Nutrition Education in U.S. Medical Schools 'Precarious,' Say Researchers

Student, Physician Knowledge of Nutrition Facts 'Suboptimal'

October 20, 2010 04:00 pm Barbara Bein

Although the importance of nutrition in preventing obesity and other diseases is universally acknowledged, nutrition education in U.S. medical schools remains inadequate -- 25 years after a national scientific organization announced specific recommendations for including nutrition instruction in medical education. That's according to a study published in the September Academic Medicine.

Researchers in the department of nutrition at the University of North Carolina at Chapel Hill, or UNC, said in the study(journals.lww.com) that medical schools are falling far short of providing adequate training. Few medical schools incorporate 25 hours of nutrition instruction in the undergraduate curriculum, the minimum that was recommended by the National Academy of Sciences in 1985.

"The teaching of nutrition in U.S. medical schools still appears to be in a precarious position, lacking a firm, secure place in the medical curriculum of most medical schools," the study authors said. "Concerns remain that many future physicians will lack adequate preparation in this essential component of modern medical practice."

For the study, which was conducted as part of the UNC Department of Nutrition's Nutrition in Medicine(www.nutritioninmedicine.org), or NIM, project, nutrition educators at U.S. medical schools completed a two-page online survey between August 2008 and July 2009. The NIM project conducted a similar survey in 2004.

In each survey, educators were asked about the number of nutrition instruction contact hours that are required for their medical students and whether those hours are accumulated via a designated nutrition course, within another course or during clinical rotations.

Although most of the 109 medical schools that responded to the 2008-2009 survey reported requiring some form of nutrition education, other survey findings were not so promising.

  • Only 28 medical schools, or 27 percent, met the recommended minimum of 25 hours; in 2004, 40 schools, or 38 percent, did so.
  • Only 26 schools, or 25 percent, required a dedicated nutrition course; in 2004, 32 schools, or 30 percent, did so.
  • Medical students received an average of 19.6 contact hours of nutrition instruction; the average in 2004 was 22.3 hours.

According to study co-author Martin Kohlmeier, M.D., a research professor in the UNC department of nutrition and the NIM project director, the study results are cause for concern.

"It does concern us to see a steeply declining number of dedicated nutrition courses at the medical schools because we also find that schools with such courses offer about a third more hours of nutrition education," Kohlmeier told AAFP News Now. "Something is clearly getting lost with the integration into other courses."

Graduating medical students "are not satisfied with the amount of nutrition education they have received," he added. "It is just that they live day-to-day and spend their time on the subjects most critical to their survival in medical school.

"It has always amazed me how students are cajoled into spending long hours on basic science minutiae that are nowhere near as important as the nutrition skills they miss out on. We have to continue to push for adequate nutrition education."

NIM Offers Courses Tailored to Practicing Physicians

In addition to courses for medical students, the University of North Carolina at Chapel Hill's Nutrition in Medicine, or NIM, project also has a number of courses aimed at the practicing physician.

Through the NIM project's newest initiative, Nutrition Education for Practicing Physicians(www.med.unc.edu) (free registration required), nutrition educators provide evidence-based clinical nutrition information to address nutrition-related health concerns encountered in daily practice.

The free online modules give physicians the knowledge and skills to counsel patients on nutrition and treat nutritional deficiencies. Topics include nutrition management, dietary supplement interviews, behavior change counseling, physical activity guidance and breast feeding assessment.

Indeed, said the NIM researchers, more than half of graduating medical students rate their nutrition knowledge as "inadequate," and physicians also report they have not received adequate training to counsel their patients. In fact, previous surveys of both groups have found "suboptimal knowledge" regarding nutrition facts.

"This deficit in preparation is rather alarming, considering the importance of nutrition in obesity prevention and the critical role of diet in the energy balance equation," the researchers said.

Moreover, they added, medical students receive nutrition education primarily during the first two years of school, which is the basic science period, when, ideally, it should be incorporated into the later clinical years, when students can see the relation between nutrition principles and medical treatment.

The study cited two major reasons for the deficits in nutrition education in medical schools: the lack of expert nutrition faculty and the lack of time for new courses or more lectures.

The NIM project was designed to address both of these problems, said the researchers. The project, which offers a free, interactive and comprehensive nutrition online curriculum(www.nutritioninmedicine.net), includes content that supplements the curriculum when a faculty member is not available. In addition, the online modules have units that can be customized to the amount of time available to an instructor.

According to Kohlmeier, there's a clear correlation between medical schools' use of the NIM online materials and the number of nutrition education contact hours they offer. Those that use the online courses provide 76 percent more nutrition education hours than nonusers.

In fact, he added, users provide more than 24 hours of nutrition education, which is close to the recommended minimum; nonusers provide less than 14.


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