Fit For Residents Curriculum by ACGME Competencies Fit for Residents Childhood Overweight and Residency Core Curriculum Outline Introduction: The Fit for Residents project is a 3-year program coordinated by University of California, Los Angeles (UCLA) in collaboration with the American Academy of Pediatrics (AAP) and The American Academy of Family Medicine (AAFP) Fit for Residents is funded by the Wellpoint Foundation. The goal of the Fit for Residents project is to reduce the prevalence rates of pediatric obesity and in turn type 2 diabetes and heart disease through improved training of future primary care physicians and support system changes within community and hospital based primary health care practices serving racially and ethnically diverse populations. A multispecialty team of experts in childhood obesity (CO), graduate medical education, and public health identified the key resources, objectives and skills outlined in this curriculum. The Fit for Residents curriculum is designed to easily integrate into established residency programs in: pediatrics, family medicine, preventive medicine, medicine-pediatrics. There are 3 major sections included in this curriculum outline: I) II) and III). Each section is divided into A) Learner and B) Clinic Change objectives. This document organizes the objectives by ACGME competencies to support faculty involved with curriculum development. Learner objectives address knowledge and skills that residents are expected to be able to demonstrate after exposure to the curriculum; Clinic changes describe changes in clinical practice that will support best practice in childhood obesity prevention and management, and reinforce the information from the didactic sessions. All objectives should be addressed by using various activities. A few of the objectives are labeled advanced which could be considered by residency programs with more mature childhood obesity and advocacy initiatives. Woven throughout the curriculum is the expectation that students deliver culturally competent patient care in order to be most effective in the delivery of patient care.
PREVENTION Goal: Residents will understand the risks and determinants of childhood obesity and the basic skills needed to promote optimal nutrition and physical activity. Objective 1: Describe U.S. childhood obesity and overweight (CO) trends in the population as a whole and in specific age, gender and ethnic/racial groups. Objective 2: Identify familial and environmental factors that contribute to increased rates of CO Objective 3: Understand the benefits of exclusive breastfeeding in the prevention of CO Objective 4: Identify the strong and moderately strong evidence-based interventions for prevention of CO. Objective 5: Identify and communicate strategies to help families implement these interventions to prevent CO at home and in the community. Objective 6: Identify practical strategies that families can use to promote healthy lifestyle behaviors Objective 7: Understand how to appropriately support a breastfeeding mother to meet the AAP recommendations and her personal goals. Objective 8: Understand eating behaviors, hunger and satiety regulation and food insecurity issues as they relate to CO. Objective 9: Describe basic parenting skills including setting limits and routines. Objective 10: Define CO according to BMI percentiles. Epidemiology Cultural Factors Built Environment
Objective 11: Calculate BMI and use the CDC growth charts to determine BMI percentiles in the clinical setting. Objective 12: Correctly interpret growth charts for all ages. Objective 13: Discuss weight category and CO in a culturally sensitive way Objective 14: Conduct a risk assessment for future childhood obesity Objective 15: Identify the 3 sensitive growth periods for future CO. Objective 16: Identify 3 barriers to health care services for CO. Objective 17: All children over 2 years old will have their BMI calculated and plotted in their charts at least annually Objective 18: All families will be assessed during well child visits regarding diet and activity levels as specified by the Expert Workgroup for Level 1. Objective 19: All families will receive counseling in optimal nutrition and physical activity during well child visits. MANAGEMENT Goal: Residents will understand the co-morbid conditions associated with childhood obesity. They will have the basic skills needed to manage childhood overweight and the more common comorbidities. Objective 1: Describe the strong and moderately strong evidence based interventions for management of CO. Objective 2: Develop a treatment plan for CO based on expert committee guidelines.
Objective 3: Identify strategies to help families implement these changes in their families. Objective 4: Describe physiologic and psychosocial co-morbidities associated with CO. Objective 5: Describe the appropriate medical evaluation for conditions associated with CO. Objective 6: Understand how to identify indications for referral to specialty care for the treatment of co-morbidities associated with CO. Objective 7: Understand the principles and skills of patient-centered motivational interviewing (i.e. developmentally appropriate, family centered) in order to deliver effective messages and minimize negative messages. Objective 8: Describe counseling on appropriate diet for healthy weight. Objective 9: Describe at least 3 evidence-based strategies to reliably improve CO care. Objective 10: Discuss weight category and CO in a culturally sensitive way. Objective 11: Identify strategies to engage the whole family in decision making and behavior changes. Objective 12: Provide counseling on basic parenting skills including setting limits and routines. Objective 13 Advanced: Describe the benefits of a multi-disciplinary approach to treatment. Objective 14 Advanced: Describe the appropriate use of weight-loss medication. Co-morbidities Co-morbidities Co-morbidities Cultural Factors Family-Centered Care
MANAGEMENT CLINIC CHANGE OBJECTIVES Objective 1: Based on Expert Consensus Guidelines, all children who are overweight and obese will receive appropriate Level 1 and Level 2 assessments (e.g. diet, physical activity, family history, environment factors, screening labs). Objective 2: Based on Expert Consensus Guidelines, all children who are overweight and obese will receive appropriate Level 1 and Level 2 treatment and management Objective 3: Based on Expert Consensus Guidelines, all children who are overweight and obese will receive appropriate Level 1 and Level 2 referrals for care for co- morbidities. Objective 4: All children who are overweight and obese will be referred to level 3 or 4 obesity centers when appropriate progress towards BMI goals has not been made after 6-12 months of care. Objective 5: Residents will demonstrate the principles and skills of a patient-centered counseling style (e.g. motivational interviewing). Objective 6 Advanced: Residents will participate effectively in a multidisciplinary clinic/approach of care of CO in a Level 3 or 4 setting. ADVOCACY Family-Centered Care Goal: Residents will understand advocacy for the healthy nutrition and physical activity at the individual, family, clinical practice, community, and legislative levels. Objective 1: To understand the principles of an asset-based community development strategy to optimize physical activity and access to healthy and fresh foods. Objective 2: To identify community resources (using the asset mapping approach) to optimize physical activity and access to healthy foods in particular child care facilities and schools. Child Training Objectives and Child Training Objectives and
Objective 3: To be knowledgeable on the goals and objectives of the obesity action plans from your local and national state obesity efforts Objective 4 Advanced: To have basic knowledge of the legislative process, and legislative skills that provide the background and tools to engage in advocacy activities that promote health- and fitness-promoting programs and policies Objective 5 Advanced: To have basic media skills to effectively advocate for health- and fitness- promoting programs and policies through various media outlets. Child Training Objectives and Child Training Objectives and Child Training Objectives and ADVOCACY CLINIC AND COMMUNITY CHANGE OBJECTIVES Objective 1: Residents will contribute as an active, participatory community collaborator to promote healthy nutrition and/or active lifestyle activities for their clinic or hospital population (e.g. working with schools, parks and recreation) Objective 2: Residents will participate in at least one of the following activities to promote healthy nutrition and/or active lifestyle programs and policies: Letter to the Editor, local Legislative visit, Legislative activities with the AAP, or Media Interview. Objective 3 Advanced: Residents will participate as active collaborators with an insurance company or healthcare system to promote health- and fitness-promoting programs and policies and/or reimbursement for obesity treatment. Objective 4 Advanced: The residency continuity clinic will have a nutrition and physical activity friendly environment, with point of decision prompts (e.g. use stairs not elevators), noncommercial health promotion materials, and no visible unhealthy foods Child Training Objectives and Child Training Objectives and Child Training Objectives and Child Training Objectives and