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Veldhuijzen van Zanten D, Vantomme E, Ford K, Cahill L, Jin J, Keller H, Nasser R, Lagendyk L, Strickland T, MacDonald B, Boudreau S, Gramlich L. Physician Perspectives on Malnutrition Screening, Diagnosis, and Management: A Qualitative Analysis. Nutrients 2024; 16:2215. [PMID: 39064658 PMCID: PMC11279970 DOI: 10.3390/nu16142215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Malnutrition is an important clinical entity that is frequently underdiagnosed and undertreated, in part due to a lack of education and different perceptions by healthcare providers on its value in medical practice. Given this void, the purpose of this qualitative study was to explore physicians' clinical perspectives on malnutrition care, including its prevalence in their practice, and potential barriers that might preclude the delivery of malnutrition care. Using a directed content qualitative analysis approach, a total of 22 general and subspecialist physicians across three Canadian provinces were interviewed using a series of standardized questions developed by a multidisciplinary research team. Responses were transcribed and then analyzed using NVivo Version 14 software. While physicians recognized the importance of malnutrition screening and treatment, they did not view themselves as the primary drivers and often deferred this responsibility to dietitians. Lack of standard malnutrition screening, education amongst allied healthcare providers, time, personnel, and referral processes to have patients assessed and managed for malnutrition were also identified as contributing factors. For physicians, malnutrition education, standard malnutrition screening during patient encounters, and access to the necessary tools to manage malnutrition using a more centralized approach and standard referral process were viewed as strategies with the potential to improve the ability of the physician to identify and manage disease-related malnutrition and its negative consequences.
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Affiliation(s)
| | - Erik Vantomme
- Department of Medicine, University of Saskatchewan, Regina, SK S4P 2H8, Canada
| | - Katherine Ford
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, NS B3J 1V7, Canada
| | - Jennifer Jin
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Heather Keller
- Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Roseann Nasser
- Saskatchewan Health Authority, Regina, SK S4P 1C4, Canada
| | | | | | | | - Sonya Boudreau
- Nova Scotia Health Authority, Halifax, NS B3H 2E1, Canada
| | - Leah Gramlich
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Lee CD, Hardin CC, Longo DL, Ingelfinger JR. Nutrition in Medicine - A New Review Article Series. N Engl J Med 2024; 390:1324-1325. [PMID: 38598799 DOI: 10.1056/nejme2313282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Clement D Lee
- From Tufts University School of Medicine, Boston, and the Department of Hospital and Pediatrics, Newton-Wellesley Hospital, Newton, MA (C.D.L.)
| | - C Corey Hardin
- From Tufts University School of Medicine, Boston, and the Department of Hospital and Pediatrics, Newton-Wellesley Hospital, Newton, MA (C.D.L.)
| | - Dan L Longo
- From Tufts University School of Medicine, Boston, and the Department of Hospital and Pediatrics, Newton-Wellesley Hospital, Newton, MA (C.D.L.)
| | - Julie R Ingelfinger
- From Tufts University School of Medicine, Boston, and the Department of Hospital and Pediatrics, Newton-Wellesley Hospital, Newton, MA (C.D.L.)
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Frank HE, Guzman LE, Ayalasomayajula S, Albanese A, Dunklee B, Harvey M, Bouchard K, Vadiveloo M, Yaroch AL, Scott K, Tovar A. Developing and testing a produce prescription implementation blueprint to improve food security in a clinical setting: a pilot study protocol. Pilot Feasibility Stud 2024; 10:51. [PMID: 38521931 PMCID: PMC10960480 DOI: 10.1186/s40814-024-01467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Food insecurity is common in the United States, especially in Rhode Island, where it affects up to 33% of residents. Food insecurity is associated with adverse health outcomes and disproportionally affects people from minoritized backgrounds. Produce prescription programs, in which healthcare providers write "prescriptions" for free or reduced cost vegetables, have been used to address food insecurity and diet-related chronic disease. Although there is growing evidence for the effectiveness of produce prescription programs in improving food security and diet quality, there have been few efforts to use implementation science methods to improve the adoption of these programs. METHODS This two-phase pilot study will examine determinants and preliminary implementation and effectiveness outcomes for an existing produce prescription program. The existing program is funded by an Accountable Care Organization in Rhode Island and delivered in primary care practices. For the first phase, we conducted a formative evaluation, guided by the Consolidated Framework for Implementation Research 2.0, to assess barriers, facilitators, and existing implementation strategies for the produce prescription program. Responses from the formative evaluation were analyzed using a rapid qualitative analytic approach to yield a summary of existing barriers and facilitators. In the second phase, we presented our formative evaluation findings to a community advisory board consisting of primary care staff, Accountable Care Organization staff, and staff who source and deliver the vegetables. The community advisory board used this information to identify and refine a set of implementation strategies to support the adoption of the program via an implementation blueprint. Guided by the implementation blueprint, we will conduct a single-arm pilot study to assess implementation antecedents (i.e., feasibility, acceptability, appropriateness, implementation climate, implementation readiness), implementation outcomes (i.e., adoption), and preliminary program effectiveness (i.e., food and nutrition security). The first phase is complete, and the second phase is ongoing. DISCUSSION This study will advance the existing literature on produce prescription programs by formally assessing implementation determinants and developing a tailored set of implementation strategies to address identified barriers. Results from this study will inform a future fully powered hybrid type 3 study that will use the tailored implementation strategies and assess implementation and effectiveness outcomes for a produce prescription program. TRIAL REGISTRATION Clinical trials: NCT05941403 , Registered June 9, 2023.
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Affiliation(s)
- Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Linda E Guzman
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Shivani Ayalasomayajula
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brady Dunklee
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Matthew Harvey
- Integra Community Care Network, Providence, RI, USA
- Care New England Health System, Providence, RI, USA
| | - Kelly Bouchard
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Kelli Scott
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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King RE, Palermo C, Wilson AN. Mapping nutrition within medical curricula in Australia and New Zealand: a cross-sectional content analysis. BMJ Nutr Prev Health 2023; 6:196-202. [PMID: 38618533 PMCID: PMC11009527 DOI: 10.1136/bmjnph-2022-000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/19/2023] [Indexed: 04/16/2024] Open
Abstract
Objective To systematically map nutrition content in medical curricula across all 23 medical schools in Australia and New Zealand accredited by the Australian Medical Council (AMC). Methods A cross-sectional content analysis was conducted. Learning outcomes for 20 AMC-accredited medical curricula were extracted from online repositories and directly from universities in February to April 2021. Nutrition relevant learning outcomes or equivalent learning objectives/graduate attributes were identified. Nutrition learning outcomes were analysed according to Bloom's revised taxonomy to determine whether outcomes met cognitive, psychomotor or affective domains and at what level. Results Of the total 23 AMC-accredited medical curricula, 20 medical schools had learning outcomes able to be sourced for analysis. A total of 186 nutrition learning outcomes were identified within 11 medical curricula. One medical school curriculum comprised 129 of 186 (69.4%) nutrition learning outcomes. The majority of outcomes (181, 97.3%) were in the cognitive domain of Bloom's revised taxonomy, predominantly at level 3 'applying' (90, 49.7%). The psychomotor domain contained five nutrition learning outcomes (5, 2.7%), while the affective domain contained none. New Zealand medical curricula (153, 82.3%) contained 4.6-fold more nutrition learning outcomes than Australian curricula (33, 17.7%). When comparing clinical and preclinical years across curricula, the proportion of learning outcomes in the psychomotor domain was 3.7-fold higher in clinical years (4.08%) versus preclinical years (1.15%). Conclusion There is wide variation across medical curricula regarding the number of nutrition learning outcomes. This may lead to varying competency of medical graduates to provide nutrition care in Australia and New Zealand.
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Affiliation(s)
- Ryan E King
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Alyce N Wilson
- International Development, Burnet Institute, Melbourne, Victoria, Australia
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Dumm M, Moll K, Helbach A, Leineweber CG, Böttrich T, Ruhtenberg CS, Polidori MC, Matthes J. Implementing nutritional medicine into medical curricula: A student-initiated course improves knowledge and attitudes. Clin Nutr ESPEN 2023; 57:181-189. [PMID: 37739654 DOI: 10.1016/j.clnesp.2023.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 09/24/2023]
Abstract
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.
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Affiliation(s)
- Moritz Dumm
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany; Gemeinschaftskrankenhaus Havelhöhe, Department Intensive Care, First Aid & Cardiology, Kladower Damm 221, 14089 Berlin, Germany
| | - Katharina Moll
- University of Hamburg, Faculty of Medicine, Martinistraße 52, 20246 Hamburg, Germany
| | - Anna Helbach
- Institute of General Practice, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Can Gero Leineweber
- Medical Department B of Internal Medicine, Brandenburg Medical School, University Hospital Ruppin-Brandenburg, Fehrbelliner Straße 38, 16816, Germany
| | - Tim Böttrich
- University of Gießen, Faculty of Medicine, Klinikstraße 29, 35392 Gießen, Germany
| | | | - Maria Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress-Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Matthes
- University Hospital Cologne, Centre of Pharmacology, Gleueler Straße 24, 50931 Cologne, Germany; University of Cologne, Faculty of Medicine, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany.
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Influence of Nutrition Training, Eating Habits, and Culinary Skills of Health Care Professionals and Its Impact in the Promotion of Healthy Eating Habits. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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McLeod MR, Chionis L, Gregg B, Gianchandani R, Wolfson JA. Knowledge and attitudes of lower Michigan primary care physicians towards dietary interventions: A cross-sectional survey. Prev Med Rep 2022; 27:101793. [PMID: 35656221 PMCID: PMC9152810 DOI: 10.1016/j.pmedr.2022.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Physicians rarely counsel patients about dietary interventions despite the proven efficacy of such interventions. Physicians both over- and under-estimated their knowledge on different dietary interventions. >90% of participating physicians expressed interest in continuing education on dietary interventions.
Background Dietary interventions are first-line therapies for the prevention and management of many chronic diseases, yet primary care physicians prescribe these interventions infrequently. Objectives This study investigates primary care physicians’ current knowledge and opinions regarding the delivery of dietary interventions. This work aims to identify modifiable barriers to prescribing dietary interventions to prevent and treat diet-related diseases. Methods We designed and fielded an anonymous, cross-sectional survey of faculty and resident physicians across the Internal Medicine, Family Medicine, and Pediatrics departments in three academic and community hospitals in lower Michigan. Data were collected between January 15 and April 15, 2019. Self-rated knowledge and attitudes were measured on a 5-point Likert scale. Objective scores were calculated for each question as percentage answered correctly among all respondents. Objective knowledge scores were compared based on participants’ years in practice. Results Response rate was 23% (356 responses). The sample was 62.3% female and 75.3% non-Hispanic White, and 56.7% were age 40 or younger. Average objective knowledge score was 70.3% (±17.2) correct. Mean self-rated knowledge score was 2.51 (±0.96) on a scale of 1(Poor) − 5(Excellent). Overall agreement with a statement of importance of dietary interventions was 3.99 (±0.40) on a scale of 1 (strongly disagree) to 5 (strongly agree). A majority (91.7%) of respondents indicated they would like more opportunities to learn about the evidence supporting dietary interventions. Conclusions Physicians desire to incorporate dietary interventions into their practice. Findings encourage the development of educational strategies to support dietary intervention use among primary care physicians.
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Slagel N, Newman T, Sanville L, Dallas J, Cotto-Rivera E, Moore J, Roberts Mph A, Sun Lee J. Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221091926. [PMID: 35535592 DOI: 10.1177/10901981221091926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fruit and Vegetable Prescription (FVRx) Programs combine produce prescriptions and nutrition education to reduce fruit and vegetable consumption barriers and promote health among low-income patient populations. This study examined whether a multi-level FVRx intervention model with intensive education improves dietary behaviors, food security, and health outcomes over single-level interventions alone. A 6-month nonrandomized, parallel, controlled trial was conducted with one intervention, FVRx (n = 31) and two comparison groups, Ad hoc Nutrition Education (n = 13) and Control (n = 16). The FVRx group received produce prescriptions (US$1/day/household member) redeemable at a farmer's market, two SNAP-Ed programs, one financial literacy program, and monthly health screenings. The Nutrition Education (NE) group participated in one SNAP-Ed program, and the Control group received safety-net clinic care only. Surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Pre-post clinical biomarkers (blood lipid and hemoglobin A1c) and monthly biometrics (anthropometrics and blood pressure) were measured. Descriptive analysis and one-way analysis of variance (ANOVA) were conducted. Compared with comparison groups, FVRx participants significantly increased the frequency of consuming dark green vegetables, FVRx (0.36 ± 0.72); NE (0.14 ± 0.33); Control (-0.09 ± 0.19) cups/day (p < .05). FVRx participants significantly improved multiple healthful food purchasing practices, and the ability to afford more utilities (FVRx (33%); NE (0%); Control (10%); p < .05). Limited changes were observed in food security and clinical biomarker outcomes between groups. Combining expanded nutrition and financial literacy education with produce prescriptions improves low-income adults' financial and food resources, preference, knowledge, purchase, and consumption of locally grown vegetables over single-level interventions.
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Morton KF, Pantalos DC, Ziegler C, Patel PD. A Place for Plant-Based Nutrition in US Medical School Curriculum: A Survey-Based Study. Am J Lifestyle Med 2022; 16:271-283. [PMID: 35706597 PMCID: PMC9189581 DOI: 10.1177/1559827620988677] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose. To evaluate medical students' and family medicine residents' perceptions of their current degree of nutrition training in general and regarding a whole-foods, plant-based (WFPB) diet. Methods. An original survey instrument was administered to medical students and family medicine residents. Quantitative and qualitative data were collected to evaluate perceptions of nutrition education in medical training, a WFPB diet, and ideas for nutrition-focused curricular reform. Results. Of the 668 trainees surveyed, 200 responded (response rate = 30%). Of these, 22% agreed that they received sufficient nutrition education in medical school and 41% agreed that a WFPB diet should be a focus. Respondents with personal experiences with a plant-based diet were more willing to recommend it to future patients. Common ideas for curricular reform were instruction on a WFPB diet along with other healthy dietary patterns, patient counseling, a dedicated nutrition course, and electives. Conclusions. Nutrition education in US medical training needs improvement to address the growing burden of obesity-related chronic disease. Proper nutrition and lifestyle modification should therefore play a larger role in the education of future physicians. A focus on plant-predominant diets, such as the WFPB diet, may be an acceptable and effective addition to current medical school curriculum, and deserves further study.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Diana C. Pantalos
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
| | - Craig Ziegler
- University of Louisville Office of Undergraduate
Medical Education, Louisville, Kentucky
| | - Pradip D. Patel
- Department of Pediatrics, University of
Louisville, Louisville, Kentucky
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Morton KF, Pantalos DC, Ziegler C, Patel PD. Whole-Foods, Plant-Based Diet Perceptions of Medical Trainees Compared to Their Patients: A Cross-Sectional Pilot Study. Am J Lifestyle Med 2022; 16:318-333. [PMID: 35706594 PMCID: PMC9189575 DOI: 10.1177/15598276211041551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Purpose: To evaluate medical trainees' and patients' perceptions of the utility of a whole-foods, plant-based (WFPB) diet for chronic disease management. Methods: A cross-sectional study using two original survey tools was implemented. Quantitative and qualitative data were collected from trainees and patients to evaluate perceived motivations and barriers to WFPB diet implementation. Results: Two hundred trainees and 52 patients responded to the surveys. Nearly half (48%) of patients were willing to try a WFPB diet, expressing a desire for additional information and help with its practical application. Over half (53%) of trainees were willing to recommend a WFPB diet to patients but expressed concern about its acceptability and feasibility. Patients perceived significantly more barriers related to personal enjoyment of animal products while trainees perceived more socioeconomic barriers. Conclusion: Poor diet has been identified as the United States' leading risk factor for mortality from chronic diseases. Plant-predominant diets, such as a WFPB diet, are associated with improved health outcomes and may be an acceptable solution for many patients. WFPB dietary modification could be pursued with a motivational interviewing approach that targets patients' individual goals. Medical providers should address their own assumptions regarding the dietary changes their patients are willing to make.
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Affiliation(s)
- Kara F. Morton
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Diana C. Pantalos
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Craig Ziegler
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
| | - Pradip D. Patel
- Department of Undergraduate Medical Education, University of Louisville School of
Medicine, Louisville, KY, USA, (KFM, CZ); Department of Pediatrics, University of Louisville School of
Medicine, Louisville, KY, USA, (DCP. PDP)
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Keel T, Olvet DM, Cavuoto Petrizzo M, John JT, Dougherty R, Sheridan EM. Impact of an Expansion of a Clinical Nutrition Curriculum on Pre-Clerkship Medical Students' Perception of Their Knowledge and Skills Related to Performing a Nutritional Assessment. Nutrients 2021; 13:4081. [PMID: 34836343 PMCID: PMC8625690 DOI: 10.3390/nu13114081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/01/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Learning how to provide nutritional counseling to patients should start early in undergraduate medical education to improve the knowledge, comfort, and confidence of physicians. Two nutrition workshops were developed for first-year medical students. The first workshop, co-led by physicians and registered dieticians, focused on obtaining nutrition assessments. The second workshop focused on the appropriate dietary counseling of patients with chronic kidney disease and cardiovascular risk. We surveyed students before workshop 1, after workshop 1, and after workshop 2 to assess their perceptions of the value of physician nutrition knowledge and counseling skills as well as their own comfort in the area of nutritional knowledge, assessment, and counseling. We found a significant improvement in their self-assessed level of knowledge regarding counseling patients, in their comfort in completing a nutritional assessment, and in their confidence in advising a patient about nutrition by the end of the first workshop. By the time of the second workshop five months later, students continued to report a high level of knowledge, comfort, and confidence. The implementation of clinical nutrition workshops with a focus on assessment, management, and counseling was found to be effective in increasing student's self-assessed level of knowledge as well as their confidence and comfort in advising patients on nutrition. Our findings further support the previous assertion that clinical nutrition education can be successfully integrated into the pre-clerkship medical school curriculum.
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Affiliation(s)
| | - Doreen M. Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA; (T.K.); (M.C.P.); (J.T.J.); (R.D.); (E.M.S.)
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12
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Jeong Y, Yi K, Hansana V, Kim JM, Kim Y. Comparison of Nutrient Intake in Lao PDR by the Korean CAN-Pro and Thailand INMUCAL Analysis Programs. Prev Nutr Food Sci 2021; 26:40-50. [PMID: 33859958 PMCID: PMC8027042 DOI: 10.3746/pnf.2021.26.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/12/2020] [Accepted: 12/25/2020] [Indexed: 11/13/2022] Open
Abstract
A computer-based nutritional analysis program can help to identify the nutritional status of people and provide information for nutritional counseling, nutrition education, diet planning, and menu development. Although computer-based nutritional analysis has been conducted since the 1960s in developed countries, in developing countries nutritional analysis programs either do not exist or need improving. This study tests two analysis programs developed by different countries to compare the nutrition status data calculated by two different analysts to highlight the importance of developing an appropriate nutrition analysis tool. An interview-administered 24-h dietary recall method was conducted with 100 adults aged 40∼59 years in Vientiane, Laos. Analysts from Korea and Laos, respectively, calculated nutrient intake using the Institute of Nutrition, Mahidol University CALculation (INMUCAL) nutritional analysis program (Bangkok, Thailand). Nutrient intake was also compared using two different analysis tools, INMUCAL and computer aided nutrition-al analysis program (CAN-Pro) 5.0 software (Seoul, Korea). The average nutrient intake calculated by the different analysts using INMUCAL were not significantly different. Furthermore, macronutrient intake calculated by CAN-Pro 5.0 and INMUCAL did not significantly differ, aside for intake of iron, thiamin, and vitamin C. Nutrient intake calculated by one analysis program differed from those calculated by a different program in Laos. Therefore, it is necessary to develop an appropriate nutritional analysis program that reflects the diet behavior and food culture in Laos and to understand the nutritional status of Laotians.
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Affiliation(s)
- Yeseung Jeong
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
| | - Kyungock Yi
- Division of Kinesiology & Sports Studies, College of Science and Industry Convergence, Ewha Womans University Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea
| | - Visanou Hansana
- Institute of Research and Education Development, University of Health Sciences, Vientiane 7444, Lao People's Democratic Republic
| | - Ji-Myung Kim
- Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 11644, Korea
| | - Yuri Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, Seoul 03760, Korea
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Cardenas D, Díaz G, Cadavid J, Lipovestky F, Canicoba M, Sánchez P, Álvarez L, Duarte Y, Reyes JGG, de Noyola GM, Maza C, Porbén SS, Bermúdez CE, García Y, Calvo I, Arenas H. Nutrition in medical education in Latin America: Results of a cross-sectional survey. JPEN J Parenter Enteral Nutr 2021; 46:229-237. [PMID: 33735516 DOI: 10.1002/jpen.2107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
RATIONALE The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. METHODS Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. RESULTS A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0-150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students' average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients' health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. CONCLUSIONS Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Gustavo Díaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | - Jessika Cadavid
- Faculty of Medical Sciences, Federal University of Mato Grosso, Cuiaba, Brazil
| | - Fernando Lipovestky
- Faculty of Medicine, Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Marisa Canicoba
- Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Paola Sánchez
- Faculty of Medicine, Universidad Latina de Costa Rica, San José, Costa Rica
| | - Ludwig Álvarez
- Nutrition department, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Yan Duarte
- Faculty of Medicine, Universidad Estatal de Guayaquil, Guayaquil, Ecuador
| | | | | | - Claudia Maza
- Faculty of Nutrition, Centro Médico Militar, Ciudad de Guatemala, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Sergio Santana Porbén
- Nutrition department, Hospital Pediatrico Docente "Juan Manuel Marquez,", La Habana, Cuba
| | - Charles Elleri Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogotá, Colombia
| | - Yawelida García
- Faculty of Nutrition, Universidad O&M, Santo Domingo, Dominican Republic
| | - Isabel Calvo
- Nutrition service, Hospital General de Tijuana, Tijuana, Mexico
| | - Humberto Arenas
- Integrated Practice Unit on Intestinal Failure, Hospital San Javier, Guadalajara, Mexico
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14
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Sutherland M, McKenney K, Shanahan H, McKenney M, Elkbuli A. The Need for Nutritional Education Reform in US Medical Education System. Am Surg 2020; 87:1032-1038. [PMID: 33295199 DOI: 10.1177/0003134820971621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To compare the setting, quality, and utility of nutritional education received by general surgery residents and faculty surgeons and their perceptions and challenges in managing patient nutritional needs. METHODS Cross-sectional analysis utilizing anonymous survey data distributed by the Association of Program Directors in Surgery (APDS) to its affiliated general surgery residency programs. RESULTS 90.2% (n = 65) of residents and 85.7% (n = 24) of faculty surgeons reported having received nutritional education. The majority (78%) of respondents utilize patient nutrition on a regular basis (monthly or more often), with 54% reporting utilization daily or weekly. Overall, 65% of respondents reported experiencing challenges in managing patient nutritional needs, and 86% agreed that additional nutritional education during training would assist with patient care. Residents and faculty surgeons both significantly reported challenges in determining which specific nutritional formula to use (X2 = 22.414, P = .049). Residents were associated with reporting challenges in successfully managing oral, enteral, and parenteral routes of nutrition (X2 = 16.241, P = .023). CONCLUSIONS Despite receiving nutritional education, the majority of surgery residents and faculty surgeons report difficulty in managing their patients nutritional needs. Surgery residents report difficulties with all delivery modes of nutrition, including oral, parenteral, and enteral. Revising medical school nutritional education competencies to focus on more practical aspects of nutrition, reform of formal course format, greater interprofessional collaboration with dieticians starting at the student level, and enforcement of nutritional education requirements by medical school and residency program accrediting bodies can serve to advance physicians' nutritional knowledge and improve patient outcomes.
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Affiliation(s)
- Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Kelly McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Hunter Shanahan
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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Olfert MD, Wattick RA, Hagedorn RL. Experiences of Multidisciplinary Health Professionals From a Culinary Medicine Cultural Immersion: Qualitative Analysis. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Cavuoto Petrizzo M, Block L, Olvet DM, Sheridan EM, Dougherty R, Whitson M, John JT, Barilla-LaBarca ML, DiFiglia-Peck S, Fornari A. Implementation of an Interprofessional Nutrition Workshop to Integrate Nutrition Education into a Preclinical Medical School Curriculum. J Am Coll Nutr 2020; 40:111-118. [PMID: 32223644 DOI: 10.1080/07315724.2020.1737985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The patient-physician encounter provides an ideal opportunity to assess a patient's dietary history and its impact on total health. However, nutrition assessments and counseling in physician-patient encounters is often lacking. Insufficient nutrition education during medical school may lead to insecurity in assessing and counseling patients.Methods: Physicians and registered dietitians (RD) co-developed and co-facilitated a nutrition workshop for first-year medical students. Goals included increasing recognition of nutrition's impact on health and promoting student confidence and skills when attaining a nutrition history, assessing risk factors, and advising.Results: Seventy percent of students attested to having "sufficient" knowledge to counsel a patient on nutrition after the session compared to 38% before (Z= -4.46, p < 0.001). Sixty eight percent felt comfortable completing a nutritional assessment after the session compared to 35% before (Z= -4.30, p < 0.001). Sixty-three percent felt confident in advising patients about nutrition after the session compared to 32% before (Z= -4.20, p < 0.001). Students also significantly outperformed a control cohort on a nutrition-related component of an Objective Standardized Clinical Examination.Conclusions: Clinical nutrition education can be successfully integrated into the medical school curriculum as early as the first year. Interprofessional collaboration with RDs provided evidence-based content and authentic clinical experience in both the development of the workshop and in facilitating student discussion.
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Affiliation(s)
- Marie Cavuoto Petrizzo
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Lauren Block
- Departments of Science Education and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Eva M Sheridan
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rebecca Dougherty
- Departments of Science Education and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Matthew Whitson
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Janice T John
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Maria-Louise Barilla-LaBarca
- Departments of Science Education and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Alice Fornari
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Olfert MD, Wattick RA, Hagedorn RL. Experiential Application of a Culinary Medicine Cultural Immersion Program for Health Professionals. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520927396. [PMID: 32548308 PMCID: PMC7271278 DOI: 10.1177/2382120520927396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Melissa D Olfert
- Melissa D Olfert, Human Nutrition and Foods,
Division of Animal and Nutritional Sciences, Davis College of Agriculture,
Natural Resources and Design, West Virginia University, G25 Agricultural
Sciences Building, 1194 Evansdale Dr., Morgantown, WV 26506, USA.
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18
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Ramsetty A, Adams C, Berini C, Watson KH. Medical Student Attitudes on Nutrition Counseling After Implementation of a Novel Curricular Activity. J Am Coll Nutr 2019; 39:333-337. [PMID: 31518212 DOI: 10.1080/07315724.2019.1659191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Anita Ramsetty
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cristin Adams
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carole Berini
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristen Hood Watson
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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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: 221] [Impact Index Per Article: 44.2] [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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Cassidy-Vu L, Kirk J. Assessing the Need for a Structured Nutrition Curriculum in a Primary Care Residency Program. J Am Coll Nutr 2019; 39:243-248. [DOI: 10.1080/07315724.2019.1644251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Lisa Cassidy-Vu
- Wake Forest School of Medicine, Department of Family and Community Medicine, Winston Salem, North Carolina
| | - Julienne Kirk
- Wake Forest School of Medicine, Department of Family and Community Medicine, Winston Salem, North Carolina
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21
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Holman H, Dey S, Drobish I, Aquino L, Davis AT, Koehler TJ, Malouin R. Obesity education in the family medicine clerkship: a US and Canadian survey of clerkship directors' beliefs, barriers, and curriculum content. BMC MEDICAL EDUCATION 2019; 19:169. [PMID: 31133020 PMCID: PMC6537396 DOI: 10.1186/s12909-019-1614-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite concerns regarding the increasing obesity epidemic, little is known regarding obesity curricula in medical education. Medical school family medicine clerkships address common primary care topics during clinical training. However, studies have shown that many family physicians feel unprepared at addressing obesity. The purpose of this study was to evaluate factors related to obesity education provided during family medicine clerkships as well as identify future plans regarding obesity education. METHODS Data were collected through the 2017 Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors (CDs) in the United States and Canada. Survey items included the level of importance of obesity education, teaching methods, barriers to teaching, and obesity related topics taught during the clerkship. Survey data were summarized and analyzed. RESULTS The survey response rate was 71.2%. The most frequent barrier to teaching obesity related topics was time constraints (89%). The most commonly taught topics were co-morbid conditions (82.1%), diet (76.9%), and exercise (76.9%). The least commonly taught topics were addressed less than 30% of the time, and included cultural aspects, obesity bias, medications than can cause weight gain, medications to treat obesity, and bariatric surgery. Over half of CDs (59%) are not planning to change existing curriculum, with 39% planning to add to the current curriculum. The CDs' perceptions of the importance of obesity education were significantly associated with the number of topics covered during clerkship (p < 0.001). No relationship was found between clerkship duration and the number of obesity topics taught. CONCLUSION The majority of clerkship directors are planning no changes to their existing curricula which consist of three common topics: obesity related co-morbid conditions, diet, and exercise. While time was the largest self-rated barrier in teaching obesity related topics, clerkship duration didn't impact the number of topics taught. However, the relative amount of importance placed by CDs upon obesity education was significantly associated with the number of topics covered during clerkship.
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Affiliation(s)
- Harland Holman
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Sumi Dey
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Ian Drobish
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Leora Aquino
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Alan T. Davis
- Spectrum Health, Office of Medical Education, 945 Ottawa Ave NW, Grand Rapids, MI 49503 USA
| | - Tracy J. Koehler
- Spectrum Health, Office of Medical Education, 945 Ottawa Ave NW, Grand Rapids, MI 49503 USA
| | - Rebecca Malouin
- Michigan State University College of Human Medicine, 909 Fee Road, B201, East Lansing, MI 48824 USA
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22
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Mondala MM, Sannidhi D. Catalysts for Change: Accelerating the Lifestyle Medicine Movement Through Professionals in Training. Am J Lifestyle Med 2019; 13:487-494. [PMID: 31523214 DOI: 10.1177/1559827619844505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
While the Western diet has evolved to become increasingly high in saturated fat, cholesterol, protein, sugar, and salt intake, nutrition education and training of health care professionals to counsel their patients on the hazards of such a diet has trailed behind. Primary care physicians have an opportunity to bridge the gap by providing nutrition and dietary counseling as key components in the delivery of preventive services. Increasing research points to the value of a whole-foods plant-based diet in combating chronic disease, yet the knowledge of health professionals about the topic is comparable to that of the general public. This education crisis is apparent in medical training with restricted time for dedicated lectures on nutrition, physical activity, restorative sleep, emotional well-being, and avoidance of risky substance use. Together, educators and learners are valuable catalysts for culture change in medical education, training, and clinical practice. Barriers to physician ability to counsel about lifestyle are many, but one that stands out is lack of training and comfort with counseling. This has implications for the training of health care professionals. American College of Lifestyle Medicine has a committee, Professionals in Training, composed of interprofessional and multidisciplinary students, residents, and fellows nationally and worldwide who are committed to expanding exposure to lifestyle medicine and implementation of lifestyle medicine in parallel curriculum and personal care.
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Affiliation(s)
- Melissa M Mondala
- Department of Preventative and Family Medicine, Loma Linda University Health, Loma Linda, California (MMM).,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California (DS)
| | - Deepa Sannidhi
- Department of Preventative and Family Medicine, Loma Linda University Health, Loma Linda, California (MMM).,Department of Family Medicine and Public Health, University of California San Diego, San Diego, California (DS)
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