the patient is increasingly shared. Referring aspects of care to other professionals might limit the need for specific, additional, education in sport and exercise medicine (SEM). Furthermore, there is currently little evidence base to indicate how further medical student education in physical activity would improve patient health outcomes. Given the common knowledge that physical exercise is beneficial, it is not clear how effective changes to the curricula would be in improving patient health or how best to quantify these changes. Would medical students need to become experts in exercise medicine to improve patient health? It is important to recognise these findings in the context of the time available in the curricula. Medical students’ time is in high demand with a large volume of material to cover. Given that SEM education is not currently essential, it is forced to compete with other core specialities outlined by the GMC. Medical education in physical activity should be recognised as a powerful force in coping with the shifting demographics of the 21st Century. The potential benefit of exercise for population health is vast.2,13 Incorporation of physical exercise into the medical school curricula will help to embed its importance in medical education as reflected by national guidelines for management of conditions and the overwhelming prevalence of physical inactivity and obesity. Change will require recognition of a shortfall, and a united drive towards change. A national infrastructure is required to effectively integrate SEM into care pathways. Proposals to introduce physical activity into the Quality and Outcomes Framework (QOF) may help to formalise SEM incorporation into primary care.4 Projects such as the Move, Eat, Treat campaign14 will aid to establish awareness and promote health professionals to receive and maintain education on giving lifestyle advice throughout their careers.