Future doctors unprepared to deliver physical activity advice

15 February 2017

Physical activity (PA) training for medical students in Australia is not keeping pace with the growing obesity and type 2 diabetes epidemics, potentially leaving many future doctors unprepared to help patients.

Man running on treadmill

Image: Militaryhealth/Flickr (CC BY 2.0).

A team of researchers led by the University of Sydney and Exercise & Sports Science Australia (ESSA) surveyed 17 of the 19 medical schools across the country, collecting data from phone interviews and online surveys between June and October 2015 to deliver the first national snapshot of PA training across medical school curricula.

The study found PA counselling was virtually non-existent as part of medical students' total training, with almost half of all medical schools surveyed (42.9 percent) reporting the level of PA training was "insufficient" to prepare their students to provide PA counselling to their future patients. The results are published in the latest Journal of Science and Medicine in Sport.

"Many medical schools in Australia do not even teach the basic PA guidelines, the public guidelines endorsed by the Department of Health. There's a huge discrepancy between practice, knowledge and urgent public health needs," said co-author Associate Professor Emmanuel Stamatakis from the University of Sydney's Charles Perkins Centre and School of Public Health.

"Doctors are a trusted source of health information for patients, and primary care is the obvious place to intervene to help people incorporate PA in their daily living and prevent chronic diseases that costs Australia tens of billions per year. But, in reality, future doctors are largely unprepared for the task.

"Increasing the amount of pre-service PA training opportunities will not only boost doctors' knowledge on the vast importance of PA, but also their confidence to discuss preventative healthcare strategies with their patients before obesity and other chronic diseases arise."

There's a huge discrepancy between practice, knowledge and urgent public health needs.
Associate Professor Emmanuel Stamatakis

Physical activity training widely overlooked

While 15 of the responding schools (88.2 percent) reported providing specific PA training to medical students, the actual amount of time spent on PA training was minimal and varied significantly across medical school curriculums.

The longest programs (six years) spent only 12.3 hours on PA training across the entire degree, with less than half of the medical schools (47.6 percent) teaching national strength guidelines in addition to national aerobic guidelines (86.7 percent). Only six schools (42.9 percent) employed specialised instructors to deliver their PA training.

Physical activity remains the most prevalent chronic disease risk factor in Australia, with 85 percent of Australians not meeting current Department of Health endorsed guidelines for aerobic- and strength-promoting physical activity.

There is a plethora of evidence indicating how exercise can be used to treat many chronic and complex health conditions. Yet Medicare data has shown that less than one percent of patients who are overweight or obese or who had type 2 diabetes were referred to an Accredited Exercise Physiologist for treatment.

"Given the relatively high level of Australian medical schools that provide PA training (88.2 percent), it's surprising that only 60 percent of these programs believe their current level of training is adequate," said co-author Anita Hobson-Powell, Chief Executive Officer of ESSA.

"Despite this apparent insufficiency, more than half of the programs (60 percent) reported having no plans to increase PA training in their future curriculums. It is hard to envisage such a situation for other medical disciplines like cardiology or nephrology, especially when considering the majority of PA education is taught by non-specialised instructors.

"Rather than always reaching for the pharmaceutical prescription pad, we should be training our doctors to refer patients to specialist exercise physiologists and encourage healthy lifestyle changes as a form of treatment.

"It should be the responsibility of every medical school to provide effective PA training for their students, and this pre-service training should be standardised nationally to ensure every patient receives adequate wellness and lifestyle advice."

The study was part of an international program evaluating PA training in medical schools, and was a collaboration between the University of Sydney, ESSA, University of Miami, University of Melbourne, and Wake Forest University.

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