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Papadopoulou A, Ribes-Koninckx C, Baker A, Noni M, Koutri E, Karagianni MV, Protheroe S, Guarino A, Mas E, Wilschanski M, Roman E, Escher J, Furlano RI, Posovszky C, Hoffman I, Veres G, Bronsky J, Hauer AC, Tjesic-Drinkovic D, Fotoulaki M, Orel R, Urbonas V, Kansu A, Georgieva M, Koletzko B. Training in Paediatric Clinical Nutrition Across Europe: A Survey of the National Societies Network (2016-2019) of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2022; 74:662-667. [PMID: 35135959 DOI: 10.1097/mpg.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES/BACKGROUND Disease-related malnutrition is common in patients with chronic diseases and has detrimental effects, therefore, skills in nutrition care are essential core competencies for paediatric digestive medicine. The aim of this survey, conducted as part of a global survey of paediatric gastroenterology, hepatology and nutrition (PGHN) training in Europe, was to assess nutrition care-related infrastructure, staff, and patient volumes in European PGHN training centres. METHODS Standardized questionnaires related to clinical nutrition (CN) care were completed by representatives of European PGHN training centres between June 2016 and December 2019. RESULTS One hundred training centres from 17 European countries, Turkey, and Israel participated in the survey. Dedicated CN clinics exist in 66% of the centres, with fulltime and part-time CN specialists in 66% and 42%, respectively. Home tube feeding (HTF) andhome parenteral nutrition (HPN) programmes are in place in 95% and 77% of centres, respectively. Twenty-four percent of centres do not have a dedicated dietitian and 55% do not have a dedicated pharmacist attached to the training centre. Even the largest centres with >5000 outpatients reported that 25% and 50%, respectively do not have a dedicated dietitian or pharmacist. Low patient numbers on HTF and HPN of <5 annually are reported by 13% and 43% of centres, respectively. CONCLUSIONS The survey shows clear differences and deficits in Clinical Nutrition training infrastructure, including staff and patient volumes, in European PGHN training centres, leading to large differences and limitations in training opportunities in Clinical Nutrition.
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Affiliation(s)
- Alexandra Papadopoulou
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | | | - Alastair Baker
- The Paediatric Liver Centre, King's College Hospital, London
| | - Maria Noni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Eleni Koutri
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Maria-Vasiliki Karagianni
- The Division of Gastroenterology and Hepatology, First Department of Paediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece
| | - Sue Protheroe
- The Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom
| | - Alfredo Guarino
- The Department of Translational Medical Science, Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Emmanuel Mas
- The Unit of Gastroenterology, Hepatology, Nutrition, Diabetes, and inborn Errors of Metabolism, Children Hospital, Toulouse University Hospital, Toulouse, France
| | - Michael Wilschanski
- The Paediatric Gastroenterology Unit, Department of Paediatrics, Hadassah University Hospitals, Jerusalem, Israel
| | - Enriqueta Roman
- The Paediatric Gastroenterology Unit, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Johanna Escher
- The Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Raoul I Furlano
- The Division of Paediatric Gastroenterology and Nutrition, University Children's Hospital, Basel, Switzerland
| | - Carsten Posovszky
- The Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Ilse Hoffman
- The Department of Paediatric Gastroenterology, Leuven University Hospital, Leuven, Belgium
| | - Gabor Veres
- The Paediatric Institute-Clinic, University of Debrecen, Debrecen, Hungary
| | - Jiri Bronsky
- The Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Duska Tjesic-Drinkovic
- The University Hospital Center Zagreb - Division for Paediatric Gastroenterology, Hepatology and Nutrition & University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maria Fotoulaki
- The 4th Department of Paediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rok Orel
- The Department of Gastroenterology, Hepatology and Nutrition, Ljubljana University Children's Hospital, Ljubljana, Slovenia
| | - Vaidotas Urbonas
- The Vilnius University Clinic of Children's Diseases, Vilnius, Lithuania
| | - Aydan Kansu
- The Division of Paediatric Gastroenterology, Department of Paediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Miglena Georgieva
- The 2nd Department of Paediatrics, Saint Marina University hospital, Varna, Bulgaria
| | - Berthold Koletzko
- The LMU - Ludwig Maximilians Universität Munich, Department of Paediatrics, Dr. von Hauner Children's Hospital, LUM University Hospitals, Munich, Germany
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Stracciolini A, Luz J, Walker G, Edwards N, Faigenbaum AD, Myer GD. Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity? PHYSICIAN SPORTSMED 2020; 48:199-207. [PMID: 31560577 DOI: 10.1080/00913847.2019.1673685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.Study design: Cross-sectional studyMethods: 4500 randomly selected pediatricians, family practice, and sports medicine physicians in the United States were surveyed (11% response rate). Main outcome measures were questionnaire answers on clinical effort, attitudes, and barriers surrounding PA, medical education in exercise science, and awareness of ICD-9 diagnostic codes pertaining to physical inactivity.Results: Approximately 15% of patient interaction time was spent on the evaluation and treatment of physical inactivity for a normal weight child. For an overweight or obese child, clinical time spent on PA almost doubles. Regardless of weight, sports medicine physicians spent significantly more time on the evaluation of physical activity compared to family/internal medicine physicians and pediatricians. Mean percentage of time family/internal medicine physicians spent on PA evaluation and treatment was consistently less than sports medicine physicians, and consistently more than pediatricians. Most physicians strongly agreed that PA assessment and treatment are important for disease prevention; only 28% had ever made the diagnosis of childhood physical inactivity. Limited clinical time was identified as a primary barrier to diagnosing childhood physical inactivity. Eighty-five percent of respondents were unaware of ICD-9 codes for reimbursement of PA evaluation. Eighty-one percent reported a paucity of exercise science education in medical school.Conclusion: While physicians report that PA evaluation is important in practice, behavior patterns surrounding time evaluating PA and treating childhood physical inactivity are discrepant. Pediatricians showed less favorable attitudes and effort surrounding PA compared to other primary care disciplines. The majority of physicians are unaware of physical inactivity diagnostic codes, have never made the diagnosis of childhood physical inactivity, and may not be receiving basic pediatric exercise science training required for evaluating and treating childhood physical inactivity.
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Affiliation(s)
- Andrea Stracciolini
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Jennifer Luz
- Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | - Gregory D Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.,The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Bonnet JP, Edshteyn I, Phillips EM, Hull SK, Polak R. Perspectives on a Lifestyle Medicine Fellowship Curriculum From Interested Medical Students. Am J Lifestyle Med 2019; 13:106-110. [PMID: 30627082 PMCID: PMC6311614 DOI: 10.1177/1559827616681270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/12/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Lifestyle behaviors have a significant effect on preventing and treating disease, yet there is minimal graduate medical training in lifestyle medicine (LM). LM stakeholders' perspectives regarding components of a LM fellowship have been examined. However, the student perspective has not been studied. Methods. A cross-sectional study design analyzed medical student perceptions surrounding LM domains and educational experiences. A Kruskal-Wallis analysis of variance and a Wilcoxon Rank-Sum Test were performed for each topic. Results. In all, 21 medical students completed the survey. All domains (nutrition, physical activity, behavior change, stress resiliency, and personal health), except smoking cessation, were rated as important or very important by at least 75% of the respondents (P = .002). The 4 highest-rated educational experiences, by at least 69% of respondents, included developing LM interventions and health promotion programs, clinical experiences, and teaching other health care providers about LM. Significant differences overall were found among the educational experiences (P = .005), with research and fund raising considered the least important. Conclusions. Medical students felt strongly about including nutrition, physical activity, behavior change, personal health, and stress resiliency as part of a LM fellowship curriculum. There was significantly less interest in smoking cessation. Desired experiences of students focused on delivery of LM.
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Affiliation(s)
- Jonathan Paul Bonnet
- Jonathan Paul Bonnet, MD, Department of Community and Family Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710; e-mail:
| | - Ingrid Edshteyn
- Department of Community and Family Medicine, Duke University Health System, Durham, North Carolina (JPB, SKH)
- Department of Preventive Medicine, Yale-Griffin Hospital, Derby, Connecticut (IE)
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts (EMP, RP)
| | - Edward M. Phillips
- Department of Community and Family Medicine, Duke University Health System, Durham, North Carolina (JPB, SKH)
- Department of Preventive Medicine, Yale-Griffin Hospital, Derby, Connecticut (IE)
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts (EMP, RP)
| | - Sharon K. Hull
- Department of Community and Family Medicine, Duke University Health System, Durham, North Carolina (JPB, SKH)
- Department of Preventive Medicine, Yale-Griffin Hospital, Derby, Connecticut (IE)
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts (EMP, RP)
| | - Rani Polak
- Department of Community and Family Medicine, Duke University Health System, Durham, North Carolina (JPB, SKH)
- Department of Preventive Medicine, Yale-Griffin Hospital, Derby, Connecticut (IE)
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts (EMP, RP)
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Abstract
The actual causes of premature adult deaths, the preponderance of noncommunicable chronic diseases, and their associated costs are related to unhealthy behaviors, such as poor nutrition, physical inactivity, and tobacco use. Although recommended as the first line of prevention and management, providers often do not provide behavioral change counseling in their care. Medical education in lifestyle medicine is, therefore, proposed as a necessary intervention to allow all health providers to learn how to effectively and efficiently counsel their patients toward adopting and sustaining healthier behaviors. Lifestyle medicine curricula, including exercise, nutrition, behavioral change, and self-care, have recently evolved in all levels of medical education, together with implementation initiatives like Exercise is Medicine and the Lifestyle Medicine Education (LMEd) Collaborative. The goal of this review is to summarize the existing literature and to provide knowledge and tools to deans, administrators, faculty members, and students interested in pursuing lifestyle medicine training or establishing and improving an LMEd program within their institution.
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Affiliation(s)
- Rani Polak
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts (RP, RMP, EMP)
| | - Rachele M Pojednic
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts (RP, RMP, EMP)
| | - Edward M Phillips
- Institute of Lifestyle Medicine, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts (RP, RMP, EMP)
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Polak R, Dacey ML, Keenan H, Phillips EM. Bridging the gap--planning Lifestyle Medicine fellowship curricula: A cross sectional study. BMC MEDICAL EDUCATION 2014; 14:1045. [PMID: 25551283 PMCID: PMC4318224 DOI: 10.1186/s12909-014-0271-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/11/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The emerging field, Lifestyle Medicine (LM), is the evidence-based practice of assisting individuals and families to adopt and sustain behaviors that can improve health. While competencies for LM education have been defined, and undergraduate curricula have been published, there are no published reports that address graduate level fellowship in LM. This paper describes the process of planning a LM fellowship curriculum at a major, academic teaching institution. METHODS In September 2012 Harvard Medical School Department of Physical Medicine and Rehabilitation approved a "Research Fellowship in Lifestyle Medicine". A Likert scale questionnaire was created and disseminated to forty LM stakeholders worldwide, which measured perceived relative importance of six domains and eight educational experiences to include in a one-year LM fellowship. Statistical procedures included analysis of variance and the Wilcoxon signed-rank test. RESULTS Thirty-five stakeholders (87.5%) completed the survey. All domains except smoking cessation were graded at 4 or 5 by at least 85% of the respondents. After excluding smoking cessation, nutrition, physical activity, behavioral change techniques, stress resiliency, and personal health behaviors were rated as equally important components of a LM fellowship curriculum (average M = 4.69, SD = 0.15, p = 0.12). All educational experiences, with the exception of completing certification programs, research experience and fund raising, were graded at 4 or 5 by at least 82% of the responders. The remaining educational experiences, i.e. clinical practice, teaching physicians and medical students, teaching other health care providers, developing lifestyle interventions and developing health promotion programs were ranked as equally important in a LM fellowship program (average M = 4.23, SD = 0.11, p = 0.07). CONCLUSIONS Lifestyle fellowship curricula components were defined based on LM stakeholders' input. These domains and educational experiences represent the range of competencies previously noted as important in the practice of LM. As the foundation of an inaugural physician fellowship, they inform the educational objectives and future evaluation of this fellowship.
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Affiliation(s)
- Rani Polak
- Institute of Lifestyle Medicine, Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, USA.
| | - Marie L Dacey
- School of Arts & Sciences, MCPHS University, 179 Longwood Ave, Boston, MA, USA.
| | - Hillary Keenan
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, USA.
| | - Edward M Phillips
- Institute of Lifestyle Medicine, Physical Medicine and Rehabilitation, Harvard Medical School, Joslin Diabetes Center, One Joslin Place, Boston, MA, USA.
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Lenders CM, Deen DD, Bistrian B, Edwards MS, Seidner DL, McMahon MM, Kohlmeier M, Krebs NF. Residency and specialties training in nutrition: a call for action. Am J Clin Nutr 2014; 99:1174S-83S. [PMID: 24646816 PMCID: PMC3985219 DOI: 10.3945/ajcn.113.073528] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite evidence that nutrition interventions reduce morbidity and mortality, malnutrition, including obesity, remains highly prevalent in hospitals and plays a major role in nearly every major chronic disease that afflicts patients. Physicians recognize that they lack the education and training in medical nutrition needed to counsel their patients and to ensure continuity of nutrition care in collaboration with other health care professionals. Nutrition education and training in specialty and subspecialty areas are inadequate, physician nutrition specialists are not recognized by the American Board of Medical Specialties, and nutrition care coverage by third payers remains woefully limited. This article focuses on residency and fellowship education and training in the United States and provides recommendations for improving medical nutrition education and practice.
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Affiliation(s)
- Carine M Lenders
- Division of Pediatric Nutrition, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, MA (CML); the Department of Community Health and Social Medicine, City College of New York, New York, NY (DDD); Harvard University Medical School, Boston, MA (BB); University of Texas Medical School, Houston, TX (MSE); the Vanderbilt Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN (DLS); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (MMM); University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (MK); and the Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO (NFK)
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7
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Abstract
Nutritional medicine presents significant educational and clinical challenges worldwide. Major issues include physician shortages as a result of inadequate training, increasing prevalence of metabolic diseases, such as obesity, diabetes, and atherosclerosis, incorporation of molecular medicine into our understanding of nutrition, and lastly, an emergent transcultural variable that affecting implementation strategies. Examples of translating specific molecular targets to culturally sensitive food-based therapies are given.
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Affiliation(s)
- Jeffrey Ian Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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McMahon MM, Hurley DL, Mechanick JI, Handelsman Y. American Association of Clinical Endocrinologists' position statement on clinical nutrition and health promotion in endocrinology. Endocr Pract 2013; 18:633-41. [PMID: 23047926 DOI: 10.4158/ep12159.ps] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Apovian CM. Obesity medicine: a new specialty in medicine or a focus in endocrinology? Nutrition is the real subspecialty in medicine. Endocr Pract 2013; 18:649-50. [PMID: 23047928 DOI: 10.4158/endp.18.5.y43467v45h52rk2u] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Assessment of nutrition education among pediatric gastroenterologists: a survey of NASPGHAN members. J Pediatr Gastroenterol Nutr 2013; 56:137-44. [PMID: 22699840 PMCID: PMC3493684 DOI: 10.1097/mpg.0b013e3182638ce8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Pediatric gastroenterology is the only pediatric subspecialty with nutrition as part of its official curriculum and objective; however, pediatric gastroenterology fellows believe that their baseline knowledge in nutrition is suboptimal. The purpose of the present study was to assess the perceived effectiveness of nutrition training among pediatric gastroenterologists, identify areas of need for additional education, and determine the perceived role of the gastroenterologist in obesity management. METHODS A survey was sent to members and fellows of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition to assess general nutrition education as well as obesity management and educational needs. RESULTS A total of 272 responses were received, for an overall response rate of 15.2% (272/1784). Most responders reported having average or above-average knowledge base in all nutritional topics. There was strong interest in additional resources and a continuing medical education (CME) module on several nutrition topics including nutritional requirements in specific gastrointestinal (GI) disease, failure to thrive/growth failure, and parenteral nutrition support, with the format of CME dependent on the topic. There was also a strong interest in additional CME on the management of pediatric obesity (67%), as most responders believed that the management of obesity in children requires subspecialty care. The perceived role of the pediatric gastroenterologist was, however, one of support to treat the GI and hepatic comorbidities of obesity rather than serve as the main provider of comprehensive obesity care. CONCLUSIONS Pediatric gastroenterologists identified gaps in their nutrition knowledge base that may be attributed to the present nutrition education training during fellowship. Multiple topics were identified for additional nutrition education, including obesity management. The nutrition management challenges of today necessitate improved baseline nutrition knowledge and this focus on nutrition should begin at the fellowship level.
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