Influence of curricular changes in health promotion and disease prevention on residents' behaviors over a five-year period

Background. Residents’ compliance with guidelines for health promotion and disease prevention (HPDP) often fall short of the ideal. Method. After a year in which faculty developed clinical practice HPDP guidelines, an intervention consisting of curricular changes and chart modifications was planned and pilot-tested in 1985-86 at an ambulatory care clinic of the Family Practice Residency Program, University of Louisville School of Medicine. Approximately 24 residents per year (eight at each level of training) worked in the clinic throughout the study years. The HPDP curriculum required residents to attend 48 one-hour conferences conducted over a three-year period. Four retrospective chart audits were used to measure residents’ compliance with the HPDP guidelines during (1) the year before the pilot test (104 charts), (2) the pilot year (113 charts), (3) the year after the pilot test—the first year of full implementation (100 charts), and (4) five years after the pilot test (100 charts). Data from the chart audits were analyzed by using a permutation test for decreasing trend. Results. Although there was an increase in the residents’ compliance with the HPDP guidelines during the pilot year, the residents’ HPDP activities tended to return to baseline levels in the following years, despite the ongoing curriculum. Conclusion. The authors conclude that because the frequency of the residents’ HPDP activities tended to return to baseline levels, clinical education alone is not enough to sustain residents’ compliance with HPDP guidelines.