White Paper - Nutrition Education in Medical Schools.

White Paper - Nutrition Education in Medical Schools.

Carl Stuart

Stuart Medical Series

Introduction.

This white paper assesses the inadequate nutritional education given to medical students during their studies in medical schools. This fact is acknowledged by the Department of Public Health and Community Medicine within the School of Medicine at Tripoli University. The Department of Public Health and Community Medicine has several subspecialties which specialize in demography, nutrition, health system management and diseases (both communicable and non-communicable) among other specialties. All the subspecialties do relate to nutrition. The department supported a study to investigate and evaluate the nutritional education in Libyan medical schools. The medical schools surveyed were School of Medicine at the University of Tripoli, School of Medicine at the University of Zawia; and, the School of Medicine at the University of Geryan.

The study was divided into the following five specific assessment areas:  curriculum review, curriculum evaluation, syllabi content analysis current medical student survey, and General Practitioners Survey. The results obtained from the study showed that the government mandated curriculum requires a total of 50 hours of nutritional education, and the overall rate of compliance with this directive in the medical schools surveyed ranged from 95% to 100%. The study also showed that about 25% of medical students had complete knowledge about nutrition with another 40% having moderate knowledge. The students surveyed acknowledged that their knowledge about nutrition was limited and inadequate for routine clinical practice. 40% of the General practitioners surveyed recommended that medical schools should provide more clinical training, while 23% stated that the nutritional education provided as part of the clinical training should prioritize more on specific nutritional areas, such as food choices, that have the greatest impact on health.

Thus it can be inferred from the study that most of the medical students have inadequate nutritional knowledge, and this observation is shared by the General practitioners who recommend that clinical training should prioritize on clinical nutrition.

Based on the findings and conclusions of this study, this white paper has laid down a number of strategies that could be used to solve the current state of inadequate nutritional training in Libyan medical schools.

Background.

Nutritional knowledge is one of the basic pillars of medical knowledge, and as such it is a vital component of medical education. One of the most common causes of human pathologies is inadequate nutrition. Nutritional deficiencies have been known to cause non-communicable pathologies such as scurvy, beri-beri, kwashiorkor, protein-energy malnutrition, Wernicke encephalopathy, sub-acute combined cord degeneration and peripheral neuropathies. Moreover, inadequate nutrition does predispose an individual to certain chronic disease conditions such as hypertension, diabetes mellitus and anemia. Thus, proper nutrition not only promotes health, but it also prevents several diseases. Moreover, nutritional buildup has been used in the management of certain chronic diseases such as anemia. More often than not, patients normally look upon their physicians to advise them on issues related to nutrition and proper dietary intake. However, several studies have shown that physicians do have limited knowledge about clinical nutrition; and this has resulted in the physician misadvising the patient on issues related to nutrition, thereby predisposing the patient to nutritional-related pathologies (Insel, Ross, Bernstein & ‎McMahon, 2010). It is therefore imperative for doctors to consolidate their nutritional knowledge in order for the health sector to reduce the mortality and morbidity associated with inadequate nutrition and nutritional deficiencies.

Literature review.

It is well known that nutrition affects the immune status of the body. Thus, the application of knowledge derived from clinical nutrition could assist the physician in restoring the immune status of his or her patients (Insel et al., 2010). This requires the physician to have undergone clinical nutritional training in the medical school. However, studies have shown that the nutrition knowledge acquired in medical schools is inadequate. Some of these studies are reviewed below.

In 1993, an article entitled Isn't It Time to Teach Nutrition to Medical Student was published. The article stated that the nutritional education being taught in US medical schools was inadequate. According to the article, the Committee on Nutrition in Medical Education did recommend that at least 25 contact hours would be needed to teach the fundamentals of nutrition to medical students and physicians in order to enable them to manage the nutritional aspects of diseases. Moreover, the article discusses a previous study which evaluated the level of nutritional training that doctors got in their medical schools, and it concluded that the nutritional knowledge was inadequate for clinical application (Zimmermann & Kretchmer, 1993).

In 2001, Torti, Adams, Edwards, and Zeisel conducted a survey entitled Survey of Nutrition Education in U.S. Medical Schools – An Instructor-Based Analysis. The aim of the survey was to determine the state of nutrition education in US medical colleges. They surveyed 98 osteopathic and medical schools. They also surveyed nutrition educators concerning the adequacy of nutritional education offered in medical schools. The results showed that a majority of the medical schools exposed their students to at least 18 contact hours of nutrition education. These results thus show that the medical schools did not meet the standard minimum threshold of 25 contact hours of nutrition education. It was thereafter recommend that medical schools should increase the contact hours for nutrition education to 25 hours or more.

A survey on the status of nutritional training in US medical schools was conducted in 2006 by Adams, Kohlmeier, Zeisel and Liddell. Nutrition educators in 106 medical schools were involved in the survey which sought to assess the quality of nutritional training offered to medical students. The results showed that only 99 medical schools offered nutritional training to their medical students, with 32 schools offering nutrition education as a separate course. The results also showed that only 40 schools met the standard minimum threshold of 25 contact hours of nutrition education (Adams, Lindell, Kohlmeier & Zeisel, 2006). The main demerit of this study was that it excluded medical schools which had no nutrition educators. However, the survey showed that some medical schools were adhering to the recommendations of the Committee on Nutrition in Medical Education.

In 2010, a survey entitled Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey was conducted by Adams, Kohlmeier and Zeisel. The survey involved 109 medical schools. The aim of the survey was to evaluate the quality of nutrition education offered by these institutions. The results showed that 103 medical schools offered nutritional training to their medical students, with 26 schools offering nutrition education as a separate course. The results also showed that average contact hours of nutrition education was 19.6 hours (Adams, Kohlmeier & Zeisel, 2010). This is below the minimum recommended threshold of 25 contact hours. These results also show that the measures that had been put in place to improve nutrition education in medical schools were unsuccessful.

Review of the Surveys.

The student survey showed that 40% of the students had moderate nutrition knowledge while 25% had complete nutrition knowledge. The survey also showed that the amount of nutrition knowledge increases as the medical student progresses in his or her studies. During the preclinical years, most of the nutrition knowledge that the students have is gained from biochemistry and physiology. Later on during the clinical years, the students gained knowledge about food choice after they studied pathology, clinical chemistry and internal medicine. Thereafter, the students gained knowledge about nutritional assessment during their studies of community health. They also gained knowledge concerning maternal and childhood nutrition when they studied pediatrics. The survey therefore shows that the students gained nutrition knowledge as they progressed in their medical studies, but the theme of nutrition was embedded in different subjects. This leads to fragmentation of the nutrition education (thus creating knowledge gaps) as compared to nutrition being offered as a separate subject. Based on the results of this survey, the medical curricula can be improved if nutrition was taught as a separate unit during the preclinical years, so that the students could apply the nutritional concepts they have acquired in their clinical studies.

There is some degree of correspondence between the results of the general practitioners survey and the student survey. The general practitioners survey showed that 43.3% of physicians admitted that they acquired moderate nutrition knowledge in their medical schools, and this corresponds to the moderate nutrition knowledge of students. Also the survey showed that very few physicians did admit that they had poor nutritional knowledge. However, most physicians did admit that they had inadequate nutritional skills that could be applied clinically. To remedy the inadequate amount of nutritional knowledge among the physicians and to prioritize on the health of the community, it is recommended that crash courses in the fundamentals of clinical nutrition should be taught to all physicians. Moreover, further nutritional training should be offered to physicians who have specialized in systems that are inordinately affected by nutritional deficiencies. Acquisition of practical nutritional knowledge and skills would enable the doctors to improve the state of the public health.

Solutions.

To remedy the existing gap in nutrition knowledge, the solutions stated hereafter have been offered. To begin with, there is a need to increase contact hours of nutrition education to more than 25 hours. This will enable the students acquire more knowledge in nutrition, and also develop their nutritional skills. Secondly, it is imperative that nutrition should be taught as a separate subject in order to enable the students to cohesively integrate nutritional concepts such as food choices, recommended dietary intake and nutritional assessments. This would enable the students to have a strong knowledge base that can be applied to the clinical aspects of nutrition. Finally, there is a need to switch from the traditional rote learning to more active learning modes in order for the students and physicians to retain the nutritional knowledge they have acquired.

Conclusions.

Nutritional knowledge is one of the basic pillars of medical knowledge, and as such it is a vital component of medical education. However, physicians have inadequate nutritional knowledge due to the inadequate nutritional education that they received as medical students in medical schools. The study conducted showed that most of the medical students have inadequate nutritional knowledge, and this observation is shared by the General practitioners who recommend that clinical training should prioritize on clinical nutrition. The viable solutions that can remedy the situation are to increase contact hours of nutrition education to more than 25 hours, and nutrition should also be taught as a separate subject. Finally, there is a need to switch from the traditional rote learning modes to more active learning modes.

References.

Insel, ‎P; Ross, D; Bernstein, M and ‎McMahon, K. (2010). Nutrition. Sudbury, MA: Jones & Bartlett Publishers.

Torti Jr, F. M., Adams, K. M., RD, L. J. E., Lindell, K. C., & RD, S. H. Z. (2001). Res00023Survey of Nutrition Education in US Medical Schools–An Instructor-Based Analysis. [Cited 2013 Dec 18].

Adams, K. M., Kohlmeier, M., & Zeisel, S. H. (2010). Nutrition education in US medical schools: latest update of a national survey. Academic Medicine, 85(9), 1537-1542.

Adams, K. M., Lindell, K. C., Kohlmeier, M., & Zeisel, S. H. (2006). Status of nutrition education in medical schools. The American journal of clinical nutrition, 83(4), 941S-944S.

Zimmermann, M., & Kretchmer, N. (1993). Isn't it time to teach nutrition to medical students?. The American journal of clinical nutrition, 58(6), 828-829.