TEACHING DIETARY COUNSELING SKILLS TO RESIDENTS - PATIENT AND PHYSICIAN OUTCOMES

Our objective was to determine whether an educational intervention and prompting intervention for physicians improved dietary counseling of patients with high blood cholesterol and resulted in beneficial change s in patients' diets and cholesterol levels. We instituted a factorial design, multicenter, randomized, placebo-controlled trial to test two interventions. We tested the trial at continuity care clinics of inte rnal medicine residents at seven community and university medical cent ers in the northern and eastern United States. Our participants were 1 30 internal medicine residents and 254 adult outpatients with blood ch olesterol levels of 240-300 mg/dL. Interventions included an education al program for resident physicians designed to improve their skills an d confidence in dietary counseling (two one-hour sessions with special ly prepared printed materials for use in counseling) and a prompting i ntervention, which was a fingerstick blood cholesterol determination p rior to the patient's clinic visit. Resident physicians' knowledge, at titudes, and self-reported behaviors were assessed prior to the interv ention and 10 months later using chart audits and questionnaires. Resi dents' behaviors were also assessed by exit interviews with patients. Patients' knowledge, attitudes, behaviors, and fingerstick blood chole sterol levels were measured at baseline and 10 months later. The educa tional program increased the percentage of physicians who were confide nt in providing effective dietary counseling (baseline of 26% to 67%-7 8%; P < .01). The prompting intervention approximately doubled the fre quency of physician counseling (P = .0005) and increased the likelihoo d that patients would try to change their diets. When both interventio ns were combined, most outcomes were better, although not statisticall y significant. Cholesterol levels, however, decreased only marginally and were no different among groups at 10-month follow-up. Despite succ ess in changing physicians' attitudes and behaviors and increasing pat ients' willingness to change their diets, there was no significant cha nge in patients' cholesterol levels.