Capacity Building in Nutrition Science: Revisiting the Curricula for Medical Professionals

Agenda

* Presentation times are subject to change.

Abstracts

KEYNOTE LECTURE I

Be the Change You Want to See in Health: How Changing the Paradigm of Nutrition and Physical Activity Education in Health Professional Training Can Drive the System of Care Toward Better Health
Matthew D. Levy, MD, MPH, FAAP, Georgetown University School of Medicine, Washington, DC; Bipartisan Policy Center, Washington, DC

Health professionals are uniquely positioned to inform and motivate patients on the subjects of nutrition and physical activity—two key health behaviors underpinning much of our chronic disease epidemic. But the current training and education systems are not aligned to ensure that health professionals have the incentives and expertise to deliver effective messages that positively affect outcomes related to weight, nutrition, and physical activity. Providers lack consistent: knowledge of nutrition and physical activity guidelines, understanding of how to deliver key messages and exposure to complementary healthcare and community resources for patients. The consensus among medical organizations and experts is that nutrition education at all levels of health training is uneven at best and often inadequate. While some schools and training programs are experimenting with new educational models, these models should be consistent with emerging evidence. In order for these emerging models to take effect to achieve better health, however, the behavioral drivers must change. As health professionals we can advocate for better policies and programs through our health institutions, communities and professional associations. Federal, state, and the private sector organizations and individuals are beginning to see the critical role of nutrition and physical activity education on the individual health and the population health. However, there is still limited evidence of the most effective strategies. Nutrition Science is the link between pure science and better health and if we can change the incentives, programs, and policies to support a better understanding then we improve health and lower costs over time.

KEYNOTE LECTURE II

The Landscape of Nutrition Education in the Medical Student Curriculum
Martin Kohlmeier, MD PhD^1,2, ¹University of North Carolina, Chapel Hill, NC; ²UNC Nutrition Research Institute, Kannapolis, NC

Most physicians care for patients with nutrition-responsive diseases and conditions, but medical school training often does not prepare students adequately for common clinical nutrition tasks. Few medical schools provide the mandated 25 hours of nutrition education across the four-year curriculum and a majority offer less than 20 hours. Nutrition content is most often taught as part of the basic science courses. Integrated programs, often by organ systems, are a great opportunity to teach about typical nutrition challenges in clinical medicine, but the nutrition content is often diminished and presented by faculty with limited qualifications in nutrition instruction and practice. Only a minority of medical schools incorporates any nutrition education during clinical training and most of those who do add fewer than seven hours to the total. The precarious situation is compounded by the very limited number of nutrition questions on licensing exams and the lack of attention to nutrition education during accreditation reviews of medical programs.Diverse innovative instructional models can achieve nutrition teaching goals both quantitatively and qualitatively. Online instruction can support coverage of a wider range of topics and add more hours than could otherwise be sustained by the limited number of instructors. Well-planned longitudinal programs lay the basic science foundations and then teach their students to apply evidence-based nutrition practices to common case scenarios within the context of the various clinical disciplines. What is needed most is a broad consensus on core clinical nutrition competencies, targeted instructor training in nutrition education and ready availability of instructional resources.

SESSION I: NUTRITION FOR HEALTH PROFESSIONALS: CURRENT STATUS AND INNOVATIONS

Integrating Nutrition in Nursing Education: Prelicensure and Advanced Practice
Rose Ann DiMaria-Ghalili, PhD, RN, CNSC, College of Nursing and Health Professions, Drexel University, Philadelphia, PA

The American Nurses Association defines nursing as the “protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human responses, and advocacy in the care of individuals, families, communities and populations.” Nutrition is an integral component of nursing care as nurses assess and monitor nutrition and hydration status, and manage clients with an alternation in nutritional intake. In pre-licensure nursing programs, nutrition content is delivered in stand-alone nutrition courses, integrated throughout nursing courses, or through a hybrid approach. However, standards for nutrition curriculum in pre-licensure and graduate nursing programs do not exist. While advanced practice nurses (i.e. nurse practitioners) are required to complete the “Direct Care Core 3 P’s”: advanced physiology/pathophysiology, advanced health assessment and advanced pharmacology at the graduate level, no formal coursework or training is required in nutrition. This presentation will discuss models for infusing nutrition content into pre-licensure and advanced practice nursing education.

Nutrition Education for Dental Professionals: Past, Present, and Future
Carole A. Palmer, EdD, RD, LDN, Tufts University School of Dental Medicine, Boston, MA

Dentists and their teams see more patients than any other health care providers. Of the common dental problems experienced by patients, diet and nutrition play a major role in the development of dental caries (tooth decay), and in the extent and progression of periodontal disease (disease of the soft tissue and oral bone surrounding the teeth). Thus providing nutrition education to dental patients for the prevention of dental diseases is considered an important component of dental and dental hygiene practice. The need for a meaningful nutrition curriculum is implied in the accreditation standards of dental schools, and is clearly stated in the dental hygiene program standards.

Today’s focus upon the importance of general as well as dental health promotion and the movement towards interprofessional practice, provide great opportunities for meaningful nutrition programs in dental education. Yet, despite recognition of the importance of nutrition in patient dental care and thus in dental education, nutrition curricula in dental schools have suffer from numerous barriers including lack of time in the curriculum, lack of faculty skilled in applied nutrition, and lack of good models of nutrition practice in dental education. This presentation will review the landscape of dental education in dentistry and dental hygiene and offer suggestions for models of education appropriate to the needs of a 21st. century dental curriculum.

A Novel Sudent-Centered Nutrition Medicine Education Model
Carine M. Lenders, MD, MS, ScD^1,2, Kathy Ireland, MS, RD, LDN^1,2, Cynthia Schoettler, BS (Medical Student, 2015),  ^{2 1}Pediatrics,  Boston University Medical Center, Boston, MA, ²Boston University School of Medicine, Boston, MA

For more than a decade, national surveys have reported that most common deaths in the United States are preventable and related to nutrition. As a result, physicians have been urged to counsel their patients but with minimal improvement noted in nutrition medicine education in US medical schools. Our goal was to partner with various Boston University (BU) communities to enhance medical students’ knowledge, attitudes, and practice skills in nutrition medicine. Following the development of a multidisciplinary elective in Advanced Pediatric Nutrition (058.1) in 2005 and with support from the Physician Nutrition Specialist Award from the American Society for Nutrition and the Associate Dean of Academic Affairs, we assessed the medical school curriculum and developed a novel student–centered model of nutrition medicine education that focuses on student mentored extra-curricular activities to develop, evaluate, and sustain nutrition medicine. Student interest in nutrition medicine is increasing and has resulted in the development of a nutrition student interest group at BUSM (2009) and the creation of an intercollegiate alliance in greater Boston (2011). Using the NAA nutrition objectives from NIH to evaluate nutrition in the curriculum, we found that most pre-clerkship objectives were met while USMLE step 1 scores continue to improve. However, results of surveys on practical nutrition knowledge and perceived self-efficacy are suboptimal in students across the curriculum. We plan to further administer surveys to students and faculty, and partner with national groups to improve nutrition services and population wellness. Support from the New Balance Foundation and the Allen Foundation.

SESSION II: APPROACHES FOR INTEGRATING NUTRITION INTO THE MEDICAL CURRICULUM

Nutrition Education in Women’s Health
Ellen Landsberger, MD, MS, Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center/Einstein College of Medicine, Bronx, NY

Many women consider their OBGYN doctor to be their primary physician. As such, they expect and deserve their physician to be able to counsel them about nutrition and dietary issues. Historically, there has been a dearth of formal nutrition education to medical providers. Due to this lack of knowledge physicians are uncomfortable with the topic of nutrition. Opportunities to incorporate nutrition counseling into women’s health visits are numerous. Many women improve their lifestyle habits during pregnancy. Advising women about nutrition and appropriate gestational weight gain can positively influence both the mother and baby. Folic acid intake before pregnancy is critical to decreasing birth defects. Prevention and treatment of osteoporosis is important throughout a woman’s lifecycle. In order to efficiently teach women’s health and other medical practitioners about nutrition, it is essential to consider how they will learn the information and skills most efficiently and effectively.

Nutrition Science in Clinical Pediatrics for Prevention and Management of Childhood Obesity
Eugene Dinkevich, MD, SUNY Downstate Medical Center, Brooklyn, NY

Abstract available soon.

Integration of Nutrition into the Medical Curriculum: The Life Cycle Approach - Nutrition Education for Aging
Marilyn S. Edwards, PhD, RD, University of Texas Medical School, Houston, TX

Nutrition is an important topic in medical education and clinical practice yet a majority of physicians report lack of training in nutrition counseling skills. With the current rise in the incidence of chronic diseases related to diet and lifestyle, nutrition knowledge is essential among all health care professionals and particularly among physicians. Medical students and primary care residents need to be trained in medical nutrition therapy (MNT) related to obesity, diabetes, hypertension, and cardiovascular disease. As a result of the Nutrition Academic Award (NAA) program sponsored by the National Heart, Lung, and Blood Institute from 1998 to 2005, more nutrition content has been integrated into the curricula at 21 U.S. medical schools. However, the design and implementation of an effective nutrition curriculum remains challenging. This presentation will focus on an integrated nutrition curriculum at the University of Texas Medical School at Houston based on work that was done through the NAA program. In addition to a nutrition theme, the curriculum also incorporates a geriatrics theme which was supported by a Reynolds Foundation grant from 2009 to 2012. Didactic training in nutrition begins in the basic science courses during first year. Problem Based Learning (PBL), a clinical case-based curriculum during second year, builds on the basic sciences and serves as a major focal point for students to apply evidence-based nutrition and prevention strategies to patients at different stages of the life cycle. Clinical clerkships during third and fourth year include lectures and clinical nutrition relative to pediatrics, family medicine, and critical care. Finally, during a 4th year transition to residency workshop using the Nutrition in Medicine short courses, students are provided the opportunity to review motivational interviewing and counseling skills related to diet and lifestyle modification for chronic diseases. This presentation will conclude with recommendations for successful integration of nutrition into a 4-year medical curriculum.

SESSION III: CHALLENGES TO IDENTIFYING COMPETENCIES AND ASSESSING NUTRITION TRAINING FOR HEALTH PROFESSIONALS

Nutrition and Physical Activity Competencies in the Health Professions
Sharon R. Akabas, PhD, Nathalie Marchand, MS and Jill Thekkekera, MS, Institute of Human Nutrition; Columbia University, New York, New York

An important step in the integration of nutrition and physical activity into health professional training is the development of core competencies. As an extension of the National Heart, Lung and Blood Institute (NHLBI) meeting held in September 2012, a working group was formed to identify and map the core competencies that currently exist in dentistry, medicine, nutrition, nursing, pharmacy, and training of physician assistants. The core competencies will include basic knowledge about nutrition and exercise science, skills related to patient assessment, and training in behavioral science. The process of identifying competencies will acknowledge the different stages wherein nutrition and physical activity are relevant, including prevention, treatment of chronic disease, and intervention in acute care settings. Where possible, common core competencies across professions will be developed and evaluation of the core competencies will be included in their development. Once existing competencies are identified, the development of new ones will be informed by a broader initiative currently underway at the Institute of Medicine, entitled the Global Forum on Innovation in Health Professional Education. The ultimate goal for the development of inter-professional core nutrition and physical activity guidelines is to improve patient care and health outcomes. This presentation will summarize the current status of the core competency development, and the anticipated next steps.

Implementing Nutrition Across the Continuum of Medical and Health Professions, Education and Training, and Research: A Summary of an NHLBI Workshop and Related Activities
Penny M. Kris-Etherton, PhD, RD¹, Sharon Akabas, PhD², Charlotte Pratt, PhD, RD³, Edward Saltzman⁴, Nancy Krebs⁵, Matthew Levy, MD, MPH⁶. ¹Nutritional Sciences, Penn State University, University Park, PA, ²Institute of Human Nutrition, Columbia University, New York City, NY, ³National Heart, Lung, and Blood Institute, Bethesda, MD, ⁴Tufts University School of Medicine, Boston, MA, ⁵University of Colorado, Aurora, CO, ⁶Medstar Georgetown University Hospital, Washington, DC

The NHLBI collaborating with the NIH Office of Disease Prevention and the Division of Nutrition Research Coordination convened a meeting on implementing nutrition across the continuum of training medical students through residency, and training other health professionals in September, 2012. The objectives were to make recommendations 1) on the content and implementation of nutrition and healthy lifestyles education, training and competency testing, and 2) on the integration of nutrition education, training and research to improve population health, patient care and health outcomes. Guiding principles for nutrition education in professional schools were defined. Crosscutting Themes for Health Professional Training recommendations were: 1) Revise the Nutrition Academic Award (NAA) Curriculum Guide and update learning objectives and competencies for all relevant health professionals; 2) Support a Nutrition Education and Research Coordinating Center that would serve as an oversight and coordinating body for nutrition education and research; and 3) Encourage multi-disciplinary teams, approaches and referral systems across the continuum of health professional training. Nutrition education research priorities were identified to advance nutrition education in training health professionals. A core paper and companion papers on the need for nutrition education in training medical and health care professionals and the research recommended to evaluate it have been prepared for publication in an ASN journal. There is interest among professional organizations in advancing nutrition education activities for health care professionals. One example is that ASN Nutrition Education Planning Committee and Subcommittee for Professional Nutrition Education have begun to build a road map for nutrition education of health care professionals. Implementation of recommendations will require partnership with a broad coalition of organizations.

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