Medical students' licensing exam barely covers items related to obesity, study finds

Jan 20 2017

Obesity is one of the most significant threats to health in the U.S. and is responsible for the development of multiple serious medical problems such as diabetes, heart disease and some forms of cancer. Yet obesity is barely covered in medical training, according to a new Northwestern Medicine study.

The licensing exams for graduating medical students have a surprisingly limited number of test items about obesity prevention and treatment.

"It's a trickle-down effect," said lead study author Dr. Robert Kushner. "If it's not being tested, it won't be taught as robustly as it should be."

The inadequate testing means medical schools have less incentive to provide obesity education in their curriculum, and students have less incentive to learn about it.

"Tackling this challenge will require major changes in medical education," said Kushner, professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

The study appeared Dec. 29 in the journal Teaching and Learning in Medicine.

Nearly 40 percent of adults and nearly 20 percent of children and adolescents are obese in the U.S.

Of the few exam items related to obesity, the majority pertained to assessment and management of obesity-related illnesses such as diabetes and obstructive sleep disorder rather than addressing the diagnosis and management of obesity itself.

In addition, the study found the most important concepts of obesity prevention and treatment — ranging from current basic science to assessment to clinical management — were poorly represented.

To conduct the study, the authors reviewed the obesity-related content of the three United States Medical Licensing Examinations (USMLE) that must be taken by all medical students and first-year residents.

A panel of six obesity medicine specialists reviewed more than 800 test items that were pre-selected by the National Board of Medical Examiners (NMBE) staff. They used a content outline to categorize each item according to its content and relevance to obesity. (This was only the third time that the USMLE allowed an external panel to review the exam for specific test content.)

At the request of the NBME, the panel identified multiple important obesity-related topics that were insufficiently addressed or entirely absent from the examinations. The panel also recommended obesity experts be appointed to development committees to begin the process of adding relevant obesity-related items to the examination.