Technology-Guided Diet Counseling Training Prepares Residents to Implement Shared Decision Making About Diet in Routine Primary Care.

Abstract

Nutrition in medical education is undergoing major reform to prepare physicians to effectively address diet. Presently, trainings emphasize diet history collection, a time-consuming process that is becoming obsolete as automated diet assessment tools are incorporated into healthcare. Instead, physicians need training in shared decision making about diet. Therefore, we developed a diet counseling training using practice-based technology ("Nutri") that trains primary care residents to implement collaborative diet goal setting. To compare effect of Nutri training vs. standard diet counseling training on counseling precursors and identify training elements useful for addressing diet in everyday practice. Participants were randomized to Nutri training or standard diet counseling training. Participants completed a simulated diet counseling session and debrief interview. Fifty-two family and internal medicine residents. Residents completed pre/post surveys assessing diet counseling competence, attitudes, self-efficacy, intention, and training satisfaction. Thematic analysis of interview transcripts uncovered training elements valued. Nutri residents indicated significantly greater training satisfaction (4.08 ± 0.84 vs. 3.42 ± 0.99, p = 0.01) and intention to discuss diet (4.46 ± 0.58 vs. 4.00 ± 0.75, p = 0.02) compared to control. While both trainings improved counseling competence, the Nutri training resulted in greater improvements in attitudes (t = 2.17, p = 0.04) and self-efficacy (two items: t = 3.20, p = 0.004; t = 4.27, p = 0.0002). To best equip physicians to effectively address diet with their patients, residents reported that training should include (1) an explicit role for the physician, (2) a framework to drive tailored diet conversations, and (3) nutrition content aids in clinic. When considered individually, both trainings evaluated favorably; however, qualitative insights reveal Nutri training with guided practice using point-of-care software may better position resident physicians to enact diet counseling. Trainings that outline a clear role for the physician, present a guiding framework, and provide point-of-care implementation tools were suggested by participants to translate learning to practice.