A Description and Qualitative Assessment of a 4-Year Intervention to Improve Patient Counseling by Improving Medical Student Health

Erica Frank, MD, MPH; Donna Smith, MA; Dorothy Fitzmaurice

In This Article


Background: To test whether promoting medical student health could efficiently improve patient counseling, we developed and implemented a 4-year-long curricular and extracurricular intervention to promote healthy behaviors among students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia.
Methods: We asked students: (1) "What did you think about these [listed intervention components]"; (2) "did any of these interventions influence your personal health habits/attitudes toward your personal health"; and (3) "did any of these interventions influence your behavior or attitudes regarding current or future clinical practices, including history taking or counseling? If so, how? If not, why not?" Students evaluated the effectiveness of these formats and proposed changes in our intervention. The focus groups were transcribed and analyzed with QSR N5.
Results: Several major themes emerged from the focus groups:

  • Listen to the students early, often, substantively, and noticeably;

  • Incorporate many faculty and student leaders;

  • Quietly integrate the curricular activities into the regular curriculum;

  • Provide a strong, science-based, pragmatic prevention curriculum to complement the personal health promotion;

  • Don't just use lectures to teach;

  • Offer plentiful, nonrequired, fun extracurriculars;

  • Don't nag;

  • Have achievable interventions and recommendations;

  • Provide collective data, but don't overexpose the students to it, and don't assume that collective data apply to every student, especially if it's unpleasant news;

  • Provide personalized data where possible; and

  • Uncouple evaluations from the intervention, and keep evaluations brief.

Conclusions: Some students seemed pleased to have their medical school be attentive to their health, and believed that the project positively influenced their personal health practices and clinical practices (which was our goal). The students enjoyed many components of the intervention, especially the extracurricular activities, and recognized that they and their classmates were at risk for unhealthy behaviors that had personal and clinical implications. However, many also felt resentful and that they were nagged. Although we had anticipated these responses, and had therefore taken pains to avoid the things that the students most resented, we were insufficiently sensitive to how strong those responses would be.


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