# Assessing and Addressing Medical Residents' Knowledge Gaps in the Screening and Treatment of Metabolic Dysfunction-Associated Steatotic Liver Disease, Obesity, and Metabolic Syndrome: A Quality Improvement Project

## TL;DR

This study shows that a focused lecture improved residents' confidence and knowledge in managing liver disease, obesity, and metabolic syndrome.

## Contribution

A targeted educational intervention significantly increased residents' confidence and quiz scores in managing metabolic diseases.

## Key findings

- Residents' confidence in managing obesity, anti-obesity medications, and MASLD increased from 25-40% to over 90%.
- Quiz scores improved significantly after the lecture, from 73.9 to 89.6 (p < 0.001).
- Residents requested more training on pharmacologic management and institutional care pathways.

## Abstract

Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most common liver disease globally. Its rapid rise in prevalence parallels that of associated metabolic syndromes, highlighting the need for physicians well-trained in the evaluation and management of these conditions. While medical school and residency education touch on these topics, curricula often fail to address them in an adequate or longitudinal manner, leading to knowledge gaps in practice. Targeted lectures can reinforce key concepts and equip residents to manage these conditions appropriately. As such, this quality improvement study aimed to assess and enhance internal medicine residents’ confidence and understanding of MASLD, obesity, and metabolic syndrome management through a targeted educational intervention.

Methods

We integrated a structured lecture, “Obesity/Metabolic Syndrome and MASLD: The Role of the Internist,” into a Wednesday School didactic series between January 8, 2025 and February 26, 2025. Internal medicine residents attended one session each and completed pre- and post-surveys assessing confidence and knowledge in screening, risk stratification, and treatment of obesity and MASLD. Confidence was rated using four-point Likert scales, and data were visualized using stacked column charts. Participants indicated prior training through open-ended responses. Knowledge was evaluated using paired multiple-choice quizzes on the pre- and post-surveys, and scores were analyzed with paired t-tests to determine significance.

Results

Of 125 participants, 111 residents (88.8%) completed both surveys and were included in the final analysis. Confidence strongly improved across three key domains, as initially only 39.6% (n = 44), 27.9% (n = 31), and 25.2% (n = 28) of residents reported feeling “Moderately comfortable” or “Very comfortable” in managing obesity, anti-obesity medications, and MASLD, respectively. After the sessions, confidence in these realms rose to 94.6% (n = 105), 91.9% (n = 102), and 91.0% (n = 101). This increase in self-reported confidence was supported by significantly higher quiz scores after the lecture, rising from 73.9 ± 33.6 to 89.6 ± 22.5 (p < 0.001). Residents with higher baseline confidence often received prior exposure to MASLD education through conferences or clinical rotations. Qualitative feedback highlighted the relevance of the lecture and requested further instruction on pharmacologic management and institution-specific patient care pathways.

Conclusion

Targeted, lecture-based education can effectively improve internal medicine residents’ confidence and knowledge in evaluating and managing MASLD, obesity, and metabolic syndromes. Thus, integrating these interventions into residency curriculum can fill knowledge gaps and strengthen resident preparedness to address the rising burden of metabolic disease. Future directions should explore longitudinal reinforcement through multiple stages of medical training, as well as implementation in other institutions to assess clinical impact.