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Gunsalus KTW, Mixon JK, House EM. Medical Nutrition Education for Health, Not Harm: BMI, Weight Stigma, Eating Disorders, and Social Determinants of Health. MEDICAL SCIENCE EDUCATOR 2024; 34:679-690. [PMID: 38887425 PMCID: PMC11180054 DOI: 10.1007/s40670-024-02025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 06/20/2024]
Abstract
Effective nutrition training is fundamental to medical education. Current training is inadequate and can cause harm to students and patients alike; it leaves physicians unprepared to counsel on nutrition, places undue focus on weight and body mass index (BMI), can exacerbate anti-obesity bias, and increase risk for development of eating disorders, while neglecting social determinants of health and communication skills. Physicians and educators hold positions of influence in society; what we say and how we say it matters. We propose actionable approaches to improve nutrition education to minimize harm and pursue evidence-based, effective, and equitable healthcare.
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Affiliation(s)
- Kearney T. W. Gunsalus
- Department of Biochemistry and Molecular Biology, Augusta University/University of Georgia Medical Partnership, Athens, GA USA
| | - Jordan K. Mixon
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
| | - Ellen M. House
- Department of Psychiatry and Health Behavior, Augusta University/University of Georgia Medical Partnership, Athens, GA USA
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Agusala B, Broad Leib E, Albin J. The Time is Ripe: The Case for Nutrition in Graduate Medical Education in the United States. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241228651. [PMID: 38348215 PMCID: PMC10860474 DOI: 10.1177/23821205241228651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
A poor-quality dietary pattern is a leading risk factor for chronic disease and death in the United States, and the costs of medical care continue to unsustainably rise. Despite this reality, nutrition training for physicians fails to adequately prepare for them to address the complex factors that influence diet-related disease. Expanding nutrition education for physicians-in-training is imperative to equip them for the growing demand of food is medicine services and is also supported by recent policy efforts in the United States as well as the governing bodies of graduate and undergraduate medical education. A multisector approach that links graduate medical education, clinical care delivery innovation, and health and food policy experts provides momentum to advance nutrition education as a core strategy for food is medicine expansion globally.
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Affiliation(s)
- Bethany Agusala
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Jaclyn Albin
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Donovan K, Thomas OW, Sweeney T, Ryan TJ, Kytomaa S, Zhao M, Zhong W, Long M, Rajendran I, Sarfaty S, Lenders C. Eat to Treat: The Methods and Assessments of a Culinary Medicine Seminar for Future Physicians and Practicing Clinicians. Nutrients 2023; 15:4819. [PMID: 38004212 PMCID: PMC10674360 DOI: 10.3390/nu15224819] [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: 08/26/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.
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Affiliation(s)
- Kate Donovan
- Department of Pediatrics, Boston Medical Center, Boston, MA 02218, USA
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
| | - Olivia W. Thomas
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
| | - Ty Sweeney
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Tyler J. Ryan
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Sonja Kytomaa
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Molly Zhao
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Wayne Zhong
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
| | - Michelle Long
- Section of Gastroenterology, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Iniya Rajendran
- Department of General Internal Medicine, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Suzanne Sarfaty
- Department of General Internal Medicine, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Carine Lenders
- Department of Food and Nutrition, Boston Medical Center, Boston, MA 02218, USA
- Department of Pediatrics, Pediatric Nutrition and Fitness for Life, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
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Amoore BY, Gaa PK, Amalba A, Mogre V. 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. Front Nutr 2023; 10:1063316. [PMID: 36937356 PMCID: PMC10019772 DOI: 10.3389/fnut.2023.1063316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
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.
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Affiliation(s)
- Bright Yammaha Amoore
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Patience Kanyiri Gaa
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
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A scoping review of nutrition education interventions to improve competencies, lifestyle and dietary habits of medical students and residents. J Nutr Sci 2023; 12:e31. [PMID: 37008413 PMCID: PMC10052561 DOI: 10.1017/jns.2023.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Abstract
We reviewed the available research and gave an overview of the effects of nutrition education interventions (NEIs) on medical students’ and residents’ knowledge of nutrition, attitudes towards nutrition care, self-efficacy, dietary practices and readiness to offer nutrition care. From 28 May through 29 June 2021, we searched Google Scholar, PubMed, ProQuest, Cochrane and ProQuest to retrieve 1807 articles. After conducting de-duplication and applying the eligibility criteria and reviewing the title and abstract, 23 papers were included. The data were descriptively and narratively synthesised, and the results were displayed as frequencies, tables and figures. Twenty-one interventions were designed to increase participants’ knowledge of nutrition-related topics, and eighteen studies found that nutrition knowledge had significantly improved post-intervention. Only four of the eleven studies that reported on attitudes about nutrition post-intervention showed a meaningful improvement. The self-efficacy of participants was examined in more than half of the included studies (n 13, 56⋅5 %), and eleven of these studies found a significant increase in the participants’ level of self-efficacy to offer nutrition care post-intervention. At the post-intervention point, seven interventions found that dietary and lifestyle habits had significantly improved. The review demonstrated the potential of NEIs to enhance participants’ dietary habits and nutrition-related knowledge, attitudes and self-efficacy. Reduced nutrition knowledge, attitude and self-efficacy scores during the follow-up, point to the need for more opportunities for medical students and residents to learn about nutrition after the intervention.
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Caldow G, Palermo C, Wilson AN. 'What do doctors think they need to know about nutrition?'-a qualitative study of doctors with formal nutrition training. BMC Nutr 2022; 8:85. [PMID: 35996126 PMCID: PMC9394029 DOI: 10.1186/s40795-022-00577-w] [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: 12/07/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Doctors are on the frontline of patient care and in an ideal position to provide nutritional advice, yet can feel ill-equipped to do so. The aim of this study was to explore the nutrition knowledge, skills and practice required for nutrition-competent medical graduates, and their role in providing nutrition advice and care, from the perspective of doctors with formal nutrition training. METHODOLOGY We conducted an exploratory qualitative research study. A purposive sample of 12 medical doctors and students with formal nutrition training across Australia participated in in-depth semi structured interviews. Data were analysed thematically. RESULTS There were four main themes identified: 1. Identifying the role of doctors in nutrition care; 2. Understanding the interrelatedness of the social determinants of health and nutrition status is key; 3. Optimising nutrition care through multidisciplinary collaboration; and 4. Providing evidence-based nutrition care. CONCLUSION This exploratory study suggests that doctors consider that nutrition competent medical graduates require skills in referring to dietitians, an understanding and application of the social determinants of health, and practise applying multidisciplinary and evidence-based nutrition care.
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Affiliation(s)
- G Caldow
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - C Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Australia
| | - A N Wilson
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia.
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Lepre B, Mansfield KJ, Beck EJ. Attitudes, work roles and barriers to nutrition care - Interviews with Australian and UK-based medical doctors. J Hum Nutr Diet 2022; 36:920-931. [PMID: 35996856 DOI: 10.1111/jhn.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor diet is implicated in multiple chronic diseases. While doctors may be well-placed to facilitate nutrition care, nutrition remains a low priority in medical education internationally. Consensus is required on nutrition competencies as a benchmark for education with a regulatory framework to ensure implementation. The aim of this qualitative study was to explore work roles, attitudes, barriers, and enablers in the delivery of nutrition care amongst a cohort of Australian and UK doctors. METHODOLOGY Semi-structured interviews were conducted with primary care doctors/GPs (n=14) and medical specialists (n=8) based in Australia and the United Kingdom to explore work roles, attitudes, barriers and enablers in the delivery of nutrition care. RESULTS Framework analysis identified five key themes: 1) Knowledge and skills in nutrition to support medical nutrition care, 2) The delivery of nutrition education, 3) Multidisciplinary and interdisciplinary care, 4) Systemic barriers and facilitators to care and, 5) The need for a paradigm shift. Participants acknowledged nutrition as an important component of medical care but recognised they are currently ill-equipped to support such care, identifying limitations to the systems supporting integrated care. Participants identified that nutrition sits within both a health promotion and medical/treatment model, but they currently work only within the latter. CONCLUSION Participants highlighted a lack of knowledge and training around nutrition, without which change is not possible. Efforts to improve the nutrition capacity of the medical workforce must be matched by increased investments in primary prevention, including nutrition - a paradigm shift from the medical model. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Breanna Lepre
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Kylie J Mansfield
- Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Eleanor J Beck
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Northfields Ave, Wollongong, NSW, Australia
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McWhorter JW, LaRue DM, Almohamad M, Danho MP, Misra S, Tseng KC, Weston SR, Moore LS, Durand C, Hoelscher DM, Sharma SV. Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:784-793. [PMID: 35644786 DOI: 10.1016/j.jneb.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN). METHODS Prepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020. RESULTS On average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P < 0.001; range, 10-30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3). CONCLUSIONS AND IMPLICATIONS Registered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.
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Affiliation(s)
- John Wesley McWhorter
- Department of Health Promotion and Behavioral Sciences, and Nourish Program, UTHealth School of Public Health, Houston, TX.
| | - Denise M LaRue
- Population Health Transformation, Harris Health System, Houston, TX
| | - Maha Almohamad
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | - Melisa P Danho
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | - Shweta Misra
- Population Health Transformation, Harris Health System, Houston, TX
| | - Karen C Tseng
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | | | - Laura S Moore
- Department of Health Promotion and Behavioral Sciences, and Nourish Program, UTHealth School of Public Health, Houston, TX
| | - Casey Durand
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
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Lepre B, Trigueiro H, Johnsen JT, Khalid AA, Ball L, Ray S. Global architecture for the nutrition training of health professionals: a scoping review and blueprint for next steps. BMJ Nutr Prev Health 2022; 5:106-117. [PMID: 35814726 PMCID: PMC9237864 DOI: 10.1136/bmjnph-2021-000354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/17/2022] [Indexed: 11/03/2022] Open
Abstract
Background This paper provides an overview of capacity-building efforts in the context of nutrition education for medical and healthcare professionals. Methods Content analysis of eighteen reports related to nutrition education and capacity building, and interviews with key personnel from the WHO and NNEdPro Global Centre for Nutrition and Health were synthesised. Recommendations to improve nutrition education and subsequent nutrition capacity of healthcare professionals were identified based on policy guidance and interviews. Findings Most included documents noted the importance of nutrition education and capacity building for medical and healthcare professionals. Healthcare professionals and the 'health sector' were positioned as central to achieving improved public health, and the promotion of nutrition knowledge and awareness in the general population. Conclusion Increased focus on nutrition education and capacity of the health workforce are key to improvements in population health and well-being. The WHO is well placed to support global nutrition education. Recommendations Key recommendations from the literature review and interviews include improved global data collection mechanisms, a pledge from governments to prioritise nutrition education and capacity building, along with implementation of standardised nutrition curricula for all healthcare sectors. This would include the development and expansion of on-line resources.
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Affiliation(s)
- Breanna Lepre
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | | | | | | | - Lauren Ball
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- Menzies Health Institute, Queensland, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Coleraine, UK
- School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK
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Pasarica M, Boring M, Lessans S. Current practices in the instruction of lifestyle medicine in medical curricula. PATIENT EDUCATION AND COUNSELING 2022; 105:339-345. [PMID: 34116891 DOI: 10.1016/j.pec.2021.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/23/2021] [Accepted: 05/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A review of current practices of educational interventions for lifestyle medicine was performed to inform the design of interventions with long-term goals of improving patient outcomes. METHODS Systematic review of PubMed, MedEdPORTAL, and Cochrane using keywords "lifestyle medicine," "education," "medical students," and "medical school" was done by 3 independent reviewers. Location, learner, curricular hours, focus, outcomes, and impact are reported. RESULTS Of 452 identified citations, 32 met criteria. Most studies (81%) were conducted in the U.S. and designed for medical students (72%). Studies focused primarily on nutrition (78%) and exercise (59%). Curricula were delivered on average across 13.7 h. Lectures were used in 53% of papers. The outcomes most commonly studied were satisfaction (66%,), knowledge perception (66%), and reported clinical practices (34%). Intervention impact at level 2b (31%) and level 3 (34%) were most common. CONCLUSION Medical educators looking to integrate lifestyle education curriculum should consider current resources as a starting point, especially ones with higher outcome measurements. PRACTICE IMPLICATIONS Novel interventions should target lifestyle medicine competencies with equitable distribution among learners using active learning approaches. The authors propose initial efforts focusing on instruction of clinical educators and practicing physicians, with advocacy for increased reimbursement.
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Affiliation(s)
| | - Michael Boring
- College of Medicine, University of Central Florida, Orlando, USA
| | - Spencer Lessans
- College of Medicine, University of Central Florida, Orlando, USA
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Bassin SR, Al-Nimr RI, Allen K, Ogrinc G. The state of nutrition in medical education in the United States. Nutr Rev 2021; 78:764-780. [PMID: 31968104 DOI: 10.1093/nutrit/nuz100] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite the significant impact diet has on health, there is minimal nutrition training for medical students. This review summarizes published nutrition learning experiences in US medical schools and makes recommendations accordingly. Of 902 articles, 29 met inclusion criteria, describing 30 learning experiences. Nutrition learning experiences were described as integrated curricula or courses (n = 10, 33%), sessions (n = 17, 57%), or electives (n = 3, 10%). There was heterogeneity in the teaching and assessment methods utilized. The most common was lecture (n = 21, 70%), often assessed through pre- and/or postsurveys (n = 19, 79%). Six studies (26%) provided experience outcomes through objective measures, such as exam or standardized patient experience scores, after the nutrition learning experience. This review revealed sparse and inconsistent data on nutrition learning experiences. However, based on the extant literature, medical schools should build formal nutrition objectives, identify faculty and physician leadership in nutrition education, utilize preexisting resources, and create nutrition learning experiences that can be applied to clinical practice.
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Affiliation(s)
- Sandhya R Bassin
- Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rima I Al-Nimr
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kathleen Allen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Greg Ogrinc
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Lepre B, Mansfield KJ, Ray S, Beck E. Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutr Prev Health 2021; 4:307-318. [PMID: 34308139 PMCID: PMC8258055 DOI: 10.1136/bmjnph-2021-000234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023] Open
Abstract
Objective Poor diet is a leading cause of death worldwide. Doctors are well placed to provide dietary advice, yet nutrition remains insufficiently integrated into medical education. Enforcement of curriculum or accreditation requirements such as nutrition requires relevant regulatory frameworks. The aim of this review was to identify nutrition content or requirements for nutrition education in accreditation standards or formal curriculum guidance for medical education internationally. Design Non-systematic comparative analysis. Data sources An internet search using the Google Search engine, the WHO Directory of Medical Schools and Foundation for Advancement of International Medical Education and Research Directory of Organizations that Recognise/Accredit Medical Schools was conducted through September 2020 to identify government and organisational reports as well as publications from regulatory and professional bodies relevant to medical education. Eligibility criteria Eligible publications included (A) accreditation standards, (B) competency standards or a framework, (C) curricula, and (D) assessment content. Data extraction and synthesis We stratified findings by country or region and both preregistration and postregistration education. Findings were synthesised based on the existence of nutrition content or requirements for nutrition education within systems used to guide medical education internationally. Results This review found that despite an emphasis on meeting the needs of the community and the demands of the labour market, only 44% of accreditation and curriculum guidance included nutrition. Nutrition remains inadequately represented in accreditation and curriculum guidance for medical education at all levels internationally. Accreditation standards provide a mandated framework for curricula and inclusion of nutrition in accreditation frameworks provides an incentive for the integration of nutrition into medical education. Conclusions This review is a call to action for the medical profession including government, health agencies and educational and accreditation entities. The inclusion of nutrition in medical education has appeared throughout medical education literature for more than five decades, yet without consensus standards there is little likelihood of uniform adoption.
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Affiliation(s)
- Breanna Lepre
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Eleanor Beck
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Maternal education is essential but may not be sufficient to prevent child stunting: a commentary. Public Health Nutr 2021; 24:3753-3755. [PMID: 33487211 DOI: 10.1017/s1368980020003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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15
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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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16
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Berz J, Donovan K, Eyllon M. An Interprofessional Nutrition Education Session for Senior Medical Students on Evidence-Based Diet Patterns and Practical Nutrition Tips. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10876. [PMID: 32051854 PMCID: PMC7012311 DOI: 10.15766/mep_2374-8265.10876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Dietary factors are recognized as a major contributor to the global burden of disease, and the obesity epidemic continues to be a major public health problem. Patients rely on doctors for dietary advice and to serve as role models for health behaviors. However, nutrition content is significantly underrepresented in medical school curricula. METHODS We created an interactive session to address this gap during the ambulatory medicine rotation for senior medical students and delivered it as a 90- to 120-minute interactive monthly didactic session. We focused on reviewing evidence-based diet patterns for weight loss and hypertension and on use of practical tools for diet assessment and counseling. Immediately and 1 month after delivery, we administered a knowledge and confidence assessment survey to evaluate the session impact. RESULTS We incorporated the session into the regular didactic time of the clerkship. Sixty-six students attended over an 8-month period, of whom 42 completed the survey. Immediately and 1 month after delivery, participants reported statistically significant improvements (p < .001) in their confidence in the domains measured. Participants' knowledge scores increased immediately and 1 month after the session compared to before participation. DISCUSSION We delivered a single recurring seminar on diet patterns and practical tips that was well received by fourth-year medical students during the ambulatory medicine clerkship. The seminar was a practical and interactive way of delivering important nutrition content to the medical school curriculum, and we demonstrated retention of confidence and knowledge of the delivered content.
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Affiliation(s)
- Jonathan Berz
- Assistant Professor, Department of Medicine, Boston University School of Medicine
| | - Kate Donovan
- Clinical Dietitian, Department of Pediatrics, Boston Medical Center
| | - Mara Eyllon
- Postdoctoral Researcher, Department of Medicine, Boston University School of Medicine
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17
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Lang RD, Jennings MC, Lam C, Yeh HC, Zhu C, Kumra T. Community Culinary Workshops as a Nutrition Curriculum in a Preventive Medicine Residency Program. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10859. [PMID: 32051842 PMCID: PMC7010195 DOI: 10.15766/mep_2374-8265.10859] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Obesity and diabetes are common diagnoses in the primary care population, especially in urban settings. Physicians providing preventive culinary and nutrition education to patients may be able to uniquely address these medical issues; however, culinary and nutrition education among medical residency programs is insufficient. METHODS We describe a pilot of a novel interactive approach to culinary and nutrition education focused on preventive medicine residents who were trained to provide culinary and nutrition skills to community members in three separate workshops. We developed and implemented a series of three culinary education workshops with 11, eight, and nine preventive medicine residents in each respective workshop. A total of 16 residents were invited to participate. A physician-chef facilitated each workshop with the residents within a community church kitchen and meeting area. We evaluated self-reported data on confidence level with culinary education and resident attitudes toward effects of culinary education on patient behaviors, as well as frequency of home-cooked meals and personal cooking competency, as indicators of resident proficiency. RESULTS A significant increase was noted in self-reported cooking competency after culinary workshops when evaluating change from the first workshop to the final workshop ( p = .038). Increases in home-cooking frequency and belief that lifestyle medicine impacts patient behavior were also observed but did not achieve statistical significance. DISCUSSION Culinary workshops are a useful tool to enhance nutrition education in a residency curriculum and may be an effective way to improve resident perceptions regarding the impact of nutrition education in the community.
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Affiliation(s)
- Ryan D. Lang
- Instructor, Department of Health Policy and Management, Johns Hopkins University School of Public Health
| | - Mary Carol Jennings
- Assistant Scientist, Department of Health Policy and Management, Johns Hopkins University School of Public Health
| | - Clarence Lam
- Assistant Scientist, Department of Health Policy and Management, Johns Hopkins University School of Public Health
| | - Hsin-Chieh Yeh
- Associate Professor, Department of Medicine, Johns Hopkins University School of Medicine
| | - Colin Zhu
- Physician Chef-Consultant, Independent Practice
| | - Tina Kumra
- Assistant Professor, Department of Pediatrics, Johns Hopkins University School of Medicine
- Corresponding author:
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