Physician-Training Stress and Accelerated Cellular Aging.

Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ2 test was used to perform comparisons between groups. Statistical significance was determined at P < .05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important ("neutral," "not important," or "important, but I don't have the time to focus on it right now"; P < .0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education.

The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call.

BACKGROUND:Postgraduate medical residency programs are laborious and time-intensive, and can be physically, intellectually and emotionally demanding. These working conditions may lead to the neglect of personal health and well-being. The objective of this study was to compare the anthropometric and fitness characteristics of surgical and nonsurgical medical residents. We hypothesized that there is a difference in physical health between these 2 groups. METHODS:Medical residents completed a demographic information questionnaire and were assessed by trained staff for height, weight, body fat percentage, muscular strength and endurance, and peak oxygen consumption (Vᴏ2peak). The average number of working hours per week was also documented. RESULTS:Forty-five residents (21 surgical and 24 nonsurgical; 31 men and 14 women) participated in the study. Surgical residents worked more hours per week on average than nonsurgical residents (p = 0.02) and had a higher body mass index (BMI) (p = 0.04) and lower Vᴏ2peak (p = 0.01). CONCLUSIONS:Surgical residents worked more hours than nonsurgical residents, which may have contributed to their higher BMI and lower aerobic fitness levels. Despite a heavy workload, it is important for all medical residents to find strategies to promote a healthy lifestyle for both themselves and their patients to ensure long-term well-being.

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Physical fitness of medical residents: Is the health of surgical residents at risk?

Medical students and residents experience burnout at a high rate and encounter threats to their well-being throughout training. It may be helpful to consider a holistic model of education to create educational environments in which trainees flourish. As clinician educators, the biopsychosocial-spiritual model of patient care has helped shape the way we care for patients. Using the biopsychosocial-spiritual model of patient care as a framework, we examine the ways in which clinician educators can support the physical, psychological, social, and spiritual needs of their trainees. The current state of trainee well-being in each of these areas is reviewed. We discuss potential interventions and opportunities for further research to help clinician educators develop a contextualized, holistic approach to the formation of their trainees. 

/pdf/what-educators-can-learn-from-the-biopsychosocial-spiritual-1ch04i05.pdf

What Educators Can Learn from the Biopsychosocial-Spiritual Model of Patient Care: Time for Holistic Medical Education

Introduction In 2013, the U.S. Army Surgeon General implemented the Performance Triad (P3), an educational initiative to improve health-related behaviors of soldiers throughout the U.S. Army. The components of P3 are Sleep, Activity, and Nutrition with tenet behaviors for each component. This study reports the results of the 2015 U.S. Army Medical Corps survey regarding physician knowledge and adherence to the tenet behaviors of P3. Methods In 2015, an anonymous survey was sent to all active duty U.S. Army physicians to assess demographic information, work hours, and knowledge of and adherence to P3. The survey assessed the tenets of P3 with questions about the following topics: obtaining 8 h of sleep per day; performing at least 2 d of resistance training and 1 day of agility training per week; re-fueling 30-60 min after exercise; incorporating at least 150 min of moderate and 75 min of vigorous aerobic exercise per week; going caffeine free 6 h before bedtime; eating at least 8 servings of fruits and vegetables per day; and getting 15,000 steps per day. For each question, there were four response options which ranged from "Always" to "Never." A positive response to the questionnaire was defined as answering frequently or always. The responses were analyzed by comparison of several physician categories utilizing descriptive statistics and multivariable analysis. Results Surveys were completed by 1,003 of approximately 4,500 U.S. Army physicians. 79.1% of the respondents were male. Staff physicians made up 834 (83.6%) of the respondents compared with 164 (16.4%) physicians in training. Overall 25% of respondents were adherent to the sleep tenet, 45% to the exercise tenet, and 38% to the nutrition tenet. Reported work hours were significantly higher in physicians in training compared with staff physicians (p < 0.001). About 28.4% of staff reported a positive response to obtaining at least 8 h of sleep per night, compared with 12.7% of residents/fellows. In multivariable analyses, better sleep was associated with being a staff physician [odds ratio 2.4 (95% confidence interval 1.40-4.13)], working fewer hours per week [1.75 (1.37-2.25)], and belief in supervisor adherence to P3 [2.04 (1.59-2.56)]. Increased exercise was associated with male gender [2.09 (1.45-3.02)], being a staff physician [1.63 (1.09-2.43)], and belief in supervisor adherence to P3 [1.43 (1.18-1.75)]. Positive response to the nutrition tenet was associated with belief in supervisor adherence to P3 [1.23 (1.01-1.49)]. Conclusion Overall, U.S. Army physicians are most adherent to the exercise tenet and least adherent to the sleep tenet of P3; this is consistent with the military culture. Work hours seem to affect wellness behaviors. Specifically, physicians who work fewer hours are more likely to report obtaining 8 h of sleep per day and exercise on a regular basis. Importantly, belief in supervisor adherence to P3 was associated with better adherence to P3, suggesting that physician leadership has a positive effect on wellness behaviors. This suggests a role for similar wellness programs in civilian healthcare institutions. Future research should also include changes in health system policies to motivate physician wellness behaviors.

/pdf/predictors-of-wellness-behaviors-in-u-s-army-physicians-2ok74ezk1c.pdf

Predictors of Wellness Behaviors in U.S. Army Physicians

Background  Previous studies have shown a falloff in physicians' physical activity from medical school to residency. Poor fitness may result in stress, increase resident burnout, and contribute to mortality from cardiovascular disease and other causes. Physicians with poor exercise habits are also less likely to counsel patients about exercise. Prior studies have reported resident physical activity but not cardiorespiratory fitness age. Objective  The study was conducted in 2 residency programs (3 hospitals) to assess internal medicine residents' exercise habits as well as their cardiorespiratory fitness age. Methods  Data regarding physical fitness levels and exercise habits were collected in an anonymous cross-sectional survey. Cardiopulmonary fitness age was determined using fitness calculator based on the Nord-Trondelag Health Study (HUNT). Results  Of 199 eligible physicians, 125 (63%) responded to the survey. Of respondents, 11 (9%) reported never having exercised prior to residency and 45 ...

/pdf/cardiorespiratory-fitness-in-internal-medicine-residents-are-4d0yginx02.pdf

Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned?

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Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned?