Development of a measure of attitude toward nutrition in patient care

Increasing Trainee Comfort with Nutrition

OBJECTIVES

Nutrition counseling is necessary for the prevention and treatment of many chronic diseases. US survey data demonstrate that 61% of Internal Medicine (IM) residents receive little to no nutrition training. The objective of our study was to develop a curriculum to increase IM resident comfort and ability in conducting a nutritional assessment.

METHODS

Categorical IM residents at a large academic medical center participated in a curriculum that included a lecture, a small-group discussion, and a skills exercise. Residents completed pre- and posttest surveys that evaluated their attitudes and comfort level with nutritional assessment.

RESULTS

Eighty percent (84/105) of the residents participated in the curriculum and 48% (40/84) of them completed both pre- and postsession surveys. Residents who considered themselves moderately to extremely comfortable completing a nutritional assessment increased after the program (27.5% to 87.5%, P < 0.0001). The proportion of those who agreed or strongly agreed with the statement, "Nutritional counseling should be included in any routine appointment, just like diagnosis and treatment," increased from 62.50% to 80.00% (P = 0.012). The proportion of residents who considered lack of individual knowledge to be a barrier for nutrition counseling decreased from 65.79% to 42.11% (P = 0.0126).

CONCLUSIONS

This curriculum was successful in increasing IM resident comfort with conducting a nutritional assessment.

Implementing nutritional medicine into medical curricula: A student-initiated course improves knowledge and attitudes

BACKGROUND & AIMS

Although the risks and opportunities of nutrition in health trajectories are well known, it is rarely addressed in doctors' daily routine. This is partly related to physicians' lack of confidence in their ability to provide nutritional counselling, possibly due to insufficient training in medical school. Our study aimed at assessing the status quo of nutrition in the German medical curricula and the impact of a recently implemented, student-initiated online teaching initiative on perceived competence, knowledge and attitudes.

METHODS

"Eat This!" was the first Germany-wide initiative for online nutritional medicine (NM) education, consisting of 11 digital lectures on nutrition basics, nutrition medicine and public health nutrition. The contact time with NM during studies as well as the effects on students' attitudes towards NM, their self-perceived competence in NM and their nutrition knowledge were assessed from October 2020 to February 2021 in a cross-sectional as well as a prospective study using online questionnaires.

RESULTS

Over 1500 medical students from 42 German faculties participated in the lecture series and the online survey. One hundred and twenty-two students formed a control group. Although considering the topic relevant, students rated their training in NM as insufficient, in terms of both quality and quantity. Initially, they did not feel able to counsel patients and rated their knowledge as low. However, self-ratings and the score in a 33-item multiple-choice test knowledge improved by participating in Eat This! as did their attitude towards nutrition and planetary health. No such changes were observed in the control group of 122 students not attending the course.

CONCLUSION

Our results show that education in NM at German medical schools is perceived insufficient despite high student interest. But even low-threshold educational options like "Eat This!" can improve students' perceived competence, knowledge, and attitudes, and thus be an efficient and cost-effective way to address related deficits.

Impact of Experiential Learning of Nutrition Therapy on Medical Students

Despite the recognition that nutrition is a critical component of health and disease, many medical schools struggle to incorporate nutrition education into their dense curriculum. We designed this study to determine whether a brief, experiential learning project would be an effective option for teaching this content. Medical students voluntarily enrolled in the study, agreeing to (1) attempt a 2-week "medically prescribed" diet and (2) participate in small group lunch discussions related to their diet experience. Data on student perception of nutrition in medicine was collected through validated surveys. Custom surveys were designed to capture student confidence in using nutrition counseling, while qualitative analysis of lunch discussions revealed themes of experiential learning. Participants reported an overall positive sentiment and named the most impactful learning component as actively attempting the diet. Student participants showed a variety of adherence to their assigned diet, yet as a cohort demonstrated increased confidence over their non-participant peers in the use of nutrition counseling in a clinical setting. In addition, diet participants demonstrated an increased perception of the importance of physician efficacy and the physician-patient relationship in the broader landscape of nutrition in patient care (compared to the control group). This study demonstrates the educational value of a short, immersive, extracurricular opportunity in bolstering an already demanding undergraduate medical education curriculum.

Nutrition education intervention improves medical students' dietary habits and their competency and self-efficacy in providing nutrition care: A pre, post and follow-up quasi-experimental study

Objective

Most doctors and medical students report inadequate competencies in nutrition care. We evaluated the impact of a nutrition education intervention on medical students' lifestyle habits, dietary diversity, nutrition care knowledge, attitude toward nutrition care, and their level of self-efficacy in the provision of nutrition care.

Methods

All 2nd-year medical students were enrolled into a 5 week, 24-h nutrition education intervention that involved both deductive and practical sessions. Pre-, post and 4 weeks follow-up assessments were conducted.

Results

At post- and 4-weeks post-intervention the number of days participants consumed vegetables and engaged in moderate-to-vigorous physical activity significantly (p = 0.003 and 0.002) improved respectively from baseline. Mean nutrition care knowledge scores of participants increased by 3.27 points (95% Cl: 1.98-4.56, p < 0.001) from 19.49 at baseline through to 24.78 post- and 22.76 4 weeks follow-up. No significant [X ( 2 ) 2 = 1.568, p = 0.457] change in mean attitude toward nutrition care score was recorded. Mean level of self-efficacy in the provision of nutrition care improved significantly by 1.73 (95% Cl: 1.17-2.28, p < 0.001) at post-intervention and 4 weeks follow-up compared to the baseline scores.

Conclusion

The intervention improved the nutrition care knowledge, self-efficacy in the provision of nutrition care as well as medical students' own consumption of vegetables, dietary diversity and their engagement in moderate-to-vigorous physical activity. However, continuous implementation of nutrition education interventions is needed to sustain these outcomes and further improve the nutrition education experience of medical students.

Culinary Medicine as Innovative Nutrition Education for Medical Students: A Scoping Review

PURPOSE

Lifestyle-related disease substantially impacts health, but physicians lack adequate nutrition education to discuss behavioral change with patients. Many medical schools have developed culinary medicine programs as a nutrition education strategy, but common elements of success have not been defined.

METHOD

The authors conducted a scoping review of the literature on culinary medicine programs for medical students. They searched PubMed, Ovid MEDLINE, and MedEdPORTAL databases to identify English-language studies published between January 1, 2012, and October 15, 2021. Multiple search terms were used to identify medical student-focused culinary medicine programs. The authors focused inclusion criteria on medical student learners, curricular description, hands-on cooking components, reflection or application to patient care, and assessment. Additionally, the authors reviewed 2 online databases which list programs delivering culinary medicine education for U.S. medical students.

RESULTS

Authors identified 251 studies, of which 12 met inclusion criteria. These studies described programs that used a kitchen or similar space adaptable for food preparation to enable hands-on learning, and some programs provided opportunities for practical application. Most programs administered surveys to assess course impact, but the type of survey and cohort size varied. Culinary medicine programs for medical students varied in learner level, number of participants, course length and structure, and instructor background but consistently improved student knowledge in key areas of nutrition application and changed knowledge and attitudes about food and nutrition. Funding was often noted as a barrier to program sustainability. When funding source was provided, it derived from philanthropic or academic sources. When the authors reviewed the 2 online databases, they identified 34 programs offering medical student-focused culinary medicine courses.

CONCLUSIONS

As culinary education programs emerge across academic centers, standardizing programmatic and curricular elements, best practices, and assessment strategies will be vital for quality control, sustainability, and optimal population health impact.

Attitudes, behaviours, and self-reported confidence of Australian pharmacy students and interns towards nutritional counselling

INTRODUCTION

Pharmacists play a prominent role in the counselling and education of patients complementary to provision of medicines. The increase in non-communicable diseases associated with poor quality diets has placed a greater demand on pharmacists to play a role in the provision of nutritional education to patients. This study aimed to investigate pharmacy students' and interns' attitudes, behaviours, and self-reported confidence towards nutritional counselling and to examine factors associated with their intention to counsel patients in nutrition.

METHODS

An online survey was designed using the theory of planned behaviour and was distributed to final-year pharmacy students and interns enrolled at the University of Sydney. Data analysis was conducted to test for correlations between behavioural intentions, attitudes, confidence, subjective norms, and perceived behavioural control.

RESULTS

Sixty-six surveys were completed, representing an average response rate of 19.6%. Half of all participants reportedly were providing nutritional advice to patients at least once per week or more often when working in a pharmacy. Participants' intention to counsel patients about nutrition was influenced by preceptors' encouragement. The participants' average level of confidence in having the knowledge and skills to provide nutritional counselling, reported over 13 medical conditions, showed that they were on average "somewhat confident" in providing nutritional counselling, with the level of confidence differing depending upon the specific topic areas.

CONCLUSIONS

Participants acknowledged the role of pharmacists in the provision of nutritional counselling, but a more comprehensive nutrition curriculum integrated within existing pharmacy curricula is warranted to increase pharmacy students' and interns' confidence.

Impact of a Brief Culinary Medicine Elective on Medical Students' Nutrition Knowledge, Self-efficacy, and Attitudes

The aim of this study was to determine how a brief culinary medicine curriculum impacted medical students' nutrition knowledge, attitudes, and self-efficacy and to evaluate which parts of the curriculum students found to be most helpful. This preliminary intervention study enrolled participants in a 2-week culinary medicine elective course and measured pre- and post-elective. Students attending an Appalachian medical school (n = 16) participated in this study. Participants were surveyed on their nutrition knowledge, self-efficacy in providing nutrition advice, and attitudes towards use of nutrition in practice pre- and post-elective. Participants also completed elective evaluations following the course. Changes in mean outcome scores were measured pre- and post-elective using signed Wilcoxon tests. Alpha was set at .05. Frequencies of responses were calculated to determine which course components were ranked highest in their efficacy. Nutrition knowledge and self-efficacy increased significantly from pre- to post-elective (p < .0001 and p < .0001, respectively). Students valued the hands-on and culinary components of the course most. Results indicate that a brief culinary medicine curriculum can effectively improve medical students' knowledge and self-efficacy of nutrition counseling and that students prefer hands-on and applied learning when learning about nutrition.

Nutrition training in residency and fellowship programme: time for a change

Background:

Despite several measures, the nutrition education during undergraduate and postgraduate training has been identified to be suboptimal. The objective of this study was to assess the nutrition knowledge, attitudes and practice of residents, fellows and teaching faculties, following a reformation in the training curriculum, in a tertiary teaching hospital.

Method:

We conducted an anonymous survey involving residents, fellows and teaching faculties in medical and surgical speciality. We assessed four domains: (a) recognition, (b) knowledge, (c) application of basic principles of nutritional and (d) attitude towards clinical nutrition during residency and fellowship training. Each domain had five multiple choice questions and the attitude section was assessed using a five-point Likert scale.

Result:

We distributed the survey to 305 doctors: 265 completed the first three domains and 259 completed all the domains. The overall mean ± SD score between residents (6.5 ± 1.9), fellows (6.8 ± 1.8) and teaching faculties (6.5 ± 2.2) was similar. All scored similarly in the recognition, knowledge and application domain of the questionnaire. When subcategorised, the gastroenterology sub-speciality scored significantly higher than the rest (8.1 ± 2.2 vs. 6.4 ± 1.9, p = 0.001). Sixty-three per cent and 44% of the responders felt there was lack of adequate focus on clinical nutrition training in residency and during daily ward round, respectively. Only 10% of responders felt confident in providing nutritional counselling and treatment for malnourished patients.

Conclusion:

Our study shows the current nutritional education during residency and fellowship training is still inadequate and falls short in achieving the recommended goals.

Impact of nutrition education on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students: an intervention study

OBJECTIVE

Management of diet-related chronic diseases may benefit from improved nutrition education of medical students. This study aims to investigate the effects of a nutrition education course on nutritional knowledge and intentions towards nutritional counselling in Dutch medical students.

DESIGN

This is a pre-post intervention study with a comparison group. Participants completed self-reported questionnaires on nutritional knowledge and intentions towards nutritional counselling.

PARTICIPANTS

In total, 118 medical students (64.4% undergraduate, 73.2% women) were recruited from two medical schools in the Netherlands (n=66 intervention group, n=52 comparison group).

INTERVENTION

The intervention group completed a 25-hour course in nutritional counselling (the Students Experienced in Lifestyle and Food (SELF) course) in addition to the standard medical curriculum. The comparison group followed the standard medical curriculum.

OUTCOME MEASURES

Self-reported nutritional knowledge and intentions towards nutritional counselling, including attitude, self-efficacy and social support.

RESULTS

Nutritional knowledge (B: 2.42, 95% CI 1.81 to 3.02), attitude in men (B: 0.50, 95% CI 0.13 to 0.87) and self-efficacy (B: 0.78, 95% CI 0.62 to 0.95) significantly increased in the intervention group compared with the comparison group. No significant differences were found for social support (B: 0.20, 95% CI -0.02 to 0.43) and attitude in women (B: 0.08, 95% CI -0.24 to 0.31) between the two groups.

CONCLUSIONS

The SELF course increased medical students' nutritional knowledge and stimulated their intentions towards nutritional counselling. Future research is needed to evaluate the long-term impact of nutrition education interventions on physician practice patterns and patient outcomes.

Experiential Application of a Culinary Medicine Cultural Immersion Program for Health Professionals

Nutrition is a key factor in preventing and treating long-term disease. Patients should be advised to follow evidence-based dietary patterns, such as the Mediterranean diet, which has shown success in preventing or managing a variety of long-term diseases. All health professionals can play a role in providing nutrition advice to patients; however, many have shown an overall low nutrition knowledge and self-efficacy in counseling patients. Because of this, there is a call by health professional organizations for an increase in the applied nutrition education of health professionals. Increasing Culinary Health Opportunities for Professionals is a learn-first, practice second experiential learning program with currently practicing or aspiring health professionals aimed to increase nutrition knowledge, self-efficacy, attitudes, and dietary intake. Currently practicing health professionals (n = 15) and aspiring health professionals (n = 14) were recruited to participate in a 16-week online course on culinary medicine and the Mediterranean diet followed by a 2-week cultural immersion in Tuscany, Italy. Participants were taught the Mediterranean diet and lifestyle, culinary medicine, nutrition counseling, and cultural comparisons in the online course. In Tuscany, participants completed culinary lessons, organic farm tours, food production facility tours, and various tastings of Mediterranean foods. Participants completed a 51-item survey that measured nutrition knowledge, self-efficacy, attitudes, and Mediterranean diet adherence at baseline, post-online education, and post-cultural immersion. Mann-Whitney U tests were used to determine differences in mean scores between cohort 1 (currently practicing) and cohort 2 (aspiring). Results showed that cohort 1 had a greater increase in knowledge (1.07 ± 0.40 vs -0.87 ± 0.40, P = .0069) and self-efficacy (0.74 ± 0.24 vs 0.01 ± 0.24, P = 0.0441) from pre-post course, but at the conclusion of the cultural immersion, there were no significant differences between cohorts in mean changes in attitude, knowledge, self-efficacy, or Mediterranean diet scores from baseline. These results suggest that implementation of this curriculum can be equally effective in increasing nutrition-related attitudes, self-efficacy, and Mediterranean diet adherence for both currently practicing and aspiring health professionals.

Learn first, practice second approach to increase health professionals' nutrition-related knowledge, attitudes and self-efficacy

Health professionals generally have positive attitudes towards the role of nutrition in medicine, but limited knowledge and low self-efficacy for incorporating it into routine care. To assess the effectiveness of a "learn first, practice second" intervention on the nutrition-related knowledge, attitudes, and self-efficacy of multidisciplinary health professionals, the present approach consisted of 16 weeks of online education and 2 weeks of cultural immersion in Tuscany, Italy. Data was captured via online surveys at Baseline, Post-education, Post-immersion, and Follow Up. Repeated measures ANOVA with irregular spacing was used, followed by Dunnett's or Cochran-Mantel-Haenszel testing. Results indicate significantly improved participant nutrition knowledge (nonzero correlation p = .0136, means score p = .0075) and self-efficacy (T0-T1 p < .0001, T0-T2 p < .0001, T0-T3 p = .0002), with differences in attitude trending towards significance (p = .0764). Findings from this study suggest that a combination of online education and hands on learning experiences can be beneficial for increasing health professionals' nutrition knowledge, confidence, and potentially attitude.

Medical Student Attitudes on Nutrition Counseling After Implementation of a Novel Curricular Activity

Objective: The aim of this research was to determine the changes in medical student attitudes toward nutrition counseling after implementation of a novel curricular activity during a required third-year clerkship.Method: All third-year medical students completing their required family medicine clerkship were invited to participate in a voluntary survey composed of the Nutrition in Patient Care Survey (NIPS) and demographics before their required curricular clerkship activity consisting of two separate case-based modules focused on nutritional aspects of patient care. Students and faculty facilitators met via web platform at an assigned time to review and discuss questions. All students were invited to complete the postsurvey composed of only the NIPS.Results: Completion rate was 31% for both pre- and postsurveys. Students' intended specialty choice did not lead to a significant difference in scores on any of the five subscales on pre-intervention surveys. Almost half (43.9%) of the students who completed the surveys reported offering nutrition-related counseling despite lack of formal training. The Physician-Patient Relationship score went from 4.29 to 4.37 (p < 0.03) and the Physician Efficacy score went from 3.18 to 3.34 (p < 0.01). The was no significant difference identified pre- versus postintervention for the Clinical Behavior scales.Conclusions: The modules used in this pilot study resulted in positive changes in student attitudes toward counseling patients about nutrition. The inclusion of required case-based modules focused on nutrition is feasible and can positively impact student attitudes regarding their efficacy in counseling patients.

Differences in Health Education Competencies Among Obesity Prevention and Nutrition Education Professionals

The study purpose was to examine perceived health education competencies among those responsible for planning, implementing, and evaluating health education programs. A total of 172 obesity prevention and nutrition education professionals in the United States completed a survey measuring their perceived competency to plan, implement, and evaluate nutrition education/obesity prevention education programs based on the National Commission for Health Education Credentialing health education competencies and their endorsement of various health education approaches. Using a series of multiple hierarchical regression models, we found that those trained in health education had greater perceived competency in assessing needs ( B = 1.19, t = 2.11, p = .03), planning health education programs ( B = 1.63, t = 2.96, p = .004), implementing health education programs ( B = 1.00, t = 2.22, p = .03), evaluating health education programs ( B = 4.85, t = 3.54, p = .001), and managing health education programs ( B = 1.70, t = 2.21, p = .03) than those trained in nutrition or dietetics. Additionally, those trained in health education were more likely to endorse the use of a skill-based approach to obesity prevention ( B = 0.25, t = 2.53, p = .01) and less likely to endorse teaching facts and information ( B = 0.24, t = 1.99, p = .05) than those trained in nutrition or dietetics. These results have implications for improving the effectiveness of health education and promotion programs and the professional preparation of health educators and dietitians alike.

Nutrition Education in Internal Medicine Residency Programs and Predictors of Residents' Dietary Counseling Practices

BACKGROUND

Although physicians are expected to provide dietary counseling for patients with cardiovascular (CV) risk factors such as hypertension, hyperlipidemia, diabetes, and obesity, nutrition education in graduate medical education remains limited. Few studies have recently examined nutrition education and dietary counseling practices in Internal Medicine (IM) residency training.

OBJECTIVES

To conduct a contemporary assessment of outpatient nutrition education in IM residency programs in the United States, identify predictors of residents' dietary counseling practices for CV risk factors, and identify barriers for educators in providing nutrition education and barriers for residents in counseling patients.

DESIGN

Cross-sectional anonymous surveys were completed by IM program directors (PDs) and residents throughout the United States. Linear regression was used to examine the association between the amount of nutrition education received and the number of instruction methods used by the residents and frequency of residents' dietary counseling for patients with CV risk factors.

KEY RESULTS

A total of 40 educators (PDs and ambulatory/primary care PDs) and 133 residents across the United States responded to the survey. About 61% of residents reported having very little or no training in nutrition. Nutrition education in residency, both the amount of education (β = 0.20, P = .05) and the number of instruction methods used (β = 0.26, P = .02), predicted frequency of residents' dietary counseling practices independent of nutrition education in medical school, which was also significantly associated with counseling (β = 0.20, P = .03). Residents' total fruit and vegetable intake likewise predicted frequency of counseling (β = 0.24, P < .001). Low perceived faculty expertise was a major barrier for educators and was associated with lower level of provided nutrition education (r = -.33, P = .04). Low resident and low perceived clinic preceptors' interests in nutrition were also associated with lower frequency of residents' dietary counseling (r = -.19, P = .04; r = -.18, P = .05).

CONCLUSIONS

The provision of nutrition education in IM residency programs and IM residents' dietary counseling for patients need to be systematically assessed nationally. This study's preliminary findings suggest that multimodal nutrition education in IM residency and better resident dietary habits are associated with higher frequency of dietary counseling for patients. Lack of faculty expertise and low faculty and resident interests in patient counseling need to be addressed perhaps by mandating nutrition education in graduate and continuing medical education.

Nutrition advice provided by general practice registrars: an investigation using patient scenarios

BACKGROUND

Nutrition is recognized as a strong factor influencing the health outcomes of patients with chronic disease. General practitioners (GPs) require nutrition knowledge and skills to support patients to have healthy dietary behaviours.

OBJECTIVE

To investigate New Zealand GP registrars' provision of nutrition advice using patient scenarios.

STUDY DESIGN

A cross-sectional study design targeted GP registrars to investigate the nutrition care they provided to patients.

METHODS

Fourty-seven GP registrars completed a survey at a training event. The survey included patient scenarios. Respondents were asked to provide nutrition advice for each scenario, in line with best practice guidelines. Responses to each scenario were scored based on a panel of nutrition experts. Regression analysis was used to compare the scores to participants' previously reported confidence to provide nutrition care.

RESULTS

Seventeen male (36.2%) and thirty female (63.8%) GP registrars completed the survey, giving a response rate of 92.2%. GP registrars scored a mean of 7.9 ± 0.2 out of 15 for recall of dietary strategies with the scenarios. There was no association between GP registrars' scenario scores and their confidence to provide nutrition care.

CONCLUSIONS

An evidence-practice gap exists for New Zealand GP registrars' confidence to provide nutrition care, and their knowledge of evidence-based nutritional guidelines to support patients to have healthy dietary behaviours. A better understanding of the determinants of this disparity is required in order to support optimal nutrition care by GPs.

Development of a validated questionnaire to measure the self-perceived competence of primary health professionals in providing nutrition care to patients with chronic disease

BACKGROUND

Nutrition is an important aspect of chronic disease prevention and management by primary health professionals, including GPs, dietitians, practice nurses, diabetes educators and exercise professionals. In order to better understand how to improve the delivery of nutrition care, it is important to have valid and reliable tools to measure self-perceived competence.

OBJECTIVE

This study aimed to develop a valid, structured, questionnaire that measures the self-perceived competence of primary health professionals to provide nutrition care to patients with chronic disease.

METHODS

The development of the questionnaire was carried out in four stages (1): preparation of scope and structure, through a literature review and consultation with an expert reference group (2); development of questionnaire items, which were refined through feedback from the reference group and 18 primary health professionals (3); investigation of internal consistency and concurrent validity through a pilot study on 118 primary health professionals (4) and investigation of test-retest reliability through a pilot study on 33 primary health professionals who completed the questionnaire twice, 2-3 weeks apart.

RESULTS

Stages 1 and 2 resulted in four constructs and 35 questions in the questionnaire. Stage 3 confirmed internal consistency, with Cronbach's α ranging from 0.88 to 0.98 for each construct and 0.98 for all items combined. Dietitians scored significantly higher than speech pathologists (P < 0.05) in each construct, confirming concurrent validity. Stage 4 confirmed test-retest reliability, with correlation coefficients ranging from 0.89 to 0.94 for each construct and 0.95 for all items combined.

CONCLUSION

The NUTrition COMPetence (NUTCOMP) questionnaire is a valid, reliable and suitable tool that can be used to directly inform professional development and identify opportunities to support safe and effective practice.

New Zealand Medical Students Have Positive Attitudes and Moderate Confidence in Providing Nutrition Care: A Cross-Sectional Survey

Throughout the world, medical students and doctors report inadequate nutrition education and subsequently lack of knowledge, attitude, and skills to include nutrition in patient care. This study described New Zealand’s students’ attitudes to and self-perceived skills in providing nutrition care in practice as well as perceived quantity and quality of nutrition education received in training. 183 medical students from New Zealand’s largest medical school (response rate 52%) completed a 65-item questionnaire, partially validated, using 5-point Likert scales. Students believed incorporating nutrition care into practice is important, yet they were less confident patients improve nutrition behaviours after receiving this care. Students were confident in skills related to nutrition in health and disease but less confident in skills related to general food knowledge. Greater quantity and quality of nutrition education received was associated with greater self-perceived skills in providing nutrition care to patients but not with attitudes towards incorporating nutrition care into practice. This cohort of New Zealand medical students places similarly high importance on nutrition care as students and doctors from other countries. Further investigations beyond graduation are required to inform whether additional nutrition education is warranted for these doctors.

The development and validation of the childhood obesity prevention self-efficacy (COP-SE) survey

BACKGROUND

Physicians can play an important role in preventing and treating childhood obesity. There are currently no validated measures of medical students' self-efficacy in these skills; therefore, we sought to develop a valid and reliable computerized survey to measure medical students' self-efficacy in skills needed to prevent and treat childhood obesity.

METHODS

We developed the Childhood Obesity Prevention Self-Efficacy (COP-SE) survey with input from two expert panels and cognitive interviews with medical students. We administered the 43-item COP-SE computerized survey to a nation-wide sample of medical students.

RESULTS

The final sample consisted of 444 medical students from 53 medical schools. Exploratory factor analysis revealed a two-factor structure with a correlation of 0.637 between factors and high reliability within factors. The correlation between the COP-SE and a measure of general self-efficacy was moderate (0.648), and reliability within factors was high (Factor 1=0.946; Factor 2=0.927).

CONCLUSIONS

The 18-item COP-SE is a valid and reliable measure of childhood obesity prevention self-efficacy. Factor 1 assesses self-efficacy in nutrition counseling, and Factor 2 measures self-efficacy to assess readiness to change and initiate nutrition lifestyle changes. The correlation between the COP-SE and a measure of general self-efficacy indicates that the COP-SE is a distinct, valid assessment of domain-specific self-efficacy. The high reliability of items within factors indicates the items measure the same constructs. Therefore, medical schools can use this valid and reliable instrument as a formative or summative assessment of students' self-efficacy in childhood obesity prevention and treatment.

Nutrition in medical education: reflections from an initiative at the University of Cambridge

Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of Clinical Medicine, including 1) the approach to medical nutrition education, 2) evaluation of the medical nutrition education initiative, and 3) areas identified for future improvement. The initiative utilizes a vertical, spiral approach during the clinically focused years of the Cambridge undergraduate and graduate medical degrees. It is facilitated by the Nutrition Education Review Group, a group associated with the UK Need for Nutrition Education/Innovation Programme, and informed by the experiences of their previous nutrition education interventions. Three factors were identified as contributing to the success of the nutrition education initiative including the leadership and advocacy skills of the nutrition academic team, the variety of teaching modes, and the multidisciplinary approach to teaching. Opportunities for continuing improvement to the medical nutrition education initiative included a review of evaluation tools, inclusion of nutrition in assessment items, and further alignment of the Cambridge curriculum with the recommended UK medical nutrition education curriculum. This paper is intended to inform other institutions in ongoing efforts in medical nutrition education.

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease

BACKGROUND

Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated.

OBJECTIVES

The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities.

METHODS

A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored.

RESULTS

Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role.

CONCLUSION

Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.

Nutrition attitudes and knowledge in medical students after completion of an integrated nutrition curriculum compared to a dedicated nutrition curriculum: a quasi-experimental study

BACKGROUND

Nutrition education has presented an ongoing challenge to medical educators. In the 2007-2008 academic year, Harvard Medical School replaced its dedicated Preventive Medicine and Nutrition course with an integrated curriculum. The objective of the current study was to assess the effect of the curriculum change on medical student attitudes and knowledge about nutrition.

METHODS

A survey was administered in a quasi-experimental design to students in the last class of the dedicated curriculum (n = 131) and the first class of the integrated curriculum (n = 135) two years after each class completed the required nutrition course. Main measures were attitude scores based on modified Nutrition in Patient care Survey and satisfaction ratings, performance on a nutrition knowledge test, and demographic variables. Two-tailed t-tests were performed.

RESULTS

Response rates were 50.4% and 42.2%. There were no differences between the groups in attitude scores from the Nutrition in Patient care Survey (p = 0.43) or knowledge scores (p = 0.63). Students with the integrated curriculum were less satisfied with both the quantity (p < 0.0001) and quality (p = 0.008) of their nutrition education, and were more likely to have completed optional online nutrition training modules (p = 0.0089).

CONCLUSIONS

Medical student attitudes and knowledge about nutrition were not affected by the model of nutrition education they receive, though students in an integrated curriculum may feel their education is inadequate and seek additional training.

Research opportunities in simulation-based medical education using deliberate practice

There are many opportunities for the academic emergency medicine (EM) community to engage in simulation-based educational research using deliberate practice (DP). This article begins by defining and giving examples of two key concepts: deliberate practice and mastery learning. The article proceeds to report six lessons learned from a research legacy in simulation-based medical education (SBME). It concludes by listing and amplifying 10 DP research opportunities in academic EM. A coda states that the research agenda is rich and ambitious and should focus on the goal of educating superb, expert clinicians.

What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge

OBJECTIVE

Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.

METHODS

Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.

RESULTS

Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).

CONCLUSIONS

Internal medicine interns' perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.

The Nutrition Academic Award: brief history, overview, and legacy

The Nutrition Academic Award (NAA) was developed by the National Heart, Lung, and Blood Institute with additional support from the National Institute of Diabetes and Digestive and Kidney Diseases. The purpose of the NAA was to formally integrate nutrition education within the medical school curriculum. Twenty-one medical schools were funded by the NAA in 2 waves of 5 y each, beginning in 1998 for the 10 vanguard schools and ending in 2005 for the second wave. The organizational structure, goals, objectives, and results of the NAA are summarized. The overall strengths, challenges, and recommendations for future medical nutrition education efforts are also provided.

Screening for Type 2 Diabetes Mellitus in Children and Adolescents: Attitudes, Barriers, and Practices Among Pediatric Clinicians

OBJECTIVE

The American Diabetes Association (ADA) recommends screening children at risk for type 2 diabetes with a fasting plasma glucose test or an oral glucose tolerance test. The purpose of this study was to describe attitudes, barriers, and practices related to type 2 diabetes screening in children among pediatric clinicians.

METHODS

Pediatricians, nurse practitioners and physician assistants from a multispecialty, group practice in Eastern Massachusetts completed a mailed survey. To assess screening practice, three vignettes were presented representing pediatric patients with low, moderately high, and high risk for type 2 diabetes. The moderately high-risk and high-risk patients met ADA criteria for screening. ADA-consistent practice was defined as only screening the moderately high-risk and high-risk patients; lower-threshold practice was defined as also screening the low-risk patient; and higher threshold practice was screening only the high-risk patient.

RESULTS

Sixty-two of 90 clinicians responded (69%). Based on intent to screen in the 3 vignettes, 21% of respondents reported ADA-consistent screening practice, 39% lower-threshold, and 35% higher-threshold screening practice. Five percent had incomplete or nonclassifiable responses. Many clinicians ordered screening tests other than those recommended by the ADA; few (< or =8% in any vignette) ordered only an ADA-recommended test. Preferences for nonfasting tests were influenced by nonmedical factors such as access to or cost of transportation. Inadequate patient education materials and unclear recommendations for appropriate screening methods were the most frequently reported moderate/strong barriers to screening.

CONCLUSIONS

Most respondents reported type 2 diabetes screening practices that differed from current ADA recommendations. Our findings suggest that type 2 diabetes screening tests must be practical for clinicians and patients if they are to be used in pediatric practice. Further study of the benefits and cost-effectiveness of type 2 diabetes screening in children is warranted to clarify the role and optimal methods for screening in pediatric primary care.

Development of a reliable multimedia, computer-based measure of clinical skills in bedside neurology

PURPOSE

This study reports the development of reliable multimedia, computer-based measures of bedside neurology skills.

METHOD

A consortium of neurologists and medical educators (1) identified bedside skills and (2) created a computer-based test. Test-item stems were multimedia clips of standardized patients. Options appeared as text. Sixty-one junior medical students responded to these items.

RESULTS

The 77-item test yielded a reliability coefficient of 0.85. Subgroup item analysis resulted in reliability coefficients of 0.73 for the 20-question "pretest" (Test A) and 0.75 for the 20-question "posttest" (Test B).

CONCLUSION

Two sets of test items were developed that can be used as outcome measures in studies that assess the effectiveness of educational interventions in bedside neurology.

Longitudinal and horizontal integration of nutrition science into medical school curricula

The overall goal of our Nutrition Academic Award (NAA) medical nutrition program at Mercer University School of Medicine is to develop, implement and evaluate a medical education curriculum in nutrition and other aspects of cardiovascular disease (CVD) prevention and patient management with emphasis on the training of primary care physicians for medically underserved populations. The curriculum is 1) vertically integrated throughout all 4 y of undergraduate medical education, including basic science, clinical skills, community science and clinical clerkships as well as residency training; 2) horizontally integrated to include allied healthcare training in dietetics, nursing, exercise physiology and public health; and 3) designed as transportable modules adaptable to the curricula of other medical schools. The specific aims of our program are 1) to enhance our existing basic science problem-based Biomedical Problems Program with respect to CVD prevention through development of additional curriculum in nutrition/diet/exercise and at-risk subpopulations; 2) to integrate into our Clinical Skills Program objectives for medical history taking, conducting patient exams, diet/lifestyle counseling and referrals to appropriate allied healthcare professionals that are specific to CVD prevention; 3) to enhance CVD components in the Community Science population-based medicine curriculum, stressing the health-field concept model, community needs assessment, evidence-based medicine and primary care issues in rural and medically underserved populations; 4) to enhance the CVD prevention and patient management component in existing 3rd- and 4th-y clinical clerkships with respect to nutrition/diet/exercise and socioeconomic issues, behavior modification and networking with allied health professionals; and 5) to integrate a nutrition/behavior change component into Graduate Residency Training in CVD prevention.

Translation of nutritional sciences into medical education: the Nutrition Academic Award Program

For the past 40 y the scientific community has decried the inadequacy of the training of physicians and other health professionals in the subject of human nutrition. In 1997 the National Heart, Lung, and Blood Institute developed the Nutrition Academic Award (NAA) Program, an initiative to improve nutrition training across a network of US medical schools. The purpose of this funding, which began in 1998, is to support the development and enhancement of nutrition curricula for medical students, residents, and practicing physicians to learn principles and practice skills in nutrition. The NAA recipients developed the Nutrition Curricular Guide for Training Physicians, a plan to incorporate clinical guidelines into physician practice skills, create educational and assessment practice tools, and evaluate curricula, materials, and teaching tools. Dissemination of NAA activities and materials will be facilitated by a national website, presentations and publications, and consultants and advisors from the NAA nutrition education programs. The NAA Program constitutes a major new effort to enhance nutrition knowledge and skills among health care providers and to effectively apply the science of human nutrition to clinical medicine. This article describes the purpose and aims of the NAA Program, the organizational structure of the network of recipients, a profile of the recipients and individual programs at 21 medical schools, the various strategies to overcome barriers in training physicians in human nutrition, and collaborative and dissemination efforts.