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Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum

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Abstract

BACKGROUND

Clinical guidelines recommend that physicians counsel patients on diet and exercise; however, physician counseling remains suboptimal.

OBJECTIVES

To determine if incorporating performance improvement (PI) methodologies into a needs assessment for an internal medicine (IM) residency curriculum on nutrition and exercise counseling was feasible and enhanced our understanding of the curricular needs.

DESIGN AND PARTICIPANTS

One hundred and fifty-eight IM residents completed a questionnaire to assess their knowledge, attitudes, and practices (KAP) about nutrition and exercise counseling for hypertensive patients. Residents’ baseline nutrition and exercise counseling rates were also obtained using chart abstraction. Fishbone diagrams were created by the residents to delineate perceived barriers to diet and exercise counseling.

MAIN MEASURES

The KAP questionnaire was analyzed using descriptive statistics. Chart abstraction data was plotted on run charts and average counseling rates were calculated. Pareto charts were developed from the fishbone diagrams depicting the number of times each barrier was reported.

KEY RESULTS

Almost 90% of the residents reported counseling their hypertensive patients about diet and exercise more than 20% of the time on the KAP questionnaire. In contrast, chart abstraction revealed average counseling rates of 3% and 4% for nutrition and exercise, respectively. The KAP questionnaire exposed a clinical knowledge deficit, lack of familiarity with the national guidelines, and low self-efficacy. In contrast, the fishbone analysis highlighted patient apathy, patient co-morbidities, and time pressure as the major perceived barriers.

CONCLUSIONS

We found that incorporating PI methods into a needs assessment for an IM residency curriculum on nutrition and exercise counseling for patients at risk of cardiovascular disease was feasible, provided additional information not obtained through other means, and provided the opportunity to pilot the use of PI techniques as an educational strategy and means of measuring outcomes. Our findings suggest that utilization of PI principles provides a useful framework for developing and implementing a medical education curriculum and measuring its effectiveness.

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Acknowledgements

  1. 1.

    We appreciate and acknowledge the support of an intramural grant for medical education innovations from Emory Healthcare.

  2. 2.

    Prior to writing this manuscript:

    1. a.

      Drs. Fluker, Whalen, and Doyle presented a poster, “Assessing Residents’ Behaviors and Barriers to Counseling Hypertensive Patients on Diet Using Performance Improvement Tools” at the ACGME-ABMS Joint Conference, Physician Competence: From Deconstruction to Reconstruction, on September 15, 2007.

    2. b.

      Drs. Whalen and Schneider presented a workshop, “Designing and Implementing Interventions to Improve Exercise Counseling in Continuity Clinics” at the Annual American College of Sports Medicine meeting, May 28–31, 2008.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, GA, 30303, USA

    Shelly-Ann Fluker MD, Jason Schneider MD, Paul Cantey MD, MPH, Jada Bussey-Jones MD & Joyce P. Doyle MD

  2. Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Ursula Whalen MD & Donald Brady MD

Authors
  1. Shelly-Ann Fluker MD
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  2. Ursula Whalen MD
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  3. Jason Schneider MD
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  4. Paul Cantey MD, MPH
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  5. Jada Bussey-Jones MD
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  6. Donald Brady MD
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  7. Joyce P. Doyle MD
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Corresponding author

Correspondence to Shelly-Ann Fluker MD.

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Fluker, SA., Whalen, U., Schneider, J. et al. Incorporating Performance Improvement Methods into a Needs Assessment: Experience with a Nutrition and Exercise Curriculum. J GEN INTERN MED 25 (Suppl 4), 627–633 (2010). https://doi.org/10.1007/s11606-010-1404-z

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  • DOI: https://doi.org/10.1007/s11606-010-1404-z

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