Tomorrow's doctors not 'learning enough about exercise benefits'
Medical students are “not taught activity benefits” BBC News has reported, based on a survey checking how many UK medical schools provided their students with information on the health benefits of physical activity.
This led The Daily Telegraph to claim “Doctors are failing to advise patients on the benefits of exercise because its teaching is ‘sparse or non-existent’ in medical schools”.
The survey assessed the provision of physical activity teaching in the curricula of all UK medical schools. The survey results uncovered what the authors call “alarming findings”, showing that there is widespread omission of basic teaching elements, such as the guidelines of the Chief Medical Officer (CMO) on physical activity. The survey found that just under half of the schools (44%) did not teach the CMO guidelines to their students.
The current study follows an earlier article by two of the same authors, in which they presented the exercise recommendations given by 39 national guidelines. The authors argued that medical professionals have a duty of care to promote exercise as inactivity is a known risk factor for many chronic diseases, such as heart disease. They suggested that one of the problems may be a lack of education on exercise in medical schools, which seems to be a valid criticism given the results of the survey.
The authors conclude that there is an urgent need for physical activity teaching to be adequately included in medical school education.
While this is a worthy call to action for doctors and medical educators and highlights the need for further research into the best ways of promoting physical activity, it is not exacting evidence that standards of medical education are poor or that doctors are neglecting to offer sensible and straightforward exercise advice to their patients.
Where did the story come from?
The current study was authored by professionals from University College London. No sources of funding are reported.
The study was published in the peer-reviewed British Journal of Sports Medicine.
The news is generally representative of this research, although the Telegraph’s headline rests on an unproven assumption that doctors are failing to communicate the benefits of exercise to their patients. The survey only reviewed the provision of exercise education in medical schools and was not designed to look at the care provided by doctors.
There is also no acknowledgement that people can gain information on the benefits of exercise from a wide range of sources (such as the NHS Choices website), and not just their GP.
What kind of research was this?
This research presents the findings of a questionnaire issued to 31 medical schools in the UK to assess the content, form and timing of key aspects of education on physical activity promotion according to current national guidelines. As a cross-sectional survey it is representative of current practice within the assessed UK medical schools.
This survey follows an earlier non-systematic narrative review in which two of the authors of the current study had presented their viewpoint on the duty of care of medical professionals to promote exercise. In that review the authors discussed where they felt that education on exercise might have been lacking in medical schools. As part of their review they had presented the exercise recommendations given by national guidelines, including those published by the National Institute for Health and Clinical Excellence (NICE), in addition to supplementary articles including Department of Health recommendations, medical policy, exercise education in medical schools and physical activity in the UK.
The authors suggest that low levels of physical activity may contribute to the high levels of chronic disease in the UK and elsewhere.
How was the research conducted?
The researchers contacted 31 medical schools by telephone to introduce the study and to confirm who was the curriculum director for medical studies. A questionnaire and cover letter were sent by email to each curriculum director. The questionnaire quantified the amount, number of years and total time devoted to teaching about physical activity within the full undergraduate curriculum of each medical school. The questionnaire was designed to see whether future doctors were taught the basic knowledge and skills they would need to promote physical activity effectively to patients. Questions were also asked to see whether the current CMO guidance for physical activity featured in the curriculum, and to see in which specific teaching modules exercise education was contained. Information on any future plans for physical activity education was also requested.
What were the basic results?
All 31 medical schools responded to the questionnaires, though response rates for individual questions varied. The main findings were that:
- Five medical schools did not include any specific physical activity teaching within their curricula.
- Four medical schools taught physical activity within all five years of the curriculum.
- The average number of hours devoted to teaching physical activity throughout the entire curriculum was 4.2 hours, though this question was only answered by 12 schools.
- Fifteen medical schools taught the current CMO guidance for physical activity.
- Two common themes emerging from free text responses in relation to physical activity teaching were that the curriculum was ‘integrated’ (12 mentions by 8 schools) and that it is ‘difficult to quantify/assess’ (five mentions by four schools) the teaching of physical activity within these curricula.
- The modules within which physical activity teaching featured varied greatly between medical schools (for example, public health teaching, cardiology, respiratory teaching).
How did the researchers interpret the results?
The authors say that only 15 medical schools in the UK (56% of those who responded) taught the recommended CMO guidance for physical activity to future doctors. They say “there is an urgent need for physical activity teaching to have dedicated time at medical schools, to equip tomorrow’s doctors with the basic knowledge, confidence and skills to promote physical activity and follow numerous clinical guidelines that support physical activity promotion”.
What did the previous review say about duty of care and medical education?
In their earlier review, the authors said that doctors have a ‘duty of care’ - a legal obligation that their actions conform to the standards recommended by a responsible body of professionals. In the UK, such standards are set in guidelines, such as those published by NICE and royal colleges. They discussed the fact that numerous responsible bodies of professionals have recognised the extensive evidence base and cost-effectiveness of supporting physical activity promotion as a way to prevent and treat various diseases, and presented the physical activity recommendations of 39 national guidelines, including disease-specific guidelines. They had considered that if a doctor managing a patient does not advise appropriately on physical activity when it is relevant, then it could be considered medical negligence.
On medical education, the previous narrative said that guidance from the General Medical Council (GMC) on “good medical practice” suggested that doctors should “protect and promote the health of patients and the public”. However, it said that in many medical schools exercise is not part of the core curriculum. Currently, the GMC is reported not to include physical activity education as a curriculum requirement for medical schools. The GMC, the authors said, is in a position to ensure that future medical practice begins to focus on preventive medicine and health promotion as ways to treat illness. They said that the GMC also has a duty of care to the public and is in a position to review medical school curriculum requirements relating to the promotion of health and prevention of disease, providing greater emphasis and guidance for physical activity education.
This survey raises important issues. Regular physical activity, in addition to a balanced diet and other positive lifestyle behaviours, such as not smoking and limiting alcohol, is well established as an important part of maintaining good health and a good way to reduce the risk of many diseases.
In a previous non-systematic review, two of the authors of the current survey had presented physical activity recommendations of 39 national guidelines, and considered that one of the reasons why physical activity promotion may not always be given as appropriate by doctors is due to a lack of training in medical schools. This review was primarily an opinion piece based on a literature review, and it is unclear whether other evidence and other viewpoints may present a different case. The current survey lends extra support to their case, finding that only 15 schools (56% who responded) included CMO guidance for physical activity in the curriculum. Five schools gave no exercise education at all.
Together, the two articles present a “call to action” for many professionals, claiming that despite physical activity recommendations in many national guidelines, exercise is still not being adequately promoted within medical practice, and is not being consistently included as part of the curriculum at medical schools.
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