Willingness to provide behavioral health recommendations: a cross-sectional study of entering medical students

Stephen A Mccurdy

doi:10.1186/1472-6920-12-28

Abstract

BackgroundBehavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. Unfortunately, many clinical encounters do not include prevention counseling, and medical school curriculum plays an important role in training and promoting such counseling among medical students.MethodsWe surveyed all 93 freshman medical students at entry to the University of California, Davis School of Medicine in 2009 to evaluate baseline knowledge of population health principles and examine their approach to clinical situations involving four common behavioral risk factors illustrated in brief clinical vignettes: smoking, alcohol use in a patient with indications of alcoholism, diet and exercise in an overweight sedentary patient, and a 16-year-old contemplating initiation of sexual intercourse. Based on vignette responses, we assessed willingness to (1) provide information on risks, (2) recommend elimination of the behavior as the most efficacious means for reducing risk, (3) include strategies apart from elimination of the behavior for lowering risk (i.e., harm reduction), and (4) assure of their intention to continue care whether or not recommendations are accepted.ResultsStudents answered correctly 71.4 % (median; interquartile range 66.7 % - 85.7 %) of clinical prevention and population health knowledge questions; men scored higher than women (median 83.3 % vs. 66.7 %, p<0.02). Students showed high willingness to provide information and strategies for harm reduction apart from risk elimination, while respecting patient autonomy. Willingness to recommend elimination of high-risk behaviors “always or nearly always” was high for smoking (78.5 %), alcohol consumption in a patient with indications of alcoholism (64.5 %), and diet and exercise in a sedentary and overweight individual (87.1 %), and low for the 16-year-old considering initiating sexual intercourse (28.0 %; Friedman test, p<0.001). Willingness was not associated with the respondent’s background knowledge of population health principles or gender.ConclusionStudents showed high willingness to educate and respect patient autonomy. There was high willingness to recommend elimination of risk behaviors for smoking, alcohol, and poor diet/exercise, but not for sexual intercourse in an adolescent considering sexual debut. Further research should address promoting appropriate science-based preventive health messages, and curriculum should include explicit discussion of content of recommendations.

Highlights

Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks
The Guide to Community Preventive Services [2] and the U.S Preventive Services Task Force’s Guide to Clinical Preventive Services [3] are useful resources for evidence-based prevention measures on various health topics. Both include an assessment of the underlying science for each prevention measure, ranging from “insufficient evidence” to “recommended.” Professional and community organizations, such as the American Cancer Society, American Academy of Pediatrics, Alcoholics Anonymous, and others provide educational materials and preventive health recommendations, these are not always evidence-based
Harms associated with the vignette topics illustrated here are well known, and our findings suggest that this common knowledge is reflected in the willingness of entering medical students to educate regarding these behavioral risk factors

Summary

Introduction

Behavioral factors contribute importantly to morbidity and mortality, and physicians are trusted sources for information on reducing associated risks. The Guide to Community Preventive Services [2] and the U.S Preventive Services Task Force’s Guide to Clinical Preventive Services [3] are useful resources for evidence-based prevention measures on various health topics. Both include an assessment of the underlying science for each prevention measure, ranging from “insufficient evidence” to “recommended.” Professional and community organizations, such as the American Cancer Society, American Academy of Pediatrics, Alcoholics Anonymous, and others provide educational materials and preventive health recommendations, these are not always evidence-based. Physicians have the opportunity to provide prevention messages directly to patients, yet many clinical encounters do not include prevention counseling [4,5]

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