Elsevier

Preventive Medicine

Volume 44, Issue 1, January 2007, Pages 76-81
Preventive Medicine

Predictors of US medical students' prevention counseling practices

https://doi.org/10.1016/j.ypmed.2006.07.018Get rights and content

Abstract

Objective.

To understand predictors of medical students' prevention counseling practices.

Methods.

We surveyed medical students (n = 2316 individuals) in the Class of 2003 at freshman orientation, and again at entrance to wards and senior year in a nationally representative sample of 16 US medical schools (response rate = 80.3%).

Main outcome measures.

Perceived relevance of prevention counseling and seniors' frequency of prevention counseling.

Results.

Healthier personal practices (p < 0.0001), intention to become a primary care practitioner (p = 0.0007), and attending a medical school that encouraged healthy personal practices (p = 0.002) significantly predicted the frequency with which seniors reported currently counseling patients about preventive interventions (using a validated measure). Perceived counseling relevance was also significantly predicted by intention to become a primary care practitioner (p < 0.0001), attending a school that encouraged healthy personal practices (p = 0.0007), being earlier in one's training (p < 0.0001), more interested in prevention (p < 0.0001), female (p < 0.0001), non-White (p = 0.007), and by having healthy personal practices (p = 0.008).

Conclusions.

Several of the variables predicting physician counseling also predict US medical students' reporting counseling (especially personal health practices and specialty type). In addition, the avidity with which medical schools encourage students to be healthy significantly influences their reported patient counseling. These findings can give a fresh, evidence-based direction to help create physicians who counsel patients about prevention.

Introduction

A major goal of Healthy People 2010 is to “increase the proportion of persons appropriately counseled about health behaviors” (U.S. Department of Health and Human Services, 2000). The patient counseling practices with which medical students graduate form the foundation of their counseling practices as physicians. However, while a reasonably substantial literature exists about predictors of physicians' counseling practices (Frank, 2004, Frank et al., 2000, Rafferty and Frank, 1994), searches from Ovid, Medline, and similar engines reveal no national studies of correlates of these practices among medical students.

Among potential correlates of medical students' patient counseling practices, we were particularly interested in the effects of their personal health practices. Since we know (Frank, 2004) that there is a relationship between physicians' personal health and patient counseling practices, this suggests that if we encourage medical students to be healthy we could help create healthy physicians who are more likely to counsel their patients about prevention; this paper also addresses that hypothesis.

Section snippets

Design

In an IRB-approved protocol, all medical students in the Class of 2003 at 16 US schools were eligible to complete three questionnaire administrations during their medical training (at freshman orientation, orientation to wards, and in their senior year). Our sample of schools was designed to be representative of all US medical schools in our geographic distribution, age (our freshman year average was 24 vs. 24 nationally), school size (our schools averaged 563 medical students/school vs. 527

Methods

A school health promotion score was calculated using a weighted sum of Likert scaled responses at entry to wards and senior year to the following questions: “Overall, my school has encouraged a healthy lifestyle”, “The curriculum has encouraged me to be healthy”, “My school encourages extracurricular activities that promote health”, “My school tries to minimize student stress”, “My school has a good system to help students cope with stress”, “School sponsored events have healthy eating

Main outcome measures

Student clustering within schools and longitudinal data collection necessitated accounting for the lack of independence between observations and adjusting variance estimates accordingly. We used SUDAAN (Shah et al., 2001) for this purpose, treating each school as a cluster and each student's multiple responses as subclusters.

Predictor variables and outcome measures were chosen based on prior literature on predictors of physician prevention counseling (Frank et al., 2000, Rafferty and Frank, 1994

Results

These students were an average age of 25 years; 19% were Asian, 5% were Hispanic, and 8% were non-Hispanic black (data not shown). Table 1 shows bivariate relationships between our two major outcomes of interest (counseling relevance and frequency) and their potential predictors. Perceived counseling relevance scores declined between entrance to wards and senior year, were better among women than men, non-Whites (especially Blacks and Hispanics) vs. Whites, those who intended to become primary

Discussion

In this national study of medical students' personal and clinical prevention habits, we found that many of the same variables that predicted physician counseling (Frank, 2004) also predicted medical students' reported counseling. In addition, we also found an important new correlate of medical student counseling: the avidity with which students' schools encourage them to be healthy.

Regarding their demographics, these students were more likely (U.S. Census Bureau, 1999) to be Asian (19% of

Conclusions

Many of the same variables predicting physician counseling also predict medical students' counseling; additionally, the avidity with which schools encourage students to be healthy significantly influences their patient counseling. These findings, especially the links between school health promotion environments, personal health practices, and patient counseling practices, suggest important and inadequately explored directions for medical educators trying to create physicians who counsel

Acknowledgment

We would like to acknowledge the support of the American Cancer Society.

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