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Nutrition Education in Medical Programs

Many medical schools fall short of providing future healthcare professionals with adequate nutrition education; a powerful tool for managing and preventing disease.

In September 2006, I came across an article published in the American Journal of Clinical Nutrition titled “Status of Nutrition Education in Medical Schools”. The results were both stunning and baffling to me. According to the article by Kelly M. Adams, et al. (2006), "Ninety-nine of the 106 schools [surveyed] required some form of nutrition education; however, only 32 schools (30%) required a separate nutrition course".

On average, students received 23.9 contact hours of nutrition instruction during medical school (range: 2 – 70 h). Only 40 schools required the min. 25 hours recommended by the National Academy of Sciences. [1]

A Call for Nutrition Education Reform

I had just completed my first year of naturopathic medical training and learned a great deal about the crucial role of proper diet & nutrition in the prevention and management of disease. So then, how could it be possible that these institutions of medical education dedicated such an inadequate amount of time for teaching nutrition to future healthcare providers. I had high hopes that articles such as this one, which shed light on a major deficit in medical education, would shock the academic & medical community into adopting global curriculum revisions that included sufficient education in nutrition science and dietetics.


Unfortunately, this conversation still continues fifteen years later. Many articles had been published since 2006 reiterating the shortcomings of nutrition education in medical programs across the world. The Journal of Biomedical Education published an open-access article in 2015 showing that out of 121 medical schools surveyed in the USA, a surprising 71% (86/121) “fail to provide the recommended minimum 25 hours of nutrition education; 43 (36%) [schools] provide less than half that much”.[2] Adams, K. et al. (2015) had concluded:

Many US medical schools still fail to prepare future physicians for everyday nutrition challenges in clinical practice. It cannot be a realistic expectation for physicians to effectively address obesity, diabetes, metabolic syndrome…and many other conditions as long as they are not taught during medical school and residency training how to recognize and treat the nutritional root causes. [2]

It seemed that this educational delinquency had gained traction in 2019, when the Journal of the American Medical Association had published several opinion articles highlighting the current neglect of nutrition and dietetics education for medical doctors. Stephen Devries, MD et al. (2019) gave a scathing review of nutrition education in medical school, residency, and clinical practice, stating:

Nutrition education in medical school is rudimentary at best, and limited for the duration of graduate medical education…Requirements for meaningful nutrition education in all phases of medical training are long overdue. [3]

Dr. Devries goes on to discuss the obvious; diet and nutrition plays an essential role in the primary prevention & therapeutic intervention of many lifestyle-related diseases, citing an example of the 2018 AHA and ACCG clinical care guidelines for the management of Blood Cholesterol, which includes “lifestyle therapies as a primary therapeutic modality”.


The use of diet and nutrition as a primary therapeutic is found in the guidelines for managing a variety of chronic diseases; and yet, it would seem that historically, the time spent on educating medical doctors in nutrition interventions throughout the traditional four years of medical school amounts to less than two weekend conferences.


But the pièce de résistance for critically evaluating the quality of nutrition education in medical programs came in September 2019, with a published article in the prestigious Lancet journal. Jennifer Crowley et al. (2019) had performed a systematic review of nutrition in medical education, which included articles from 2012 to 2018 on students’ abilities and confidence to utilize nutrition interventions in clinical practice. The analysis included 24 eligible studies published across the world and reached the following grim conclusion:

Our analysis of these studies showed that nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education.

The Covid-19 pandemic has most likely slowed the momentum towards nutrition curriculum revision for medical students. However, I would argue that the need for healthcare professionals knowledgeable in nutrition & dietetics is undeniably urgent during these times. We are aware that those individuals infected by Covid-19 with the poorest prognosis are people with underlying chronic disease and that diet & lifestyle interventions are considered primary therapeutic agents for preventing and managing chronic health issues.


This is a golden opportunity for all medical training institutions to begin rebuilding the “new normal” on a solid foundation of preventative medicine and lifestyle intervention. Therefore, it is essential that we keep striving for nutrition education reform in medical schools, so that we can adequately prepare our frontline healthcare professionals to advise their patients on the best dietary practices for preventing disease, promoting health, and sustaining wellbeing.

 

References:

  1. Adams, K. M., et al. Status of Nutrition Education in Medical Schools. Am J Clin Nutr. 2006 April; 83(4): 941S–944S. doi:10.1093/ajcn/83.4.941s

  2. Adams, K. M., et al. The State of Nutrition Education at US Medical Schools. Journal of Biomedical Education. Volume 2015. pgs 1–7. doi:10.1155/2015/357627

  3. Devries, S. et al. Nutrition Education in Medical School, Residency Training, and Practice. JAMA online. Published March 21, 2019. doi:10.1001/jama.2019.1581

  4. Crowley, J. et al. Nutrition in Medical Education: A Systematic Review. Lancet Planet Health. Volume 3. 2019 September; 3:e379-89.

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