Teaching risk-factor counseling skills to medical students, house staff, and fellows

It is important to teach risk-factor counseling skills to medical students, primary care residents, and fellows in cardiovascular medicine. To do this, it is necessary to teach assessment and intervention skills based on the theory and techniques of preventive and behavioral medicine. Physicians should be taught to think in terms of the patient in the context of his or her lifestyle and other interacting factors affecting health and disease, and should develop a new medical "culture" within which the risk-factor and lifestyle antecedents and correlates of illness can be recognized, discussed, and approached therapeutically. In this approach to physician training, risk-factor intervention skills training is integrated into existing teaching vehicles to minimize the burden on the curriculum and maximize the extent to which the material can be incorporated into the daily practice of medicine. The objectives associated with training in behavioral medicine skills and examples demonstrating how specific teaching vehicles that are already established in most institutions can be used to accomplish this training are presented. Strategies for motivating physicians to practice prevention with their parents also are discussed.