Establishing Competencies for Physicians Who Specialize in the Practice of Lifestyle Medicine

Purpose: This activity by the Expert Lifestyle Medicine Panel (ELMP) proposes a set of competencies for providers who specialize in the practice of lifestyle medicine (LM), focused on intensive therapeutic lifestyle change. Methods: ELMP invited a core consensus group consisting of 13 providers who specialize in LM and key stakeholders to develop, by consensus, a set of competencies for those specializing in the practice of LM based on the LM core competencies for primary care physicians published in 2010. Two ELMP members (JK and MCK) facilitated and moderated the consensus process conducted by email and teleconference. The competencies were emailed to the consensus group for comment and revision and, through an iterative process, full consensus was reached by the 13-member group. Competencies were organized into the 6 Accreditation Council for Graduate Medical Education and American Board of Medical Specialties (ACGME/ABMS) categories. Results: The final set of competencies consist of 34 competencies in the 6 ACGME/ABMS categories. Conclusion: This new set of competencies will provide guidance for the education, certification, and practice of lifestyle medicine by physicians and other health providers who specialize in the practice of intensive lifestyle medicine treatment.

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Lifestyle Medicine Around the World: Lifestyle Medicine in Israel

American Journal of Lifestyle Medicine ◽

10.1177/1559827619880533 ◽

2019 ◽

Vol 14 (4) ◽

pp. 377-381

Author(s):

Lilach Malatskey ◽

Igal Hekselman ◽

Shani Afek

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Medical Profession ◽

Daily Practice ◽

Well Being ◽

The United States ◽

Noncommunicable Disease ◽

Active Member ◽

Health Providers ◽

Lifestyle Medicine

In 2015, the Centers for Disease Control in the United States declared that 7 of 10 deaths per year are caused by chronic diseases; in Israel, the situation is consistent with this assessment. Healthy Israel 2020, an Israeli Ministry of Health initiative, places physicians at the forefront of health promotion and preventive medicine. In 2012, the Israeli Society of Lifestyle Medicine (ISLM) was established under the auspices of the Israel Association for Family Physicians. This decision was taken because we, the authors, wanted to promote change in the primary care services through the recruitment of key leaders for implementation of lifestyle medicine (LM), including improved attitudes, knowledge, motivation, and skills of primary care physicians and health providers. Today, the ISLM is an active member of the Israeli Medical Association, promoting educational activities, physician’s health, and well-being initiatives; developing tools for health-promoting clinics; and more. Our future plans are to incorporate LM as an integral part of daily practice in all sectors of the medical profession in Israel. This is challenging, but we see this as the only way to effectively combat the noncommunicable disease epidemic.

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Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

SAGE Open Nursing ◽

10.1177/23779608211029067 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110290

Author(s):

Jing Xu ◽

Kristen Hicks-Roof ◽

Chloe E. Bailey ◽

Hanadi Y. Hamadi

Keyword(s):

Health Professionals ◽

Online Survey ◽

Evidence Based Practice ◽

Core Competencies ◽

Healthcare Services ◽

Interdisciplinary Teams ◽

Evidence Based ◽

Health Providers ◽

Cross Sectional ◽

The Impact

Introduction Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine’s (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice. Objective The purpose of the study was to examine the factors that influence health professional’s likelihood of accomplishing the IOM core competencies. Methods A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey. Results The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts. Conclusion There is a need to understand how health professionals’ age and experience impact their engagement with IOM’s core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers’ age and experience.

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Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities

American Journal of Lifestyle Medicine ◽

10.1177/15598276211008127 ◽

2021 ◽

pp. 155982762110081

Author(s):

Neha Pathak ◽

Amanda McKinney

Keyword(s):

Climate Change ◽

Human Health ◽

Core Competencies ◽

Well Being ◽

Health Impacts ◽

Noncommunicable Diseases ◽

Potential Health ◽

Lifestyle Medicine ◽

The Face ◽

Mitigate Climate Change

Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as “threat multipliers,” especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.

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A protocol for the Development of Core Outcome Sets for Endodontic Treatment modalities (COSET): an international consensus process

10.21203/rs.3.rs-610497/v1 ◽

2021 ◽

Author(s):

Ikhlas El karim ◽

Henry F Duncan ◽

Siobhan Cushley ◽

Venkatesh Nagendrababu ◽

Lise-Lotte Kirkevang ◽

...

Keyword(s):

Clinical Studies ◽

Endodontic Treatment ◽

Treatment Modalities ◽

Core Outcome ◽

Consensus Process ◽

International Consensus ◽

Core Outcome Sets ◽

Key Stakeholders ◽

Dental Practitioners ◽

Patient Reported

Abstract BackgroundThe outcome of endodontic treatment is generally assessed using a range of patient and clinician-centred, non-standardised clinical and radiographic outcome measures. This makes it difficult to synthesise evidence for systematic analysis of the literature and the development of clinical guidelines. Core outcome sets (COS) represent a standardised list of outcomes that should be measured and reported in all clinical studies in a particular field. Recently, clinical researchers and guideline developers have focussed on the need for integration of a patient-reported COS with clinician-centred measures. This study aims to develop a COS that includes both patient reported outcomes and clinician centred measures for various endodontic treatment modalities to be used in clinical research and practice.MethodsTo identify reported outcomes (including when and how they are measured), systematic reviews and their included clinical studies, which focus on the outcome of endodontic treatment and were published between 1990 and 2020 will be screened. The COSs will be defined by a consensus process involving key stakeholders using semi-structured interviews and an online Delphi methodology followed by an interactive virtual consensus meeting. A heterogeneous group of key ‘stakeholders’ including patients, general dental practitioners, endodontists, endodontic teachers, clinical researchers, students and policy-makers will be invited to participate. Patients will establish, via interactive interviews, which outcomes they value and feel should be included in a COS. In the Delphi process, other stakeholders will be asked to prioritise outcomes identified from the literature and patients interviews, and will have the opportunity at the end of the first round to add outcomes that are not included, but which they consider relevant. Feedback will be provided in the second round, when participants will be asked to prioritise the list again. If consensus is reached, the remaining outcomes will be discussed at an online meeting and agreement established via defined consensus rules of outcome inclusion. If consensus is not reached after the second round, a third round will be conducted with feedback, followed by the online meeting. Following identification of a COS, we will proceed to identify how and when these outcomes are measured.DiscussionUsing a rigorous methodology, the proposed consensus process aims to develop a COS for endodontic treatment that will be relevant to stakeholders. The results of the study will be shared with participants and COS users. To increase COS uptake, it will also be actively shared with clinical guideline developers, research funders and the editors of general dental and endodontology journals.Study registrationThe study is registered in COMET (https://comet-initiative.org/Studies/Details/1879)

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Billing Codes Determine Lower Physician Income for Primary Care and Non-Procedural Specialties

Forum for Health Economics & Policy ◽

10.1515/fhep-2019-0009 ◽

2019 ◽

Vol 22 (2) ◽

Author(s):

Arielle L. Langer ◽

Miriam Laugesen

Keyword(s):

Primary Care ◽

Family Medicine ◽

Primary Care Physicians ◽

Direct Consequence ◽

Medical Specialties ◽

Income Differences ◽

Income Gap ◽

Physician Income ◽

The Difference ◽

The Relationship

Abstract The income gap between specialists and primary care physicians and among specialists is well established, but the drivers of this difference are not well delineated. Using the Community Tracking Study (CTS) Physician Survey, we sought to isolate and compare premiums paid to physicians for specialization and the proportion of time spent on offices visit rather than procedures. We divided medical subspecialties according the proportion of Medicare billing for Evaluation and Management (E&M) codes for the specialty as a whole. We report substantial differences in income across physician specialty, and over 70 percent of the difference in income remained controlling for factors that may confound the relationship between income and specialty including gender, location and type of practice, and hours. We note a large variation in premiums for specialization: 11.3–46.8 percent above family medicine after controlling for confounders. Classifying medical subspecialties by E&M billing as procedural versus non-procedural specialties revealed clear income differences. Controlling for confounders, procedural medical specialties earned 37.5 percent more than family medicine, as compared with 15.3 percent for non-procedural medical specialties. This analysis suggests that differences in physician income and resulting incentives are a direct consequence of the payment structure itself, rather than compensation for additional years of training or a reflection of different underlying demographics.

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Catalysts for Change: Accelerating the Lifestyle Medicine Movement Through Professionals in Training

American Journal of Lifestyle Medicine ◽

10.1177/1559827619844505 ◽

2019 ◽

Vol 13 (5) ◽

pp. 487-494 ◽

Cited By ~ 2

Author(s):

Melissa M. Mondala ◽

Deepa Sannidhi

Keyword(s):

Health Care ◽

Nutrition Education ◽

Health Care Professionals ◽

Primary Care Physicians ◽

Medical Training ◽

Salt Intake ◽

Saturated Fat ◽

Well Being ◽

Dietary Counseling ◽

Lifestyle Medicine

While the Western diet has evolved to become increasingly high in saturated fat, cholesterol, protein, sugar, and salt intake, nutrition education and training of health care professionals to counsel their patients on the hazards of such a diet has trailed behind. Primary care physicians have an opportunity to bridge the gap by providing nutrition and dietary counseling as key components in the delivery of preventive services. Increasing research points to the value of a whole-foods plant-based diet in combating chronic disease, yet the knowledge of health professionals about the topic is comparable to that of the general public. This education crisis is apparent in medical training with restricted time for dedicated lectures on nutrition, physical activity, restorative sleep, emotional well-being, and avoidance of risky substance use. Together, educators and learners are valuable catalysts for culture change in medical education, training, and clinical practice. Barriers to physician ability to counsel about lifestyle are many, but one that stands out is lack of training and comfort with counseling. This has implications for the training of health care professionals. American College of Lifestyle Medicine has a committee, Professionals in Training, composed of interprofessional and multidisciplinary students, residents, and fellows nationally and worldwide who are committed to expanding exposure to lifestyle medicine and implementation of lifestyle medicine in parallel curriculum and personal care.

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Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

Clinical Pediatrics ◽

10.1177/0009922818810881 ◽

2018 ◽

Vol 58 (2) ◽

pp. 213-225 ◽

Cited By ~ 1

Author(s):

David J. Kolko ◽

Eunice Torres ◽

Kevin Rumbarger ◽

Everette James ◽

Renee Turchi ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Behavioral Health ◽

Integrated Care ◽

Primary Care Physicians ◽

Empirical Literature ◽

Health Providers ◽

Pediatric Health ◽

Care Experience ◽

Pediatric Health Care

This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study’s limitations and empirical literature.

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Lifestyle Medicine Professionals in Training: A Survey of Behaviors, Knowledge and Needs

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2017.1655 ◽

2017 ◽

Author(s):

Camille Clarke ◽

Jonathan Bonnet ◽

Marsha Gail Davis ◽

Elizabeth Frates

Keyword(s):

Healthy Lifestyle ◽

Disease Risk ◽

Core Competencies ◽

Medical Model ◽

Training Experience ◽

Health Habits ◽

Lifestyle Medicine ◽

Behavioral Counseling ◽

Interdisciplinary Healthcare ◽

Lifestyle Related Diseases

Background/Purpose: It is well known that healthy lifestyle habits can influence chronic disease risk and outcomes. The effective practice of Lifestyle Medicine (LM), however, goes beyond general recommendations and has been encapsulated in well-defined clinical competencies. While it has been documented that graduating medical students feel inadequately prepared to counsel patients in nutrition and exercise, the purpose of this study is to explore the perceptions and experiences of Lifestyle Medicine in a group of interdisciplinary healthcare trainees. Methods: A pilot survey of trainees at the 2015 Annual American College of Lifestyle Medicine (ACLM) Conference assessed perspectives on the inclusion of nutrition and exercise in their educational curricula, knowledge of core LM competencies and personal health habits. Results: Of the 37 trainees registered, 22 surveys were completed. Twenty-six percent indicated they were exposed to courses in exercise; sixty-five percent reported having a nutrition block and fifty percent received instruction on counseling about LM behaviors. Relative importance using Likert scale (1-not important, 5-very important) ascribed similar levels of importance to exercise (4.44), nutrition (4.31), and behavioral counseling (4.58) training. Ninety-five percent reported personal engagement in physical activity, however only forty-two percent were familiar with the Lifestyle Medicine core competencies. Ninety-four percent indicated that the current medical model was insufficient in educating trainees to address lifestyle related diseases. Conclusion: In a select multidisciplinary sample of trainees, there is recognition of the importance of Lifestyle Medicine training. Although trainees surveyed practice healthful behaviors, the majority were not familiar with core Lifestyle Medicine competences and express strong interest in increased Lifestyle Medicine in their training experience.

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Exploring perception and usage of narrative medicine by physician specialty: a qualitative analysis

Philosophy Ethics and Humanities in Medicine ◽

10.1186/s13010-021-00106-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Daniel A. Fox ◽

Joshua M. Hauser

Keyword(s):

Primary Care ◽

Time Management ◽

Primary Care Physicians ◽

Qualitative Content Analysis ◽

Narrative Medicine ◽

Primary Care Providers ◽

Negative Consequences ◽

Care Providers ◽

Medical Specialties ◽

General Internists

Abstract Background Narrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research. Methods Fifteen senior physicians who specialize in internal medicine, pediatrics, or surgery (5 physicians from each specialty) were interviewed in a semi-structured format about the utilization, benefits, drawbacks (i.e., negative consequences), and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed. Results Three themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians (general internists and general pediatricians) also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers (surgeons) generally believed narrative medicine is valuable in their practice as well. Within specialties, providers’ choice of language varied when trying to obtain patients’ narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient’s narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients’ narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine. Conclusions This study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study.

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