Improving Nutrition Education In Medical School - Brief Article

Nutrition Research Newsletter, July, 2001

Several organizations, including the American Society for Clinical Nutrition and the American Medical Student Association, have identified nutrition education for medical students as an important part of medical education. Despite this, many medical schools in the US fail to provide the recommended 25 hours of nutrition education. In 1994, 62.6% of graduates from US medical schools felt they received an inadequate amount of nutrition training during their schooling. Efforts to include more nutrition education have had variable success as several organizations have recommended nutritional competencies for graduating medical students.

The objective of a study at the University of Arizona College of Medicine was to evaluate an integrated nutrition education program. The evaluated project was initiated in 1993 and fully implemented in 1997. UA COM enrolls less than 100 students in each class. The curriculum was not comprised of a single nutrition course but rather integrated nutrition content into the required courses throughout the four-year undergraduate medical program. In order to determine changes in total hours of nutrition content, researchers performed an analysis in each course to identify the nutrition content before and after the development and implementation of the nutrition curriculum. Each course syllabus, including all seven basic science courses and five mandatory clerkship lectures, was reviewed for potential nutrition content by a nutrition professional. This evaluator also attended all course presentation in which potentially nutrition-related content was presented and recorded the time dedicated to nutrition-specific content. A meeting was then held with the faculty to explicitly define the nutrition objectives and to determine the potential and process of expanding nutrition content. Finally, the new nutrition content was integrated into the course materials and lectures. The number of hours that nutrition content was taught in each class was calculated after the integrated approach was implemented. The number of hours was then compared with the baseline number of hours. In order to determine recent nutrition content, the course directors were contacted by telephone and questioned about their perception of current content, specifically asking about the newly introduced curriculum. The evaluation of the curriculum was focused on three areas. The first was the number of hours of nutrition instruction, the second was the application of nutrition within a clinical setting, and third were the perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes using analysis of variance. Researchers utilized data from the American Association of Medical Colleges to determine the change in proportion of students who reported that the amount of time spent teaching nutrition was adequate.

The new nutrition curriculum resulted in twice as many total hours of required instruction being spent on nutrition education. Prior to the initiation of the program, a total of 35 hours was spent teaching nutrition; after the program was implemented, a total of 75 hours was spent on nutrition. The mean OSCE nutrition score significantly improved following implementation. In addition, the number of students who felt satisfied with the amount of nutrition education improved from 32% to 88%.

It was concluded that a curriculum that integrates nutrition into preexisting scientific classes improved medical students' clinical nutrition skills and satisfaction with nutrition knowledge.

D. Taren, C. Thomson, N. Koff, et al. Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training. Am J Clin Nutr; 73:1107-1112. (June 20001) [Correspondence: D.L. Taren, University of Arizona, College of Public Health, Box 245163, Tucson, AZ 85724. E-mail: taren@u.arizona.edu].