Extension of the 5As Team Study for Improved Provider Obesity Management to Physicians and Medical Trainees (Part 2)
Extension of the 5As Team Study for Improved Provider Obesity Management to Physicians and Medical Trainees (Part 2)
Results from the 5As Team (5AsT) Study have identified critical gaps in medical school
 curricula on obesity, leading to a wave of new family physicians who lack confidence and are
 poorly equipped to manage obesity with their patients. In an effort to address this gap, all
 first year medical residents training in family medicine at the University of Alberta during
 the 2015/2016 year will be required to take a 2 day workshop in Obesity Management as part of
 the Doctor-Patient Relationship Course. The comprehensive workshop provides medical residents
 with knowledge and training in obesity prevention and management through didactic lectures,
 experiential learning, and clinical practice. Participants were asked to complete and submit
 pre- and post- workshop assessment measuring self-reported confidence on aspects of weight
 management counselling, narrative reflections regarding the experiential components of the
 course, and measures to assess beliefs and attitudes towards people living with obesity. The
 purpose of our program evaluation was to assess the program's impact on residents' knowledge
 of obesity and attitude towards counselling patients with obesity, as well as to refine and
 further develop the course. Evaluation of the 5AsT-MD pilot project shows increases of
 residents' understanding of the complexity and chronicity of obesity, and an uptake of the
 5As framework and tools by residents to improve confidence and success of their weight
 management practice.
Background:

 Obesity is a complex chronic condition that negatively impacts individuals, society, and the
 healthcare system. Family physicians are one of many health practitioners tasked with the
 long-term care of patients with obesity and its associated co-morbidities. However, focus
 groups conducted by the 5As Team (5AsT) have identified critical gaps in medical school
 curricula on obesity, leading to a wave of new family physicians who are unconfident and
 poorly equipped to manage obesity with their patients. To address this education gap, the 5As
 team developed a comprehensive training module on obesity management for family medicine
 residents at the University of Alberta.

 Study Objectives:

 This study aimed to evaluate the impact of this course on the residents' attitudes and
 beliefs about obesity, as well as confidence levels using key aspects of the 5As of obesity
 management to help their patients.

 Methods:

 Based on focus groups conducted with medical students and practicing physicians during a
 summer project, a list of learning objectives was made to address known deficiencies in
 obesity education. These learning objectives were adapted to a two-day training module on
 obesity management for first year family medicine residents. All 2015/2016 and 2016/2017
 first year medical residents were required to take a 2 day Obesity Management Workshop as
 part of their Doctor-Patient Relationship course. Prior to the workshop, residents were asked
 to complete a pre-workshop assessment which asked them to rate their level of confidence
 counselling patients on several aspects of obesity management. In addition, residents
 enrolled in the year 2015/2016 were asked to complete the Attitudes Toward Obese Persons
 (ATOP) and Beliefs About Obese Persons BAOP questionnaires, residents enrolled in the
 2016/2017 year were asked to complete the NEW Attitudes Scale. The first day consisted of
 didactic lectures on the basic pathophysiology of obesity, obesity management in pediatrics
 and pregnancy, and an introduction to the 5As of obesity management. Residents were also
 given the opportunity to experience wearing a bariatric suit in a simulated living
 environment after which they were asked to complete their first narrative reflection
 assignment. The second day of the workshop consisted of didactic lectures on lifestyle
 management and bariatric surgery, followed by practice sessions with standardized patients.
 Residents were then asked to find a patient with lived experience in their own clinic and
 practice using the 5As approach with their own patient and then complete their second
 narrative reflection assignment.

 Consent:

 Residents were informed about the 5AsT MD2 study on the first day of the 2-day workshop and
 asked if they would like to participate. If a resident declined to participate, they were
 still able to take part in the workshop and were still required to complete the course
 assignments listed above, however, their course materials were not provided to the research
 team.

 Study Procedures:

 Those residents who consented to participate in the study, were asked to place their required
 course materials into a sealed envelope and will then submit them to a neutral, third party.
 The neutral, third party was an employee in the Department of Family Medicine and had no
 responsibilities with regards to evaluation of the medical residents. The neutral, third
 party recorded that the resident had completed their assignment for the course, assigned an
 Identification (ID) number to each resident and labelled each document as well as the
 envelope with the resident's ID number. Using a paper cutter, the neutral, third party
 removed the resident's name from each document. A master list was kept by the neutral, third
 party, which allowed her to track which ID number corresponded to which resident so that she
 could appropriately label all of the post-workshop documents with the resident's assigned ID
 number. Only the neutral, third party had access to the master last with the residents names.

 Following the workshop on the second day, the residents who consented to participate, were
 asked to submit their post-workshop course materials, in a sealed envelope, to the neutral
 third party. The neutral, third party recorded that the resident completed their assignment
 for the course, labelled their documents and envelope with the correct ID number and then
 removed the resident's name from the documents. The de-identified materials of those
 residents who consented to participate were given to study staff. The narrative reflective
 exercises for both part 1 and part 2 of the workshop were due 2 weeks post-workshop event.

 Results:

 Participants completed the validated ATOP (Attitudes Toward Obese Persons) and BAOP (Beliefs
 About Obese Persons) questionnaires, as well as pre- and post- workshop assessment
 questionnaires to measure their level of confidence in performing key aspects of obesity
 management. All questionnaires were de-identified, but responses were tracked both before and
 after the training module to quantify the change seen in each study participant. Participants
 also wrote two de-identified narrative reflections to be used for qualitative analysis. The
 first was on the weight bias bariatric suit experience, and the second was on the application
 of the lessons of the workshop in clinical practice.
Inclusion Criteria:

 -  Participants must be first year medical residents training in family medicine at the
 University of Alberta. They will be recruited from the Obesity Management Workshop
 that is a required component of their course on Doctor-Patient Relationships. All
 participants must be over the age of 18 and be able to communicate effectively in
 English.

 Exclusion Criteria:

 -  If participants are unable to communicate effectively in English, they will not be
 able to participate in the study. The Obesity Management Workshop will be presented in
 English and participants must be able to understand the presentation and written
 documents that they are being asked to complete.