Technology-Guided Diet Counseling Training Prepares Residents to Implement Shared Decision Making About Diet in Routine Primary Care

BACKGROUND: Nutrition in medical education is undergoing major reform to prepare physicians to effectively address diet. Presently, trainings emphasize diet history collection, a time-consuming process that is becoming obsolete as automated diet assessment tools are incorporated into healthcare. Instead, physicians need training in shared decision making about diet. Therefore, we developed a diet counseling training using practice-based technology ("Nutri") that trains primary care residents to implement collaborative diet goal setting. OBJECTIVE: To compare effect of Nutri training vs. standard diet counseling training on counseling precursors and identify training elements useful for addressing diet in everyday practice. DESIGN: Participants were randomized to Nutri training or standard diet counseling training. Participants completed a simulated diet counseling session and debrief interview. PARTICIPANTS: Fifty-two family and internal medicine residents. APPROACH: Residents completed pre/post surveys assessing diet counseling competence, attitudes, self-efficacy, intention, and training satisfaction. Thematic analysis of interview transcripts uncovered training elements valued. KEY RESULTS: Nutri residents indicated significantly greater training satisfaction (4.08 ± 0.84 vs. 3.42 ± 0.99, p = 0.01) and intention to discuss diet (4.46 ± 0.58 vs. 4.00 ± 0.75, p = 0.02) compared to control. While both trainings improved counseling competence, the Nutri training resulted in greater improvements in attitudes (t = 2.17, p = 0.04) and self-efficacy (two items: t = 3.20, p = 0.004; t = 4.27, p = 0.0002). To best equip physicians to effectively address diet with their patients, residents reported that training should include (1) an explicit role for the physician, (2) a framework to drive tailored diet conversations, and (3) nutrition content aids in clinic. CONCLUSIONS: When considered individually, both trainings evaluated favorably; however, qualitative insights reveal Nutri training with guided practice using point-of-care software may better position resident physicians to enact diet counseling. Trainings that outline a clear role for the physician, present a guiding framework, and provide point-of-care implementation tools were suggested by participants to translate learning to practice.