An area where we can’t neglect nutrition
Given the vast impacts that poor diet have had on global health, a deficit in nutrition education in medicine represents a big problem, writes the University of Auckland's Dr Jennifer Crowley
It is widely understood that nutrition is a central component of a healthy lifestyle. But despite this common knowledge, over the past 50 years, diets low in key nutrients found in fruit and vegetables and high in salt and fats have contributed to poor dietary intake for many people all over the world.
The effect this has had on world population health is huge and the burden on health care systems is growing. Globally, 11 million deaths are attributable to dietary factors each year, placing poor diet ahead of any other risk factor for death in the world. People in almost every region of the world would benefit from rebalancing their diets and increasing their consumption of key nutrients and foods.
In many countries the job of passing on good nutrition guidance falls to doctors and they are usually a patient’s most trusted source of health-related information. But when graduates begin their careers as medical professionals, just how well-prepared are they to begin conversations with patients about diet and nutrition?
In a recently-published review of medical students nutrition education worldwide, published in The Lancet Planetary Health, it was found there is not enough nutrition incorporated into medical education, regardless of country, setting, or year of medical education. The review included 24 papers from the US, Europe, the Middle East, Africa and Australasia.
This deficit in nutrition education impacts on medical students’ knowledge, skills and confidence to include nutrition advice in patient care. This means that they will miss opportunities where such advice could help. On a broader level, failure to prioritise nutrition during medical training means its importance and relevance to a healthy lifestyle isn’t reinforced.
The failure of medical graduates to feel adequately prepared to provide nutrition care is in contrast with the expectation that doctors will provide nutrition information to patients to support management of diet-related conditions where poor nutrition is a major risk factor. In many countries, the practice of giving such nutrition care is recommended to doctors by health authorities and their professional organisations.
To provide even basic nutrition care, doctors must have adequate nutritional knowledge and skills, and appropriate attitudes to support its integration into routine practice with patients. They also need to know enough to recognise when referral onto other specialist health professionals such as dietitians or nutritionists is required for more detailed information.
The outcome of this study was not unexpected. Internationally, inadequate nutrition education, dissatisfaction with the nutrition education received and feeling unprepared to counsel in nutrition have been themes among studies on medical nutrition education for more than five decades, suggesting that minimal clear gains in nutrition education have been made in recent years. Graduating medical students have also consistently reported that they lack nutrition knowledge and skills required to effectively support dietary behaviour change in patients. Adequate nutrition knowledge is essential for doctors to work as effective team members to support the nutrition needs of patients.
So how can this change? Firstly, there must be an institutional commitment to make nutrition education compulsory. Currently, inclusion of nutrition in the medical curriculum and the time devoted to it is at the discretion of individual medical schools. With the content of medical programmes already perceived as overcrowded, this inclusion will require innovative teaching practices so the subject can be incorporated within existing time frames.
Further, it should begin early in medical training, such as in the basic sciences, and be revisited and expanded throughout the training programme. Medical nutrition should be taught by medical nutrition experts or dietitians alongside other system experts, for example cardiologists. Medical nutrition experts or dietitians can demonstrate how nutritional knowledge is applied in clinical settings and students can see its relevance to patient care and the benefits of inter-professional and team-based education.
Agreement would need to be made on the content of a nutrition curriculum and the level of nutrition knowledge required for students to achieve during medical training. In line with delivery of other aspects of medical training, information technology and self-directed learning could be used to enhance the nutrition education received. Finally, within medical schools, research funding needs to be available for the ongoing development of innovative ways to resource and evaluate the effectiveness of the nutrition education provided.
These recommendations will enhance the nutrition education received by medical students, making it intrinsic and relevant to their medical training. In turn, as medical graduates and new doctors, they will become more effective and knowledgeable health professionals who support positive diet and lifestyle behaviours for patients and populations.