By Eric Neilson, MD

Dr. Neilson is Assistant Professor, Department of Clinical Foundations at Ross University School of Medicine, Barbados, West Indies

Dr. Neilson reports no financial relationships relevant to this field of study.

SYNOPSIS: In a systemic review of recent publications, investigators found that medical students and recent graduates worldwide are ill-prepared to counsel patients on nutritional guidelines and have deficits in both knowledge and confidence about the topic. The researchers found a perceived lack of training, but found that interventions undertaken to improve curriculum showed positive effects on nutrition competencies.

SOURCE: Crowley J, et al. Nutrition in medical education: A systematic review. Lancet Planet Health 2019:3:e379-e389.

EXECUTIVE SUMMARY

Current medical education training in many parts of the world has shown deficits in preparing students to confidently provide patients with appropriate nutritional guidance.


Diet is a key driver of four of the top six risk factors for death worldwide, contributing to some 10 to 15 million deaths annually.1 Nutrition is a critical component in the prevention and treatment of diabetes, hypertension, cardiovascular diseases, and cancer, among other conditions.2-5 Because diet is such an important factor in the health and well-being of the population, one would expect nutrition to be a central component of medical education. Previous articles have shown that the U.S. medical education system is deficient in this critical area, with only 25% of programs requiring a nutrition course, and only 27% meeting the National Academy of Sciences’s recommendation of at least 25 hours of instruction.6,7

Crowley et al recently conducted a systemic literature review of articles published between 2012 and 2019, and found that medical education worldwide continues to inadequately prepare medical students for nutrition care. This study included 24 articles from the United States, Europe, Africa, Asia, Australia, and New Zealand. All articles met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline criteria and were evaluated using the Mixed Methods Appraisal Tool (MMAT). Key deficits were found in medical students’ and recent graduates’ perception of their education, knowledge, and confidence in their ability to provide appropriate nutrition counseling. Additional findings included inadequate time and integration of nutrition in the curriculum, as well as a lack of faculty and patient-centered management approaches regarding nutrition for high-risk patients. Similar sentiments were expressed by faculty. One positive finding was that curriculum development, such as elective courses or cooking classes, increased student nutritional competency.

This review expands on much of what has been documented previously. Students recognize the central role of nutrition in health and disease, they desire the skills to deliver quality care, and they benefit from additional time and resources. Better integrating nutrition in the curriculum and providing applicable training translates to improved patient outcomes and decreased costs. At the end of the day, it is not just a matter of insufficient hours in the classroom. Rather, is the students’ inability to apply that knowledge in a clinical setting that critically effects patient care. Medical education must do a better job providing hands-on training in the application of nutrition guidelines. This can be accomplished through a variety of program advances, such as cooking classes and dedicated time working directly with dieticians or interdisciplinary care teams. As members of the medical education community, we must champion these initiatives.

REFERENCES

  1. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. 2009. Available at: https://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. Accessed Jan. 15, 2020.
  2. American Diabetes Association. Standards of medical care in diabetes—2020. Diabetes Care 2019;43(Suppl 1):S1-S2.
  3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension 2018;71:1269-1324.
  4. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guidelines on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force of practice guidelines. Circulation 2014;129:S76-S99.
  5. Emenaker NJ, Vargas AJ. Nutrition and cancer research: Resources for the nutrition and dietetics practitioner.J Acad Nutr Diet 2018;118:550-554.
  6. Adams KM, Lindell KC, Kohlmeier M, Zeisel SH. Status of nutrition education in medical schools. Am J Clin Nutr 2006;83:941S-944S.
  7. Devrie S, Dalen JE, Eisenberg DM, et al. A deficiency of nutrition education in medical training. Am J Med 2014;127:804-806.