Physical activity counseling in medical school education: a systematic review.
Physical activity counseling in medical school education: a systematic review.
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DOI：
10.3402/meo.v19.24325
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发表时间：
2014
影响因子：
4.6
通讯作者：
Phillips EM
中科院分区：
文献类型：
--
作者：
Dacey ML;Kennedy MA;Polak R;Phillips EM
尽管有大量证据表明定期体育活动（PA）对健康有益，但很少有医生将PA咨询纳入办公室就诊。医疗培训不足被认为是造成这种情况的一个原因。这篇综述描述了课程的组成部分，并评估了已报道的医学院校PA咨询教育结果的有效性。作者系统地检索了MEDLINE、EMBASE、PsychINFO和ERIC数据库，检索了2000年至2012年期间发表的符合PICOS纳入标准的PA咨询技能发展和结果评估的医学院项目的英文文章。最初的检索得到了1944次引用，有11项研究代表了10个独特的项目符合本综述的标准。对这些研究进行了描述和研究质量分析。本研究还评估了多个研究共有的六个测量结果的证据强度，即学生对PA益处的认识、学生对PA态度的改变、个人PA行为的改变、PA咨询知识和技能的提高、进行PA咨询的自我效能感和对PA咨询态度的改变。注意到教学方法、持续时间和课程安排的相当大的异质性。薄弱的研究设计限制了对有效性的最佳评估，也就是说，很少有研究提供干预前/干预后评估，和/或包括对照比较，或满足干预透明度和偏倚风险控制的标准。改善证据最明显的课程在学生对PA的态度、PA咨询知识和技能以及进行PA咨询的自我效能感方面都有积极的变化。这些项目很可能遵循之前的建议，包括体验式学习、基于理论的框架和学生的个人PA行为。目前的结果为以前的建议提供了一些支持，目前正在开展以这些建议为基础的举措。然而，在医生的做法和病人的结果的改善的证据是缺乏的。建议包括课程发展的未来方向和更严格的研究设计。
Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs.