Curriculum design and development
Secondary Topic: Teaching, learning, and assessment
Tertiary Topic: Education Research
Clinical Nutrition for Doctors-in-Training: Reflections and Challenges of Incorporating Nutrition Education into Medical School Curricula
Catherine Crawford, BA; Mary P Smith, BA; Raymond Teets, MD, , New York, NY, United States
Late Breaker: No
Background: Effective lifestyle management, including nutrition education, is an invaluable component of integrative healthcare management. In practice, however, few physicians feel comfortable addressing the nutritional aspects of diseases. What's more, nutrition education is underrepresented at many medical schools, with most recent surveys showing that only 25% of programs in the United States require nutrition education.
Program Description: We created and implemented the Clinical Nutrition for Doctors in Training course to fill this gap by supplementing the standard medical curriculum at the Icahn School of Medicine with instruction about clinical nutrition. Our goal is to improve medical students' competence regarding their own health behaviors, and to provide training for incorporating nutritional management into patient care. The course was designed in Fall 2016 in collaboration with the Students for Integrative Medicine Group and the Mount Sinai Hospital Clinical Nutrition Department as a 7-week extracurricular learning experience. To receive credit, students are required to attend four out of seven sessions. By completion, students will be able to differentiate the role of inpatient and outpatient dietary specialists, better understand typical diets consumed by patients, and counsel patients about dietary modification within the context of their health and social needs.
Conclusion: Since Fall 2016, five participants completed the program. In post curriculum surveys, all participants reported improved confidence in their ability to counsel patients on proper dietary habits in the context of diabetes, heart disease, and chronic kidney disease. As a result of feedback, the Office of Medical Education is incorporating themes from the sessions into the standard medical curriculum. This will improve student understanding of how disease progression can be slowed, stopped or reversed by diet. In this way, the rising generation of medical professionals will be better trained to improve patient outcomes through diet, an increasingly meaningful component of integrative healthcare management.
Providers who understand the impact of diet on disease states and who can effectively counsel patients with regard to dietary needs can offer a more integrative approach to addressing their patient’s health. Nevertheless, nutrition education is conspicuously absent from most undergraduate medical curricula across the United States, with most recent studies showing that only 25% of US medical programs require nutrition education (Adams et al, 2010). We believe that this is a gross oversight given the current healthcare landscape within the united states: per the CDC's latest reports, 30.3 million individuals (9.4% of the population) currently live with diabetes in the United States; more that 610,000 individuals die of heart disease each year; approximately 75 million (1 in 3) adults in the United States live with high blood pressure. These statistics are staggering, and not enough is being done to educate physicians about how to treat their patients with dietary and lifestyle modification (Morris, 2014). What's more, a 2008 study that surveyed a random sample of internal medicine residents across the country showed that while 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling (Vetter et. al, 2008). With our Clinical Nutrition for Doctors in Training curriculum, we strive to meet this need by providing the next generation of medical professionals with the tools to better advise and motivate patients with regard to nutrition.
By the completion of this course, participants will:
1. Understand the differences in the role of an inpatient and an outpatient dietitian/nutrition specialist.
2. Be able to make better decisions about their own nutrition within the context of our current lifestyle (medical students) and community (East Harlem/Upper East Side)
3. Have a better understanding of the typical diets consumed by our patients, and how that is influenced by the availability and cost of food in this community.
4. Give advice regarding how to modify traditional meals so as to improve health but not sacrifice taste and tradition.
5. Have a better understanding of the practice of ‘mindful eating’, and how that can translate into a healthier body and environment.
6. Learn about various ‘lifestyle diets’ defined as dietary restrictions resulting from a patient’s taste preferences, ethical convictions, environmental stances, or religious observations.
7. Gain an understanding of how the progression of certain diseases can be slowed, stopped, or in some scenarios, reversed by diet.
8. Have gained experience interviewing and engaging patients about maintaining healthy diets, especially in the context of dietary restrictions or clinical conditions.
9. Learn more about how to incorporate Integrative Medicine practices and education into their medical school curriculum.