The Need for Nutritional Education Reform in US Medical Education System

Abstract

Background To compare the setting, quality, and utility of nutritional education received by general surgery residents and faculty surgeons and their perceptions and challenges in managing patient nutritional needs. Methods Cross-sectional analysis utilizing anonymous survey data distributed by the Association of Program Directors in Surgery (APDS) to its affiliated general surgery residency programs. Results 90.2% (n = 65) of residents and 85.7% (n = 24) of faculty surgeons reported having received nutritional education. The majority (78%) of respondents utilize patient nutrition on a regular basis (monthly or more often), with 54% reporting utilization daily or weekly. Overall, 65% of respondents reported experiencing challenges in managing patient nutritional needs, and 86% agreed that additional nutritional education during training would assist with patient care. Residents and faculty surgeons both significantly reported challenges in determining which specific nutritional formula to use ( X2 = 22.414, P = .049). Residents were associated with reporting challenges in successfully managing oral, enteral, and parenteral routes of nutrition ( X2 = 16.241, P = .023). Conclusions Despite receiving nutritional education, the majority of surgery residents and faculty surgeons report difficulty in managing their patients nutritional needs. Surgery residents report difficulties with all delivery modes of nutrition, including oral, parenteral, and enteral. Revising medical school nutritional education competencies to focus on more practical aspects of nutrition, reform of formal course format, greater interprofessional collaboration with dieticians starting at the student level, and enforcement of nutritional education requirements by medical school and residency program accrediting bodies can serve to advance physicians’ nutritional knowledge and improve patient outcomes.

Medical Nutrition Education for Health, Not Harm: BMI, Weight Stigma, Eating Disorders, and Social Determinants of Health

“…Physicians who receive more nutrition training provide counseling to more of their patients [ 36 ]. However, the majority of physicians report receiving insufficient training to address their patients’ nutritional needs [ 36 – 41 ], despite 72–95% feeling that it is a physician’s responsibility to discuss nutrition with patients [ 36 , 37 , 40 , 42 ].…”

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education

“…Beyond the obvious specialties that routinely care for patients with diet-sensitive diseases, the physician’s ability to support patient adherence to a nourishing dietary pattern also has niche implications, such as in the field of renal transplantation and the subsequent care of donors [ 47 ]. In fact, the intersection of nutritional health and surgical outcomes and intensive care is increasingly recognized, deepening the value of nutrition education for surgical fields, as well [ [48] , [49] , [50] , [51] ]. There are few GME fields that lack the need for a basic foundation of nutrition knowledge layered with specialty-specific tailored content.…”

The Relation of Diet and Health: You Are What You Eat

“…Therefore, it is justified to discuss whether it is ethically reasonable to neglect nutrition in medical training and everyday medical life [40]. Although the research of the recent decades has accentuated the overwhelming role of diet in health and disease, recent publications indicate many physicians' just basic knowledge of diet [52,53]. In the future, we have to pay more attention to the diets of patients as nutrition appears to be a key contributor to health, longevity and delayed ageing [3,54,55].…”