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Incorporating Formal Nutrition Education into a Medical School Curriculum: A Student-Initiated Lecture Series

Published:January 14, 2017DOI:https://doi.org/10.1016/j.amjmed.2016.12.017
      Since the 1985 report titled “Nutrition Education in U.S. Medical Schools,” The National Research Council has recommended at least 25 to 30 hours of nutrition education in graduate medical education.
      • Winick M.
      • Aronson S.M.
      • Behrman R.
      • et al.
      Nutrition Education in U.S. Medical Schools.
      However, a 2013 survey of 133 US medical schools found that 71% of programs continue to fall short in providing the minimum recommended 25 hours of nutrition education.
      • Adams K.M.
      • Butsch W.S.
      • Kohlmeier M.
      • Adams K.M.
      • Butsch W.S.
      • Kohlmeier M.
      The state of nutrition education at US medical schools.
      Poor or inadequate nutrition is the root cause of many common diseases and exacerbates the disease progression of many acute and chronic ailments. Studies correlate the role of nutrition in the prevention and treatment of cognitive impairment and epilepsy.
      • Adams K.M.
      • Butsch W.S.
      • Kohlmeier M.
      • Adams K.M.
      • Butsch W.S.
      • Kohlmeier M.
      The state of nutrition education at US medical schools.
      In fact, as many as one third of all cancer diagnoses are related to nutritional factors.
      • Doll R.
      • Peto R.
      The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today.
      • Katz D.L.
      Nutrition in Clinical Practice.
      Evidence suggests that with growing attention to the importance of nutrition in the treatment of chronic diseases, the variety of problems for which patients are referred to dieticians is increasing.
      • Crustolo A.M.
      • Kates N.
      • Ackerman S.
      • Schamehorn S.
      Integrating nutrition services into primary care.
      Without adequate training in the basic tenets of nutrition and the skills needed to provide effective nutrition counseling to patients, graduates of medical schools are ill equipped to assist their patients in making necessary lifestyle changes.
      Despite no uniform nutrition education requirements in medical school curricula, prior research has shown that providing medical students with education in nutrition translates to positive clinical outcomes. A recent randomized controlled trial demonstrated potential for positive impacts on parameters such as hemoglobin A1C, diastolic blood pressure, and cholesterol levels for patients participating in nutrition education courses taught by medical students trained in cooking techniques and healthy eating habits.
      • Monlezun D.J.
      • Kasprowicz E.
      • Tosh K.W.
      • et al.
      Medical school-based teaching kitchen improves HbA1c, blood pressure, and cholesterol for patients with type 2 diabetes: results from a novel randomized controlled trial.
      As the United States continues to face increasing rates of chronic diseases directly related to poor nutrition, it has become critical to address the lack of evidence-based, practical nutrition education. We approached this problem at Wake Forest School of Medicine by creating a student-led nutrition lecture series with the aim of instituting a sustainable nutrition education model. A total of five 1-hour evidence-based lectures were created by students along with a faculty mentor, and surveys were conducted before and after the lectures to assess feedback.
      On the basis of survey data from Wake Forest School of Medicine, 85% of the 65 participating students in their clinical years of education are not confident in their preparedness to counsel patients about nutrition topics. Likewise, the majority of respondents (86%) stated they would be interested in more practical evidence-based nutrition education (Appendix).
      Additional survey data collected after each of the 5 peer taught lectures were overwhelmingly positive. Students agreed that each lecture expanded their knowledge, that they would be able to use this information to counsel patients, and that the material was taught to their educational level (Figure 1). On the basis of these results, it seems the peer-taught lecture series may be an effective model for addressing the current academic deficit in nutrition education. Furthermore, the postparticipation survey data endorsed that peer teaching of evidence-based nutrition education is an effective way to expand medical students' current level of knowledge and prepare them to counsel patients. A total of 93% of students surveyed agreed with the statement: “I like the peer teaching aspect of this lecture series and think it is an effective way to learn” (Figure 2).
      Figure thumbnail gr1
      Figure 1Students were asked after each nutrition lecture to rate the effectiveness of the task. A high percentage of the students agreed the lectures were beneficial.
      Figure thumbnail gr2
      Figure 2After the lecture series students were asked to comment on the peer teaching modes and a majority of students favored this approach.
      There is student interest in the implementation of formal nutrition education into medical school curriculum. Our research demonstrates a novel initiative to deliver current, evidence-based lectures of importance to medical students on the ever-changing topic of nutritional science. Our study unveils the challenges of adding nutritional education to an already dense curriculum. Many factors, such as required testing in other subjects, lecture timing, and elective nature of the course, may pose challenges in the delivery of lecture content. A prior study concluded that the best way to make an evidence-based course is to incorporate nutrition into the formal medical school curriculum.
      • Agrawal N.
      • Ostrosky S.A.
      • Henzi D.
      The introduction of nutrition education into the medical school curriculum: using an elective course to teach students the fundamentals, the science, and the clinical implications of food.
      Future studies that incorporate a nutrition lecture series into the general curriculum as opposed to an elective course will clarify how to best bring evidence-based nutrition education into medical student education.
      This educational initiative at Wake Forest School of Medicine demonstrated that the peer teaching model is an effective way to begin incorporating further nutrition education into a curriculum. It remains to be seen if evidence-based nutrition lectures incorporated as course requirements for students will be feasible in the future.

      Appendix

      • A.
        Preparticipation survey of third- and fourth-year medical students (administered electronically):
        • 1.
          What is your year in medical school?
          • Response options: third year, fourth year
        • 2.
          The nutrition education I received at Wake Forest School of Medicine has prepared me to counsel patients and answer questions concerning nutrition and diet:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 3.
          I would be interested in a lecture series that provided further practical nutrition education:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 4.
          What nutrition-related topics would you most like to learn about?
          • Free-text response
      • B.
        Survey questions to be given after attendance of each nutrition lecture:
        • 1.
          This lecture expanded my current knowledge of nutrition and personal meal planning:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 2.
          I will be able to use the information presented in this lecture to counsel patients:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 3.
          This lecture was appropriately taught to my level of knowledge:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
      • C.
        Survey questions to be administered to participants who attend a majority of lectures after the termination of the last lecture:
        • 1.
          This lecture series expanded my knowledge of nutrition-related topics:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 2.
          I liked the peer teaching aspect of this lecture series and think it was an effective way to learn:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree
        • 3.
          Something similar to this lecture series should be incorporated into the Wake Forest School of Medicine curriculum to supplement current material:
          • Response options: strongly disagree, disagree, neutral, agree, strongly agree

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