A Survey of Nutrition in Medical School Curricula

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February 2004

 

A Survey of Nutrition in Medical School Curricula

Today's Dietitian

By LuAnn Soliah, PhD, RD

Vol. 6 No. 2 p. 20

http://www.todaysdietitian.com/archives/td_0204p20.shtml

 

In 1990, the United States Congress mandated that nutrition education

become an integrated component of medical education.4 In 1994, the

National Academy of Sciences called for improved nutrition education in

all U.S. medical schools.3,5 The Healthy People 2010 report also

identified the need for physician counseling and education that relates

to diet and disease.6

 

Furthermore, physicians and medical students have stated that they need

more general training in nutrition theory and specific training in

medical nutrition therapy.7,8 In particular, pediatricians have reported

in a Health and Human Services study that they need help dealing with

overweight children and unmotivated, uninvolved parents.9

 

Despite the acknowledgment that physicians are frequently asked to

provide guidance and information in nutritional aspects of disease and

frequently request such training, nutrition has not been consistently

emphasized in medical school curricula.10,11,12 Because of this

deficiency, most physicians in the United States enter their

professional field without the skills or knowledge necessary to apply

nutrition information in their medical practice.

 

The purpose of this study was to survey all of the accredited medical

and osteopathic colleges in the United States to determine the present

state of nutrition training in the curriculum. The titles of the actual

courses offered and the credit hour(s) were also appraised.

 

Justification

Nutrition is a key element in attaining and maintaining an optimal

health state. Poor diets combined with insufficient exercise are known

risk factors for chronic diseases and death (cardiovascular disease,

stroke, diabetes, and some cancers). Collectively, these disorders

account for two-thirds of all deaths in the United States.13 For these

reasons, renewed interest has emerged in nutrition education, and

several medical schools are including nutrition in the curricula. Table

1 lists seven reasons to justify changing medical school curricula to

place more emphasis on nutrition.

 

Methods

The 2003 Princeton Review, a comprehensive directory of medical schools,

was used to obtain the addresses of all of the accredited medical and

osteopathic colleges in the United States.16 The survey was mailed in

February 2003 to the 122 accredited medical schools and the 19

accredited osteopathic colleges in the United States. The survey

recipients had the option of completing and returning the survey via

mail or e-mail.

 

The survey asked two basic questions: 1) Does your school require

nutrition courses in the medical curriculum? 2) If nutrition is not a

requirement, is it offered as an elective course? Each of the two

questions also asked for the course title and how many credit hours each

course contained.

 

If the medical curriculum advisor did not respond to the survey, the

information about the medical curriculum was provided by the 2003

Association of American Medical Colleges (AAMC) database.17 Thus,

results were available for all of the medical schools in the United

States. The osteopathic colleges were not included in the AAMC database.

 

Results and Discussion

Approximately 40% of all medical schools and osteopathic colleges

provided a separate, required course in nutrition (see Sidebar). Several

of the survey respondents provided quantifiable descriptions of the

nutrition classes. At schools where nutrition was required, the mean

number of credit hours was 2.5 with a range of one to 10 credits. It was

rare for medical programs to require more than one nutrition course or

for the course to exceed three credits.

 

Several medical schools and osteopathic colleges offered nutrition as an

elective course (see Sidebar). Preclinical or clinical nutrition

elective courses are often excellent, but these courses must frequently

compete with other equally valid electives such as medical ethics,

medical Spanish, geriatrics, and occupational health. The range of

responses for the elective courses varied from 1% to 70% selection;

however, the typical enrollment was quite low (generally below 25%

enrollment for a two-credit course).

 

Nutrition is often incorporated into other courses (see Sidebar) such as

biochemistry, physiology, pharmacology, or pathology. The schools that

offered nutrition as an integrated subject matter provided this through

class lectures, seminars, clinical rotations, independent study, or

computer modules. Too often in science courses, nutrition is cited, but

the primary emphasis is on the major discipline. For example, in a

biochemistry course, nutrition may be covered in the metabolism unit.

Therefore, it is possible to complete the course and not even realize

that nutrition was covered. Nutrition taught in this manner is both

unsuccessful and irrelevant. The nutrition component of today’s major

public health problems (hypertension, diabetes, obesity, anorexia,

cancer, and obesity) must be the focus of the material covered.

 

Prestigious medical colleges such as Harvard, Boston; Vanderbilt,

Nashville, Tenn.; Case Western Reserve, Cleveland; and the Mayo Medical

School, Rochester, Minn., require nutrition as a part of the medical

school curriculum. This is a noteworthy observation because esteemed

programs frequently set the pace for other medical programs.

 

In a 1997 to 1998 survey, the AAMC reported that a nutrition course was

required in 26% of the programs, an elective course in 48%, and 26% of

the schools lacked nutrition instruction.5 In 2003, this study

determined that a nutrition course was required in 40% of the medical

and osteopathic programs, an elective course in 13%, and 24% of the

schools integrated the subject in other courses. Approximately 23%

lacked nutrition instruction of any type or were unable to specify the

amount of nutrition courses offered.

 

Even though it is favorable to know that several medical schools and

osteopathic colleges offer a nutrition course, it is still minimal. Most

programs (roughly 60%) do not require nutrition. Most dietitians would

agree that 100% of medical schools need to teach nutrition to achieve

nutrition literacy among future physicians. Nutrition literacy means

more than knowing technical aspects of nutrition; it means incorporating

nutrition information into therapeutic care. (See Table 2 for reasons

why some physicians minimize nutrition information in their current

medical practices.)

 

The American Dietetic Association (ADA) has stated that nutrition is an

essential component of medical education. In 1994, it issued a formal

position statement on this topic: “The position of the American Dietetic

Association is to support the inclusion of education in nutrition as an

essential component at all levels of medical education.”3 The ADA has

identified five key periods when nutrition could reasonably be included

in medical education. They are: 1) during the undergraduate years

(premedical education), 2) medical school—preclinical stage, 3) medical

school—clinical stage, 4) graduate residency, or 5) continuing medical

education.

 

There is agreement among physicians that nutrition comprises an

essential aspect of healthcare. Sixty percent of physicians reported a

positive attitude toward nutrition, and they also valued nutrition as a

subject matter.3,5,10 These are very encouraging trends. Similarly, the

results from this study confirm the diversity, but definite presence, of

nutrition education in medical schools and osteopathic colleges. If this

momentum continues, nutrition education in all medical programs will

become a reality within a few decades.

 

— LuAnn Soliah, PhD, RD, is a professor at Baylor University in Waco,

Tex. She also directs the undergraduate nutrition sciences program. She

expresses gratitude to Jen-Yu Wei and Keely Wild for their assistance in

data collection and preparation of this manuscript.

 

References

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4. National Nutrition Monitoring and Related Research Act of 1990.

Public Law 101-445/HR 1608. Section 302. 1990.

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Objectives for improving health. Washington, D.C.: U.S. Government

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attitudes and practices of primary-care physicians relating to

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14. U.S. Department of Health and Human Services, Centers for Disease

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15. Wardlaw GM, Hempl JS, DiSilvestro RA. Perspectives in Nutrition. 6th

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16. The Princeton Review, The Complete Book of Medical Schools. New

York: Random House, Inc.; 2003.

17. Association of American Medical Colleges, Curriculum Management and

Information Tool (CurrMIT) online database. Division of Medical

Education & Online Resources; 2003.