Promoting medical student health as an innovative way to improve physician counseling practices.
According to the World Health Organization (WHO), noncommunicable diseases (NCDs) kill 41 million people each year, equivalent to 71% of all deaths globally. Tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets all increase the risk of dying from an NCD. If these figures were not alarming enough, the COVID-19 pandemic has demonstrated the importance of healthy lifestyles, which can affect our body’s ability to prevent, fight and recover from infections.
A significant cost-effective method of addressing NCDs is to focus on reducing the common modifiable risk factors. Maintaining a proper diet, engaging in physical exercise, improving the quality of sleep, not smoking, and limiting alcohol consumption, help to support our immune system. Research has shown that physicians can play a significant role in counseling their patients on this type of behavior. This is the theory put forward by Dr. Erica Frank, the Founder/Principal Investigator of the Healthy Doc = Healthy Patient initiative.
Dr. Frank has undertaken extensive research on the extent to which physicians’ habits shape their patients’ habits. She has collaborated with organizations and individuals around the world on research and interventions on the physical and mental health practices of physicians and on their ability to improve patient health by improving provider health. The Healthy Doc = Healthy Patient initiative was explored in the 2013 research paper “The association between physicians’ and patients’ preventive health practices” by Erica Frank, Yizchak Dresner, Michal Shani, and Shlomo Vinker. The investigators hypothesized that physicians’ preventive health practices would be directly correlated with those of their patients. They were able to determine that objectively establishing this healthy doctor–healthy patient relation should encourage researchers to test various ways to promote physician health as a way to encourage patient health, medical schools to produce more avid preventionists, and health care systems to support physician health.
While prior literature showed that promoting physicians’ personal health habits would more likely result in patients adopting similar habits, Dr. Frank and her colleagues were the first to study whether such promotion occurs in medical school. Based on compelling data illustrating that healthcare providers preach what they practice, Dr. Erica Frank and her colleagues investigated the possibility that promoting medical student health would be an innovative, efficient, and effective way to improve physician counseling practices.
Dr. Frank and her research team undertook various studies involving several medical schools, tracking the history of medical students’ attitudes about health and their subsequent counseling behaviors. These studies included data from surveys of students in 17 medical schools between 1999 and 2003, and showed a strong correlation between teaching healthy behaviors to medical students, and them becoming better counselors and more avid preventionists. They also worked on a series of programs built into and around the medical curriculum at Emory University School of Medicine in Atlanta, Georgia. The project was designed to improve prevention counseling by improving the personal health practices of medical students.
The research reveals that the patient counseling practices with which medical students graduate, provide the foundation of their counseling practices as physicians. 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 healthy behaviors.
This is illustrated in Frank, Smith, and Fitzmaurice (2005) where a set of curricular and extracurricular activities were developed to improve prevention counseling by improving the personal health practices of Emory University School of Medicine’s Class of 2003. Overall, the students enjoyed many components of the intervention, especially the extracurricular activities, and recognized that they and their classmates were at risk for unhealthy behaviors that had personal and clinical implications. However, many also felt resentful and that they were nagged.
In the study “Predictors of US medical students’ prevention counseling practices” (Frank et al., 2007), in order to understand predictors of medical students’ prevention counseling practices, medical students in the Class of 2003 at freshman orientation were surveyed at entrance to wards and again during senior year, in a nationally representative sample of 16 US medical schools. It was concluded that several of the variables predicting physician counseling, also predict US medical students’ reporting counseling, particularly personal health practices and specialty type. It should be noted that students believed that the avidity with which medical schools encourage them to be healthy, significantly influenced their reported patient counseling.
Another study was also conducted where data was collected through four different modalities: a literature review, a written survey of medical school Deans and students, focus groups of preclinical and clinical medical students and deans, and site visits and interviews with medical schools, with reportedly outstanding student health promotion programs (Frank, Hedgecock & Elon, 2004). It was found that while students seemed to have thought little about the relationships between their own personal and clinical health promotion practices, deans felt strongly that faculty members should model healthy behaviors.
In addition to schools surveyed in the United States, the association between personal health practices and attitudes toward preventive counseling among first and fifth-year students from 8 medical schools in Bogotá, Colombia was also examined (Duperly et al., 2009). In 2006, a total of 661 first- and fifth-year medical students completed a culturally adapted Spanish version of the “Healthy Doctor = Healthy Patient” survey. Similar to U.S. physicians and medical students, a positive association was found between the personal health habits of Colombian medical students and their corresponding attitudes toward preventive counseling, independent of gender and medical training-related factors.
The significant research done by Dr. Frank and her colleagues was the first which tested the correlation between medical students’ personal health habits and counseling practices. It proved that the promotion of healthy behavior by medical schools can affect the counseling practices of physicians in training.
Since the research initiated by Dr. Frank and her colleagues on medical students’ healthy behaviors, there has been a growing body of work in this area, many of which have cited the work by Dr. Frank. This includes Rempel, Barlow, and Kaldjian (2021), where a cross-sectional, anonymous, online survey of all medical students at the University of Iowa Carver College of Medicine was conducted in fall 2019, regarding professional challenges and expectations for living healthy lifestyles. The findings showed that most medical students support the professional responsibility to live a healthy lifestyle and believe doing so increases their effectiveness in counseling patients about healthy lifestyle habits.
Additionally, the research was cited in Bin Abdulrahman et al., (2021), in research conducted among medical students from six medical colleges in Saudi Arabia between September and December 2019. The study proposed that conservation of doctors’ health and well-being should begin when they start their training in medical school. The findings revealed that the majority of these medical students in Saudi Arabia exhibited healthy lifestyles to some extent, and these health-promoting behaviors differed based on sex, especially concerning physical activity and eating patterns.
In a study by Greco et al. (2020) that sought to determine if osteopathic medical students (OMS) who establish healthy behaviors for themselves are more likely to counsel their future patients on appropriate self-care, the lifestyle habits of OMS were compared with those of age-matched peers in other areas of study, which served as the control group. The findings illustrated that OMS studied, exercised, and slept more than age-matched peers, but used more substances to stay awake. While aspects of this study were found to be encouraging, it suggests that further evaluation is needed for schools to assist students in establishing lifelong habits to encourage the wellness of their future patients. These studies support the findings of the Healthy Doc = Healthy Patient initiative. However, it was felt that more research was needed in this area.
Dr. Frank, in founding NextGenU.org, the world’s first portal to free, accredited higher education, used now in over 100 countries, recognized the need to not only democratize health education but also to help primary-care physicians, nurses, and allied health professionals gain a deeper understanding of the adverse effects of lifestyle choices on health, including smoking and alcohol use. Through courses like Lifestyle Medicine, NextGenU.org provides a foundation for theoretical and practical knowledge and skills, as well as an opportunity to plan strategies and practice techniques to encourage positive health behavior changes.
Additionally, the Addiction Training for Health Professionals (ATHP) program is a key partner and sponsor, contributing to the creation of courses, curricula, and training programs for physicians and their teams to prevent and treat substance use disorders. The program’s primary aim is to maximize the number of physicians receiving addiction training and improve health systems through education related to clinical practice, research, policy, and public health.
As the COVID-19 pandemic has illustrated how crucial healthy lifestyles are in preventing and recovering from infections, the impact of physicians on their patients’ health choices cannot be overstated. Accordingly, by training medical students on the effects of lifestyle choices on health, there would be a greater number of physicians who are more likely to counsel their patients about healthy behaviors.
In our next blog, we explore some discoveries and key takeaways from the research on Residents and Addiction. Stay tuned!
References
Abramson, S., Stein, J., Schaufele, M., Frates, E., & Rogan, S. (2000). Personal Exercise Habits and Counseling Practices of Primary Care Physicians: A National Survey. Clinical Journal of Sport Medicine, 10(1), 40–48.
Bin Abdulrahman, K. A., Khalaf, A. M., bin Abbas, F. B., & Alanezi, O. T. (2021). The Lifestyle of Saudi Medical Students. International Journal of Environmental Research and Public Health, 18(15), 7869.
Duperly, J., Lobelo, F., Segura, C., Sarmiento, F., Herrera, D., Sarmiento, O. L., & Frank, E. (2009). The association between Colombian medical students’ healthy personal habits and a positive attitude toward preventive counseling: cross-sectional analyses. BMC Public Health, 9(1).
Frank, E., Carrera, J. S., Elon, L., & Hertzberg, V. S. (2007). Predictors of US medical students’ prevention counseling practices. Preventive Medicine, 44(1), 76–81.
Frank, E., Dresner, Y., Shani, M., & Vinker, S. (2013). The association between physicians’ and patients’ preventive health practices. Canadian Medical Association Journal, 185(8), 649–653.
Frank, E., Hedgecock, J., & Elon, L. K. (2004). Personal health promotion at US medical schools: a quantitative study and qualitative description of deans’ and students’ perceptions. BMC Medical Education, 4(1).
Frank, E., Smith, D., & Fitzmaurice, D. (2005). A description and qualitative assessment of a 4-year intervention to improve patient counseling by improving medical student health. Medscape General Medicine, 7(2), 4.
Greco, L., Gindi, M., Yusupov, E., Niwagaba, L., & Pino, M. A. (2020). Are Medical Students Prepared to Model Healthy Behaviors for Their Future Patients? A Survey Comparing Aged-Matched Peers. Medical Science Educator, 30(2), 843–848.
Kushner, R. (1995). Barriers to Providing Nutrition Counseling by Physicians: A Survey of Primary Care Practitioners. Preventive Medicine, 24(6), 546–552.
Non communicable diseases. (2021, April 13). World Health Organization. Retrieved July 14, 2022, from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Oberg, E., Lobelo, F., Sallis, R., & Frank, E. (2013). HEALTHY DOCS= HEALTHY. First Do No Self Harm: Understanding and Promoting Physician Stress Resilience, 193.
Rempel, A. M., Barlow, P. B., & Kaldjian, L. C. (2021). Medical Education and the Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles. Southern Medical Journal, 114(12), 783–788.
Sherry Joseph
Author
