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Sousa JR, Afreixo V, Carvalho J, Silva P. Nutrition and Physical Activity Education in Medical School: A Narrative Review. Nutrients 2024; 16:2809. [PMID: 39203945 PMCID: PMC11357297 DOI: 10.3390/nu16162809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/10/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
This review explores the diverse landscape of integrating nutrition and physical activity education into medical school curricula, focusing on the imperative role of physicians in promoting health through lifestyle changes. By examining global medical education structures, we uncovered disparities in nutrition and physical activity training, and highlighted the need for a shared framework to address international and regional challenges. Despite acknowledging the importance of both nutrition and physical activity, studies have consistently uncovered deficiencies in medical school curricula, especially in skills related to providing lifestyle advice and behavioral counseling. Survey studies among medical students have illuminated various perceptions and knowledge gaps, emphasizing the need for more comprehensive and mandatory nutrition and physical activity training. While acknowledging progress, challenges, such as time constraints, resource availability, and faculty expertise, persist. Integrating lifestyle education results in resistance, a demand for strategic communication, and faculty buy-ins. These findings underscore the importance of a holistic approach that balances theoretical knowledge, practical skills, and confidence that medical students need to promote effective nutrition and physical activity in healthcare.
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Affiliation(s)
- Joana Rodrigues Sousa
- Laboratory of Histology and Embryology, Institute of Biomedical Sciences Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira n.° 228, 4050-313 Porto, Portugal
| | - Vera Afreixo
- Center for Research & Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Joana Carvalho
- Research Centre in Physical Activity, Health and Leisure of University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Paula Silva
- Laboratory of Histology and Embryology, Institute of Biomedical Sciences Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira n.° 228, 4050-313 Porto, Portugal
- iNOVA Media Lab, ICNOVA-NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, 1069-061 Lisbon, Portugal
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Qubty L, Hicks-Roof K. How might enhanced interprofessional collaboration between primary care physicians and registered dietitian nutritionists impact clinical outcomes related to obesity and associated illnesses? A commentary. Public Health Nutr 2022; 26:1-4. [PMID: 36458843 PMCID: PMC9989699 DOI: 10.1017/s1368980022002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.
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Affiliation(s)
- Leah Qubty
- Department of Applied Health Sciences, Bethel University, St. Paul, MN, USA
| | - Kristen Hicks-Roof
- Department of Nutrition & Dietetics, Brooks College of Health, University of North Florida, Jacksonville, FL32224, USA
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McClave SA. 2022 Peggi Guenter Excellence in Clinical Practice Lectureship: Expanding the clinical practice of nutrition—Challenging the known, exposing inconvenient truths, and engaging the young. Nutr Clin Pract 2022; 37:1257-1271. [DOI: 10.1002/ncp.10918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/10/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stephen A. McClave
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine University of Louisville Louisville Kentucky USA
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Casting Light on the Necessary, Expansive, and Evolving Role of the Critical Care Dietitian: An Essential Member of the Critical Care Team. Crit Care Med 2022; 50:1289-1295. [PMID: 35984051 DOI: 10.1097/ccm.0000000000005607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of COVID-19 outbreak on the diet, body weight and food security status of students of higher education: a systematic review. Br J Nutr 2022; 129:1916-1928. [PMID: 35946073 DOI: 10.1017/s0007114522002604] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has impacted college students' lifestyles and placed them at a greater risk of obesity and food insecurity. The purpose of the systematic review was to consolidate evidence for the effect of Covid-19 on students' dietary quality, dietary habits, body weight and food security status. A comprehensive literature search was conducted utilising various databases including Google Scholar, MEDLINE, ScienceDirect, Embase and Scopus to identify relevant studies. To be incorporated in this review, studies had to include higher education students, measure the prevalence of food insecurity and assess the dietary and body weight changes during the COVID-19 pandemic. The studies showed that the diet quality of college students was compromised during the pandemic in many nations due to the decrease in the intake of whole grains, dairy products, legumes, nuts, fruits and vegetables and the increase in consumption of alcohol, confectionery products and refined grains. There was an increase in the frequency of cooking, binge eating, breakfast skipping and unhealthy snacking. These modifications, in return, were associated with body weight changes, with no less than 20 to 30 % of students gaining weight during the pandemic. The pandemic also impacted food security status of students, with over 30% being food insecure worldwide. The COVID-19 outbreak has exacerbated the students' diet quality and dietary habits and placed them under high risk of weight gain and food insecurity. Higher education institutions and governments should improve students' access to nutritious foods and incorporate nutrition education interventions in the curricula.
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Magallanes E, Sen A, Siler M, Albin J. Nutrition from the kitchen: culinary medicine impacts students' counseling confidence. BMC MEDICAL EDUCATION 2021; 21:88. [PMID: 33541352 PMCID: PMC7863372 DOI: 10.1186/s12909-021-02512-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school. METHODS We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item. RESULTS Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001). CONCLUSIONS Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.
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Affiliation(s)
- Emily Magallanes
- UT Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Ahana Sen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Milette Siler
- Moncrief Cancer Institute at UT Southwestern, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jaclyn Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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Dutra B, Lissauer M, Rashid H. Nutrition Education on the Wards: A Self-Study Module for Improving Medical Student Knowledge of Nutrition Assessment and Interventions. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10968. [PMID: 33094154 PMCID: PMC7566223 DOI: 10.15766/mep_2374-8265.10968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Nutrition plays a key role in the prevention and treatment of disease. Hospitalized patients are often malnourished, which is a major contributor to medical complications, decreased quality of life, lengthened medical stay, increased health care costs, and mortality. However, medical students continue to have inadequate education in nutrition and report feeling poorly trained in nutrition. We proposed an online module that could be used by medical students as a self-study activity to learn about key signs for the diagnosis of malnutrition and the nutrition interventions available in the hospital setting. METHODS Third- and fourth-year medical students at Rutgers Robert Wood Johnson Medical School in medicine, surgery, and critical care clerkships were given access to an online nutrition education module discussing the signs of malnutrition in hospitalized patients and the interventions available in the inpatient setting. A premodule and postmodule survey was given via email at the beginning and at the end of the clerkship. A one-sample t test was used to assess the relationship between the mean scores of the pre- and postmodule surveys. RESULTS One hundred nine out of 255 students responded to the premodule survey. Thirty-two students completed the module and postmodule survey. There was a significant difference in mean scores between students who completed the module and postmodule survey compared to the overall student population prior to having access to the module. DISCUSSION Medical students have limited training in nutrition education, and our findings show that a self-study online module can improve students' knowledge.
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Affiliation(s)
- Barbara Dutra
- Resident, Department of Internal Medicine, University of Texas Health Science Center at Houston
| | - Matthew Lissauer
- Associate Professor of Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School
| | - Hanin Rashid
- Associate Director, Office for Advancing Learning, Teaching, and Assessment, Rutgers Robert Wood Johnson Medical School; Assistant Professor, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School
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Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health 2019; 3:e379-e389. [PMID: 31538623 DOI: 10.1016/s2542-5196(19)30171-8] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In many countries, doctors are recommended to provide nutrition care to patients to improve the dietary behaviours of individuals and populations. Here, we present a systematic review that aims to critically synthesise literature on nutrition education provided to medical students. METHODS In this systematic review, a literature search was done between May 1 and July 1, 2018, for articles on medical students' nutrition knowledge, skills, and confidence to counsel patients, from Nov 1, 2012, to Dec 31, 2018. Search terms related to medical students included "nutrition in medical education", "medical nutrition education", and "undergraduate medical nutrition education". Search terms for topic of interest included "nutrition", "knowledge", "skills", "nutrition counselling", "confidence", "nutrition care", or "nutrition education". Included studies examined any aspect of recently graduated (ie, ≤4 years) or current medical students' nutrition knowledge, attitudes, skills, or confidence (or all three) in nutrition or nutrition counselling; evaluated nutrition curriculum initiatives for medical students; or assessed recently graduated or current medical students' perceptions of nutrition education. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. Curriculum initiatives were also appraised. FINDINGS 66 studies were identified by the search and 24 were eligible for full-text analysis. 16 quantitative studies, three qualitative studies, and five curriculum initiatives from the USA (n=11), Europe (n=4), the Middle East (n=1), Africa (n=1), and Australasia (n=7) met the inclusion criteria. Our analysis of these studies showed that nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education. Deficits in nutrition education affect students' knowledge, skills, and confidence to implement nutrition care into patient care. A modest positive effect was reported from curriculum initiatives. INTERPRETATION Despite the centrality of nutrition to healthy lifestyle, medical students are not supported to provide high-quality, effective nutrition care. Medical education can be enhanced by institutional commitment to make nutrition education compulsory in medical training, establishment of nutrition competencies to provide a benchmark for nutrition knowledge and skills to be included in curricula, and supported by funding for innovative curriculum initiatives. These initiatives will improve nutrition in medical training to support future doctors for the 21st century. FUNDING Sir John Logan Campbell Medical Fellowship 2017, and an Australian National Health and Medical Research Council Fellowship.
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Affiliation(s)
- Jennifer Crowley
- Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Gerrit Jan Hiddink
- Strategic Communication Chair Group, Wageningen University, Wageningen, Netherlands
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Hays E, Levine J, Rethi S, Smith EK, Upadhya S, Sobering AK, Weiler T. Reevaluating Biochemistry and Nutrition Education Through Opinions of Clinicians and Educators. MEDICAL SCIENCE EDUCATOR 2019; 29:189-197. [PMID: 34457467 PMCID: PMC8368119 DOI: 10.1007/s40670-018-00652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Biochemistry is a core component of medical education as it contributes to the fundamental basis and understanding of molecular mechanisms in pathophysiological processes. The convergence of nutritional factors also gives insight to many chronic diseases. Topics of nutrition are often incorporated into biochemistry coursework and must be integrated in a way that makes sense within the overall curriculum. An important issue raised by this structure is determining which topics are most important to a student's understanding and what topics are most relevant to future clinical practice. Previous surveys show medical undergraduates feel that much of current medical biochemistry coursework lacks clinical relevance and pays too much attention to small details. Here we report the results of a survey that aims to determine the biochemical and nutritional topics that physicians and educators feel are most important to teach in medical school. This information is important for medical schools to better prepare their students for what they will see and apply in their future clinical practice. Physicians and medical educators were surveyed, asked demographic questions, and then requested to provide a prioritized list of the top 10 biochemistry and nutrition topics that they believed should be focused on in undergraduate medical education. Topics suggested by participants were normalized for spelling, acronyms, and abbreviations and given a weight from 10 to 1. A prioritized list was then created based on the suggested topics. This list provides insight into the topics that medical educators and physicians consider important to cover in undergraduate medical education.
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Affiliation(s)
- Emily Hays
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Jake Levine
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
| | - Shruthi Rethi
- Department of Biochemistry, St. George’s University, St. George’s, Grenada
| | - Emily K. Smith
- Department of Biochemistry, St. George’s University, St. George’s, Grenada
| | - Sharmila Upadhya
- Department of Biochemistry, St. George’s University, St. George’s, Grenada
| | - Andrew K. Sobering
- Department of Biochemistry, St. George’s University, St. George’s, Grenada
| | - Tracey Weiler
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL 33199 USA
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Robertson TR, Eldridge NE, Rattray ME, Roberts SJ, Desbrow B, Marshall AP, Ali AB, Hickman IJ. Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation. Nutr Diet 2018; 75:345-352. [PMID: 30187634 DOI: 10.1111/1747-0080.12473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022]
Abstract
AIM Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice. METHODS A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5. RESULTS In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%. CONCLUSIONS The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.
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Affiliation(s)
- Tayla R Robertson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Naomi E Eldridge
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Megan E Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Shelley J Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast Health, Gold Coast, Queensland, Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast Health, Gold Coast, Queensland, Australia
| | - Azmat B Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Williams AS, Patel PM, Beucke NL, Koopman RJ. Community-Based Medical Student Nutrition Counseling Training for Low-Income Families. PRIMER (LEAWOOD, KAN.) 2018; 2:5. [PMID: 32818179 PMCID: PMC7426123 DOI: 10.22454/primer.2018.809708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Physician nutrition counseling has become increasingly important due to increases in child and adult obesity. However, medical student education on nutrition counseling, especially for low-income families, is insufficient. METHODS Eat Healthy, Stay Active! (EHSA) is a community-based child obesity program that provided experiential learning for medical students to counsel low-income Head Start families about nutrition. The authors conducted a focus group to explore medical students' opinions about the proficiency of their nutrition education skills, especially in low-income families, and the role of EHSA. The authors also surveyed students about their self-confidence in providing low-income families with nutrition counseling. RESULTS Most students reported a favorable overall impression of EHSA with a mean score of 7 on a 10-point scale (1=poor experience, 10=very positive experience) and 70% reporting they would recommend EHSA to their classmates. They also reported a significant (80%, P< 0.0001) increase in their confidence of counseling patients about child obesity after participating in EHSA. In focus groups, students felt that EHSA improved their nutrition knowledge and helped them to understand barriers of low-income families for healthy nutrition. CONCLUSIONS Students participating in EHSA, a novel, community-based, experiential learning project, gained self-confidence in providing nutrition counseling to low-income families. The program also positively impacted medical student personal opinions of low-income families by providing a personal reference for low-income struggles.
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Affiliation(s)
- Amy S Williams
- Department of Family and Community Medicine, University of Missouri in Columbia, MO
| | - Pooja M Patel
- Providence St. Peter Hospital, University of Washington in Olympia, WA
| | - Nathan L Beucke
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
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Cooke NK, Ash SL, Goodell LS. Medical students' perceived educational needs to prevent and treat childhood obesity. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2017; 30:156-162. [PMID: 28928346 DOI: 10.4103/efh.efh_57_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Medical schools are challenged to incorporate more prevention-based education into curricula, offering an opportunity to revisit approaches to nutrition education. The objective of this study was to explore United States (US) medical students' understanding of childhood obesity, specifically barriers to childhood obesity prevention and treatment and students' perceived educational deficits. METHODS The research team conducted phone interviews with 78 3rd- and 4th-year medical students, representing 25 different medical schools across the US. Using a semi-structured interview guide, researchers asked students to describe the etiology of childhood obesity and reflect on where they acquired knowledge of the etiology and what additional resources they would need to treat obese children. Using a phenomenological approach to analysis, researchers identified five dominant emergent themes. RESULTS Student-perceived barriers to childhood obesity prevention and treatment in clinical care included student-centered (e.g., lack of knowledge), patient-centered (e.g., lack of access), and healthcare system-centered barriers (e.g., limited time). Students requested more applicable nutrition information and counseling skills relevant to preventing and treating childhood obesity; however, they tended to identify others (e.g., parents, schools), rather than themselves, when asked to describe how childhood obesity should be prevented or treated. DISCUSSION To provide students with an understanding of their role in preventing and treating childhood obesity, US medical schools need to provide students with childhood obesity-specific and general nutrition education. To build their self-efficacy in nutrition counseling, schools can use a combination of observation and practice led by skilled physicians and other healthcare providers. Increasing students' self-efficacy through training may help them overcome perceived barriers to childhood obesity prevention and treatment.
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Affiliation(s)
- Natalie K Cooke
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Sarah L Ash
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - L Suzanne Goodell
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC 27695, USA
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Han SL, Auer R, Cornuz J, Marques-Vidal P. Clinical nutrition in primary care: An evaluation of resident physicians' attitudes and self-perceived proficiency. Clin Nutr ESPEN 2016; 15:69-74. [DOI: 10.1016/j.clnesp.2016.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/15/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
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Exploring healthcare experiences among online interactive weight loss forum users. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2015.12.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Frantz DJ, McClave SA, Hurt RT, Miller K, Martindale RG. Cross-Sectional Study of U.S. Interns' Perceptions of Clinical Nutrition Education. JPEN J Parenter Enteral Nutr 2015; 40:529-35. [PMID: 25712959 DOI: 10.1177/0148607115571016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/14/2015] [Indexed: 11/16/2022]
Abstract
Background Medical students have historically perceived a lack of training in clinical nutrition. Rapid advances in medical science have compelled significant changes in medical education pedagogy. It is unclear what effect this has had on student's perceptions. Objective To assess interns' perception of clinical nutrition education during medical school. Design A cross-sectional survey of medical, surgical, and obstetric interns from 6 academic hospitals across the United States during the middle of their first year in November of 2010 (n = 289). Bivariate analysis and logistic regression was used to describe interns' perceptions and evaluate for factors that determined these perceptions. Results A total of 122 interns responded to the survey, for a response rate of 42%. These interns represented 72 different medical schools. Only 29% of interns reported they had been sufficiently trained in nutrition. On average, interns who reported being prepared reported a mean of 4 ± 3.4 weeks of training during medical school, while unprepared interns reported a mean of 2 ± 2.6 weeks of training (P = .02). Interns with prior graduate training in nutrition (n = 18) almost exclusively reported that medical school training was insufficient (94%, P = .02). After adjusting for age, gender, internship, undergraduate training, and being a foreign graduate, only the number of weeks of training remained significantly associated with perceived preparation (P = .03). Conclusion Most interns in medicine, surgery, and obstetrics feel unprepared to handle cases requiring knowledge of clinical nutrition. Interns feel that medical school is not adequately preparing them for the needs of clinical practice.
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Affiliation(s)
- David J Frantz
- Department of Medicine, Central Utah Clinic, American Fork, Utah
| | | | - Ryan T Hurt
- Department of Medicine, University of Louisville, Louisville, Kentucky Divisions of General Internal Medicine Gastroenterology and Hepatology Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - Keith Miller
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Robert G Martindale
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
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Lewis KO, Frank GR, Nagel R, Turner TL, Ferrell CL, Sangvai SG, Donthi R, Mahan JD. Pediatric trainees' engagement in the online nutrition curriculum: preliminary results. BMC MEDICAL EDUCATION 2014; 14:190. [PMID: 25223502 PMCID: PMC4179838 DOI: 10.1186/1472-6920-14-190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 09/03/2014] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Pediatric Nutrition Series (PNS) consists of ten online, interactive modules and supplementary educational materials that have utilized web-based multimedia technologies to offer nutrition education for pediatric trainees and practicing physicians. The purpose of the study was to evaluate pediatric trainees' engagement, knowledge acquisition, and satisfaction with nutrition modules delivered online in interactive and non-interactive formats. METHODS From December 2010 through August 2011, pediatric trainees from seventy-three (73) different U.S. programs completed online nutrition modules designed to develop residents' knowledge of counseling around and management of nutritional issues in children. Data were analyzed using SPSS version 19. Both descriptive and inferential statistics were used in comparing interactive versus non-interactive modules. Pretest/posttest and module evaluations measured knowledge acquisition and satisfaction. RESULTS Three hundred and twenty-two (322) pediatric trainees completed one or more of six modules for a total of four hundred and forty-two (442) accessions. All trainees who completed at least one module were included in the study. Two-way analyses of variance (ANOVA) with repeated measures (pre/posttest by interactive/non-interactive format) indicated significant knowledge gains from pretest to posttest (p < 0.002 for all six modules). Comparisons between interactive and non-interactive formats for Module 1 (N = 85 interactive, N = 95 non-interactive) and Module 5 (N = 5 interactive, N = 16 non-interactive) indicated a parallel improvement from the pretest to posttest, with the interactive format significantly higher than the non-interactive modules (p < .05). Both qualitative and quantitative data from module evaluations demonstrated that satisfaction with modules was high. However, there were lower ratings for whether learning objectives were met with Module 6 (p < 0.03) and lecturer rating (p < 0.004) compared to Module 1. Qualitative data also showed that completion of the interactive modules resulted in higher resident satisfaction. CONCLUSIONS This initial assessment of the PNS modules shows that technology-mediated delivery of a nutrition curriculum in residency programs has great potential for providing rich learning environments for trainees while maintaining a high level of participant satisfaction.
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Affiliation(s)
- Kadriye O Lewis
- />Children’s Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO USA
| | - Graeme R Frank
- />Cohen Children’s Medical Center, Division of Pediatric Endocrinology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA
| | - Rollin Nagel
- />The Ohio State University College of Medicine, Office of Evaluation, Curriculum Research and Development, Columbus, Ohio USA
| | - Teri L Turner
- />Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas USA
| | - Cynthia L Ferrell
- />Oregon Health and Science University, Doernbecher Children’s Hospital, Portland, Oregon USA
| | - Shilpa G Sangvai
- />Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio USA
| | - Rajesh Donthi
- />Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California USA
| | - John D Mahan
- />Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio USA
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Martindale RG, McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr 2014; 37:5S-20S. [PMID: 24009250 DOI: 10.1177/0148607113496821] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Poor nutrition status has long been linked to increases in postoperative complications and adverse outcomes for the patient undergoing elective surgery. While optimal planning for nutrition therapy should be comprehensive spanning throughout the perioperative period, recent advances have focused on the concept of "prehabilitation" to best prepare the patient prior to the insult of surgery. Adding immune/metabolic modulating formulas the week of surgery with carbohydrate drinks to optimize glycogen deposition immediately prior to surgery, enhances patient recovery and return to baseline function. Such nutrition strategies should now be combined with a host of other practices (such as smoking cessation, weight loss, glucose control, and specialized exercise program) as part of a structured protocol to maximize patients' chances for a full and rapid recovery from their elective surgical procedure.
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Affiliation(s)
- Robert G Martindale
- Department of Surgery, University of Oregon Health Sciences University, Portland, Oregon, USA
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18
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Kiraly LN, McClave SA, Neel D, Evans DC, Martindale RG, Hurt RT. Physician Nutrition Education. Nutr Clin Pract 2014; 29:332-7. [DOI: 10.1177/0884533614525212] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Laszlo N. Kiraly
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | - Stephen A. McClave
- Division of Gastroenterology and Hepatology, University of Louisville, Kentucky
| | - Dustin Neel
- Department of Surgery, University of Louisville, Kentucky
| | - David C. Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | | | - Ryan T. Hurt
- Department of Medicine, University of Louisville, Kentucky
- Divisions of General Internal Medicine, Gastroenterology and Hepatology, and Endocrinology, Mayo Clinic, Rochester, Minnesota
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19
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Integrating nutrition education into the cardiovascular curriculum changes eating habits of second-year medical students. J Clin Lipidol 2013; 8:199-205. [PMID: 24636180 DOI: 10.1016/j.jacl.2013.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/01/2013] [Accepted: 11/15/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Survey of medical curricula continues to show that nutrition education is not universally adequate. One measure of nutritional educational competence is a positive change in student eating habits. OBJECTIVE The objective of this study was to evaluate whether integrating nutrition education within the second-year cardiovascular course for medical students, using the "Rate Your Plate" (RYP) questionnaire, coupled with knowledge of student personal 30-year risk of a cardiovascular event was useful in changing students' eating behaviors. METHODS Thirty-two students completed an unpublished 24-item questionnaire (modified-RYP) about their eating habits in the spring of their first year. The same students then completed the questionnaire in the spring of their second year. Paired t test was used to analyze the difference in RYP scores. Pearson correlation coefficients were calculated for the Framingham 30-year cardiovascular event risk and change in RYP score to examine whether risk knowledge may have changed eating habits. RESULTS Mean scores at baseline and 1 year later were 57.19 and 58.97, respectively (paired t test, P < .01). Correlation coefficient between 30-year relative risk, adjusted for family history, and change in RYP score was -0.322. CONCLUSION Although medical students were eating healthy at baseline, integration of nutrition education within the second-year cardiovascular medical curriculum was associated with improved heart healthy eating habits. Because student attitudes about prevention counseling are influenced by personal eating habits, this suggests that students with a more healthy diet will be more likely to recommend the same for their patients.
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20
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Assessment of nutrition education among pediatric gastroenterologists: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr 2013; 56:137-44. [PMID: 22699840 PMCID: PMC3493684 DOI: 10.1097/mpg.0b013e3182638ce8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Pediatric gastroenterology is the only pediatric subspecialty with nutrition as part of its official curriculum and objective; however, pediatric gastroenterology fellows believe that their baseline knowledge in nutrition is suboptimal. The purpose of the present study was to assess the perceived effectiveness of nutrition training among pediatric gastroenterologists, identify areas of need for additional education, and determine the perceived role of the gastroenterologist in obesity management. METHODS A survey was sent to members and fellows of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition to assess general nutrition education as well as obesity management and educational needs. RESULTS A total of 272 responses were received, for an overall response rate of 15.2% (272/1784). Most responders reported having average or above-average knowledge base in all nutritional topics. There was strong interest in additional resources and a continuing medical education (CME) module on several nutrition topics including nutritional requirements in specific gastrointestinal (GI) disease, failure to thrive/growth failure, and parenteral nutrition support, with the format of CME dependent on the topic. There was also a strong interest in additional CME on the management of pediatric obesity (67%), as most responders believed that the management of obesity in children requires subspecialty care. The perceived role of the pediatric gastroenterologist was, however, one of support to treat the GI and hepatic comorbidities of obesity rather than serve as the main provider of comprehensive obesity care. CONCLUSIONS Pediatric gastroenterologists identified gaps in their nutrition knowledge base that may be attributed to the present nutrition education training during fellowship. Multiple topics were identified for additional nutrition education, including obesity management. The nutrition management challenges of today necessitate improved baseline nutrition knowledge and this focus on nutrition should begin at the fellowship level.
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Ray S, Udumyan R, Rajput-Ray M, Thompson B, Lodge KM, Douglas P, Sharma P, Broughton R, Smart S, Wilson R, Gillam S, van der Es MJ, Fisher I, Gandy J. Evaluation of a novel nutrition education intervention for medical students from across England. BMJ Open 2012; 2:e000417. [PMID: 22327628 PMCID: PMC3277906 DOI: 10.1136/bmjopen-2011-000417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Problems such as hospital malnutrition (∼40% prevalence in the UK) may be managed better by improving the nutrition education of 'tomorrow's doctors'. The Need for Nutrition Education Programme aimed to measure the effectiveness and acceptability of an educational intervention on nutrition for medical students in the clinical phase of their training. DESIGN An educational needs analysis was followed by a consultative process to gain consensus on a suitable educational intervention. This was followed by two identical 2-day educational interventions with before and after analyses of Knowledge, Attitudes and Practices (KAP). The 2-day training incorporated six key learning outcomes. SETTING Two constituent colleges of Cambridge University used to deliver the above educational interventions. PARTICIPANTS An intervention group of 100 clinical medical students from 15 medical schools across England were recruited to attend one of two identical intensive weekend workshops. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure consisted of change in KAP scores following intervention using a clinical nutrition questionnaire. Secondary outcome measures included change in KAP scores 3 months after the intervention as well as a student-led semiqualitative evaluation of the educational intervention. RESULTS Statistically significant changes in KAP scores were seen immediately after the intervention, and this was sustained for 3 months. Mean differences and 95% CIs after intervention were Knowledge 0.86 (0.43 to 1.28); Attitude 1.68 (1.47 to 1.89); Practice 1.76 (1.11 to 2.40); KAP 4.28 (3.49 to 5.06). Ninety-seven per cent of the participants rated the overall intervention and its delivery as 'very good to excellent', reporting that they would recommend this educational intervention to colleagues. CONCLUSION Need for Nutrition Education Programme has highlighted the need for curricular innovation in the area of clinical health nutrition in medical schools. This project also demonstrates the effectiveness and acceptability of such a curriculum intervention for 'tomorrow's doctors'. Doctors, dietitians and nutritionists worked well in an effective interdisciplinary partnership when teaching medical students, providing a good model for further work in a healthcare setting.
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Affiliation(s)
| | - Ruzan Udumyan
- Epidemiology and Public Health, University College London, London, UK
| | - Minha Rajput-Ray
- Department of Medicine, Cambridge University Hospitals, Cambridge, UK
| | - Ben Thompson
- Division of Medical Education, King's College London, London, UK
| | | | - Pauline Douglas
- School of Biomedical Sciences, University of Ulster, Northern Ireland
| | - Poonam Sharma
- Department of Rheumatology, Peterborough and Stamford Hospitals, Peterborough, UK
| | | | | | - Rick Wilson
- Nutrition and Dietetics, King's College Hospital, London, UK
| | - Stephen Gillam
- Public Health and Primary Care, IPH, University of Cambridge, Cambridge, UK
| | - Mike J van der Es
- NNEdPro Group, c/o MRC Human Nutrition Research, Cambridge, Cambridge, UK
| | - Ilana Fisher
- NNEdPro Group, c/o British Dietetic Association, Birmingham, UK
| | - Joan Gandy
- Dietetics, University of Hertfordshire, Hatfield, and British Dietetic Association, Herts, UK
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