Obesity Gets Little Attention in Medical Licensing Exams

If the nation’s doctors are going to do more to help patients fight obesity, a new study suggests a good place to start: put it on the test.

A study from Northwestern University finds that obesity is barely covered in medical training, and licensing exams for graduating medical students have very few questions about the condition, even though it is rising health threat that leads to diabetes, cancer, and other problems.

Lead study author Robert Kushner, MD, professor of medicine at the Northwestern’s Feinberg School of Medicine, described the phenomenon as a “trickle-down effect,” in a statement. “If it’s not being tested, it won’t be taught as robustly as it should be.”

Attitudes of primary care physicians can be one of the biggest hurdles for obese patients seeking good care, according to Janine Kyrillos, MD, an obesity specialist at Thomas Jefferson University Hospital in Philadelphia. She told The American Journal of Managed Care in an interview last year, “There’s still a big obesity bias, the thought that patients need to do this on their own, that it’s a lifestyle flaw. And granted, there’s personal responsibility, but all chronic diseases have personal responsibility.”

The Northwestern study, which appeared in the journal Teaching and Learning in Medicine, allowed a panel of 6 content experts to examine and code 800 test items that were selected by the National Board of Medical Examiners. The items were coded based on terms used on the certification test from the American Board of Obesity Medicine (ABOM), a licensing body created in 2011. The expert panel then evaluated the frequency and relevance of the obesity items on the 3 steps of the United States Medical Licensing Examinations (USMLE), which are required of all medical students and first-year residents.

Researchers found:

• Most of the obesity-related items were found on questions about diagnosing and managing comorbid conditions that result from obesity, rather than obesity itself.
• According to the study, “The most important concepts of obesity prevention and treatment were not represented,” on the USMLE.
• The review panel found several important obesity-related topics that were inadequately addressed or left off the licensing exams.

With nearly 40% of adults and 20% of children and adolescents classified as obese—meaning their body mass index has reached 30 mg/k², Kushner said a change is in order.

“Tackling this challenge will require major changes in medical education,” he said.

Reference

Kusher RF, Butsch WS, Kahan S, Machineni S, Cook S, Aronne LJ. Obesity coverage on medical licensing examinations in the United States. What is being tested? [published online December 29, 2016]. Teach Learn Med. 2017; DOI: 10.1080/10401334.2016.1250641.