Clinical Nutrition Education of Doctors and Medical Students: Solving the Catch 22

Abstract

There is a well-documented pandemic of malnutrition. It has numerous sequelae, including physical and psychological ill health, early death, and socioeconomic burden. The nutrition landscape and dynamics of the nutrition transition are extremely complex, but one significant factor in both is the role of medical management. Doctors have a unique position in society from which to influence this scenario at global, public, and personal levels, but we are failing to do so. There are several reasons for this, including inadequate time; historical educational bias towards disease and therapeutic intervention-rather than diet, lifestyle, and prevention; actual or perceived incompetency in the field of nutrition; confusion or deflection within medicine about whose role(s) it is on a medical team to address nutrition; and public confusion about whom to turn to for advice. But the most fundamental reason is that current doctors (and thus the trainers of medical students) have not received-and future doctors are thus still not receiving-adequate training to render them confident or competent to take on the role. A small number of important educational approaches exist aimed at practicing doctors and medical students, but the most effective methods of teaching are still being evaluated. Without properly trained trainers, we have no one to train the doctors of tomorrow. This is a "catch 22. " To break this deadlock, there is an urgent need to make appropriate nutrition training available, internationally, and at all levels of medical education (medical students, doctors-in-training, and practicing doctors). Until this is achieved, the current pandemic of nutrition-related disease will continue to grow. Using important illustrative examples of existing successful nutrition education approaches, we suggest potential approaches to breaking this deadlock.

Nutrition in medical education: a systematic review

“…The reviewed studies reported that foundation nutrition education provided in medical training should enable graduates to begin conversations with patients and recognise when referral to other health-care professionals is required. 11,44,45 However, medical students reported inadequate nutrition knowledge, whether assessed objectively or subjectively. When nutrition knowledge was assessed in purposely developed tests, half the medical students scored below the school's passing rate, 22 and only half of new medical graduates answered the questions correctly.…”

“…53 Increasing students' nutrition knowledge and confidence to counsel patients through awareness and appreciation of diet in their personal health status better prepares students to overcome the barriers to consuming a healthy diet that occur in the community, 48 which can then be extended to regional and global levels to address public health nutrition issues. 44 Curriculum initiatives that emphasise medical students' health habits and behaviours are crucial, given that as medical practitioners they will be required to address the increasing prevalence in chronic disease, 45 and can align calls to better standardise learning outcomes of medical education and training. 48 It is paramount that students are supported by learning about their own personal health and diet, and about theory and practice of behaviour change of diet and lifestyles of patients, to improve their ability to apply behaviour change theory as future doctors.…”

Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

“…To this end, we call upon physician leaders to determine how they can facilitate early identification of malnutrition (under- and overnutrition) in their community clinics and practices. 46 Clearly, there is a need for medical education on nutrition at all levels of training—medical school, residency practices, and continuing education for practicing physicians, physician assistants, and other healthcare provider groups. 46 - 48 Even RDNs do not all use consistent nutrition practices, so it may be helpful to engage them in streamlining screening and care in order to help address such practice variations.…”

“…46 Clearly, there is a need for medical education on nutrition at all levels of training-medical school, residency practices, and continuing education for practicing physicians, physician assistants, and other healthcare provider groups. [46][47][48] Even RDNs do not all use consistent nutrition practices, so it may be helpful to engage them in streamlining screening and care in order to help address such practice variations. 49 We propose consideration of a simple solution-routine use of the 3-question Malnutrition Screening Tool (MST) to identify undernutrition in everyday practice, 26,50 in combination with other "red flag" observations that indicate disease-related poor nutrition (this would be applicable even in overweight/obese patient population).…”

How does self-perceived nutrition competence change over time during medical training? A prospective longitudinal observational study of New Zealand medical students

“…10 As future medical practitioners, students will be required to address the increasing prevalence of chronic disease and public health issues. 36 To prepare for this role, medical students need to also be competent in the practice of behaviour change, and to be reflective practitioners. 37 At three time points during medical training, the majority of medical students in this study perceived need for further nutrition education.…”