Submitted to: Teaching and Learning in Medicine
Publication Type: Peer reviewed journal
Publication Acceptance Date: 7/1/2006
Publication Date: 7/1/2006
Citation: Rogers, L.Q., Gutin, B., Humphries, M.C., Lemmon, C.R., Waller, J.L., Baranowski, T., Saunders, R. 2006. Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived Success. Teaching and Learning in Medicine. 18(3):215-221. Interpretive Summary: Physicians need to counsel their patients to be more physically active. This study examined correlates of physical activity counseling among 51 internal medicine residents. Most residents did not have the attributes to be successful physical activity counselors.
Technical Abstract: Background: Patients perceive physicians who practice healthy personal behaviors as more credible and better able to motivate patients to make healthy lifestyle choices. Purposes: To evaluate internal medicine resident physicians as role models for promoting exercise by an assessment of physician physical activity behavior, cardiovascular fitness, physical activity knowledge, personal use of behavior modification techniques, attitudes toward personal physical activity practice, and confidence (i.e., self-efficacy) in the knowledge and personal utilization of behavior modification techniques and to explore the associations with self-reported patient counseling behavior, confidence, and perceived success. Methods: Cross-sectional study of internal medicine resident physicians with a self-administered survey, treadmill fitness testing, and a 7-day physical activity recall. Results: Fifty-one resident physicians agreed to participate (response rate = 81%). Fitness levels were below average for 60%, average for 25%, and above average or excellent for 15%. The mean energy expenditure was 234 kcal/kg/week, with 41% of physicians meeting recommended physical activity guidelines. Few reported high self-efficacy (33%) or perceived success (25%) in the ability to be regularly active. Few demonstrated adequate knowledge useful for patient counseling (e.g., listing 3 ways to integrate physical activity into daily life [27%], calculating target heart rate [29%], and identifying personal exercise stages of change [25%]). Personal use of behavior modification techniques was reported infrequently. Although 88% reported confidence in the knowledge of exercise benefits, less than half reported confidence in the knowledge of local facilities, American College of Sports Medicine (ACSM) guidelines, and behavior modification techniques. Multiple linear regression demonstrated that a higher level of training (p=0.02) and a greater confidence in the knowledge of ACSM guidelines (p=0.048, total R2=0.21) independently predicted more frequent self-reported counseling. Sex (i.e., male; p=0.01) and greater physical activity self-efficacy (p=0.017, total R2=0.23) independently predicted greater perceived counseling success. Greater physical activity enjoyment (p=0.03) and greater perceived success at engaging in regular physical activity (p=0.028, total R2=0.28) independently predicted greater counseling self-efficacy. Conclusions: Most internal medicine resident physicians may not be adequate role models for promoting exercise adherence. Confidence in the knowledge of current guidelines, personal physical activity enjoyment, and perceived success and self-efficacy in engaging in regular physical activity may be useful targets for enhancing resident physician physical activity counseling for their patients.