20 May, 13 | by Karim Khan
Sport and Exercise Medicine: The UK trainee perspective (A BJSM blog series)
By Lucinda Poulton1, Paul Kelly2, Justin Richards2, Moiz Moghal3, Wilby Williamson2,3
1. University of Oxford Medical School (4th Year Medical Student)
2. British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford
3. OxSport, Nuffield Orthopaedic Centre, Oxford.
Lack of physical activity is a major risk factor for mortality, yet 25% of students at Oxford medical school are unaware of the World Health Organization global guidelines for physical activity1. There is concern that this gap in awareness and understanding is not limited to our medical students. With the arrival of Public Health England, there is an increasing responsibility for all doctors to consider the challenges of preventive medicine. Understanding the problems patients face and having the confidence to tackle them is critical. Weiler and colleagues highlighted a UK nationwide deficit in the provision of medical student teaching on physical activity and have championed a call for reform2. A survey of 4-6th year medical students at the University of Oxford aimed to identify where gaps in local education could be improved. The results identified three hurdles to changing patient behaviour – students’ education, knowledge and attitudes to physical activity.
First, searching for physical activity in the Oxford curriculum drew a blank. Whilst other leading risk factors for global mortality such as smoking cessation and dietary changes, were covered, physical activity was not mentioned in the core curriculum. Perhaps this explains why, when asked to rank risk factors for global mortality, physical activity was ranked bottom of the pile by the majority of students.
Should we describe the lack of curriculum as a false start? It certainly appears to leave the students struggling at the next hurdle: grasping the basic knowledge of the role physical activity plays in prevention and treatment of non-communicable diseases. More than 60% of students believed there was no evidence to support promoting physical activity as a preventive approach to bowel and breast cancers 3. More worryingly, 16% of students said the same for cardiovascular health. Overall, 85% of students felt they had inadequate knowledge of the role of physical activity in preventing and treating chronic disease.
Encouraging behaviour change in patients requires more than just knowledge of guidelines. The ability to motivate, promote patient’s capabilities and identify opportunities for change requires medical professionals to take ownership of this problem, and to have the confidence to do so.
Three groups of 5th year students were asked to list everything they had, or had not done, in the past week that was a threat to their health. They all keenly acknowledged the risks they took in not eating enough fruits and vegetables, riding bikes without helmets or over indulging in some other vice. But of the 50 students surveyed, none identified a lack of physical activity as a personal risk they had taken. Yet when specifically questioned approximately 90% did not meet physical activity guidelines (150 minutes per week)4. How can tomorrow’s doctors encourage physical activity behaviour change when they don’t see it as a problem in themselves? With the rising burden of non-communicable diseases it is increasingly important for medical students to be prepared and to feel motivated to gain the knowledge and expertise needed to promote physical activity. However, over three-quarters of students felt they hadn’t received enough training, and a majority lacked the confidence to provide advice to patients on physical activity.
Oxford currently leads the world in medical student education5. Now they are taking steps to guarantee students receive appropriate training in physical activity and preventive medicine. However, this is a global issue, and our fear is that we are joining a small minority of institutions where educational reform is being driven by passionate physical activity researchers and clinicians. Nationally and internationally, are others taking up the call to champion undergraduate physical activity education? Will the gap in curriculums be filled?
2. Weiler R. Et al, Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow’s doctors equipped to follow clinical guidelines?, Br J Sports Med, 46, 1024-6 (2012)
Dr Natasha Jones and Dr Julia Newton
Oxsport, Nuffield Orthopaedic Centre, Oxford.
Wilby Williamson, Academic Clinical Fellow, Oxford
Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.