RUNNING HEAD: IMPROVING PHYSICAN NUTRITION KNOWLEDGE

Improving Physician Nutrition Knowledge

Matthew Thigpen
EDHP 501: Curriculum Design
April 19, 2015
Curriculum Topic: Disease treatment and prevention through nutrition
Audience: 1st year medical students M1
Problem Statement:
Currently US medical schools are underpreparing doctors for informing
patients about proper nutrition and its associated effects on health. While
not solely responsible for the continued increase in obesity and other chronic
illness, this lack of intervention is an area that could greatly aid in hindering
its continued growth.
Curriculum Goals:
1.

All students will gain an understanding of the preventative nature of

nutrition and exercise on overall wellness of patients and be able to

2.

convey this in a way that is applicable to patients lives.

All students will obtain an understanding of nutritions role in the
treatment of diseases and be able to apply this information to
patient care with clarity and compassion.

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Background
Currently in the United States, disease conditions are shifting from
acute conditions to more chronic diseases that are greatly influenced by
nutrition. As of 2012, the number of adults suffering from one or more
chronic diseases has reached 117 million, about one half of the population
(Centers for Disease Control [CDC], 2014a). One of these most prevalent of
these diseases, obesity, has a direct link with nutrition and 78.6 million
adults are currently obese in America (CDC, 2014b). This state directly
contributes to the risk of developing a range of comorbidities including heart
disease, stroke, type 2 diabetes, and certain types of cancer. Those suffering
from type 2 diabetes in 2012 was estimated to be about 9.3% of the
population (CDC, 2014c). Further concerning about this statistic is that 8.1
million of these people are believed to be undiagnosed increasing their risk
of complications or even death (CDC, 2014c). Another common chronic
condition, heart disease, accounts for roughly 610,000 deaths per year
making up a fourth of deaths in the US (CDC, 2014d). Alongside the physical
and emotional burden of these diseases, the financial cost of their treatment
is staggering. The CDC (2014a) estimates that eighty four percent of
healthcare spending is on this half of the population suffering from chronic
diseases. With the majority of these chronic illnesses, nutrition plays a key
component in both their development and treatment. Furthermore, of the
top four causes of death in the US three (diseases of the heart,

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cerebrovascular disease, and malignant neoplasms) have been discovered to
have nutrition as a key determinant (Kris-Etherton et al., 2014).

State of Medical Nutrition Curriculum

To gain a better understanding of how well medical schools are
currently preparing doctors to face this mounting need for nutritional
knowledge in the healthcare field today, a needs assessment was conducted
that focused on both the existing data of what is being taught in medical
schools and how that is being carried into practice. This was conducted
through review of literature and research articles examining the attitudes
towards nutrition education of medical students, examination of current
nutrition curriculum practices in medical schools, and policies associated
with nutrition guidelines for medical schools.
Many researchers and regulating entities recognize the role nutrition
has in modern healthcare. One example of this can be seen in the emphasis
the Affordable Care Act is trying to make in shifting to a greater focus on
wellness rather than merely treatment of conditions (Kris-Etherton et al.,
2014). Furthermore, as far back as 1985 the Institute of Medicine
recognized a need for a minimum of 25-30 hours of specific nutrition
education in medical school; however, a survey of the number of schools that
offer specific nutrition classes found this rate has actually declined from 35%
in 2000 to 25% in 2008 (Kris-Etherton et al., 2014). That same survey found

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that the average number of hours devoted to specific nutrition topics was
only 19.8 hours on average for medical school (Kris-Etherton et al., 2014).
Another survey saw similar results on the decline of medical schools with
dedicated nutrition classes and even found the average number of hours
dedicated to nutrition slightly less at 19.6 hours; this average has also
declined alongside the decrease in dedicated nutrition courses (Adams,
Kohlmeier, & Zeisel, 2010). A study examining specific objectives directly
relating to course curriculum found that 156 of the 1757 reported by medical
schools in their study were related to nutrition; however, upon further review
by the research team only 49 of those objectives explicitly discussed
nutrition (Nowson, Wells, & Perlstein, 2015). Another article examining
graduate medical education found similar results with only 26% of
respondents having a formal nutrition curriculum; furthermore, only 23% of
program directors said their nutrition education goals were met (Daley et al.,
2015).
Despite this lack of nutrition education students are receptive to the
subject of preventative medicine and see its value in medicine. A survey of
students at Marshall University Medical School found that students were very
receptive to nutrition education and felt underprepared by their current
curriculum. Roughly 90% agreed or strongly agreed they had an obligation
to help their patients improve their health including the use of nutritional
means; however only 25% agreed that they were satisfied by their nutrition
education. Only 40% agreed or strongly agreed they felt confident about

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counseling a patient in nutrition after their coursework (Hardman, Miller, &

Shah, 2015).
Goals & Objectives of New Curriculum
1.

All students will gain an understanding of the preventative nature of

nutrition and exercise on overall wellness of patients and be able to
convey this in a way that is applicable to patients lives.
a. Given a particular macronutrient, vitamin, or mineral students
should be able to explain the role and consequences of
imbalance of that nutrient without error.
b. Students should be able to give patients examples of at least
three foods high in each of the essential nutrients to proper
health
c. Students should be able to give at least two physical activities
and recommended times to perform them given a patients age,

2.

weight, and health history.

All students will obtain an understanding of nutritions role in the
treatment of diseases and be able to apply this information to
patient care with clarity and compassion.
a. Given a list of symptoms and patients attributes, students will be
able to identify a disease matching these conditions with 100%
accuracy.
b. Given a patients gender, activity level, weight, and disease
status, students will be able to develop a diet plan meeting 100%
of the patients dietary needs.
Learning Activities & Materials

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1. Sections of information will begin with lecture associated with block of

material being covered. This will start with the biochemistry block
where general nutrition is covered including roles of the various
nutrients in the healthy physiological state, foods high in these
necessary nutrients, nutrient absorption, and consequences when
inadequate or excess of these compounds are taken in. There will also
be some time to cover how general exercises, age, and weight status
can affect these nutrients and their balance. As the year moves
through various anatomical systems, associated diseases related to
nutrition will then be covered alongside those segments with particular
focus on how nutrients can affect the physiological state and
associated research supporting these methods.
a. Materials required will be presentation materials for professors,
outside research articles, and textbooks.
2. Alongside the introduction of nutrition segment, students will be
divided into groups that will work together throughout the year to
perform problem based learning assignments. At the start of each
block, each group will be given the basic information of a patient
including gender, age, common daily habits, average daily diet,
symptoms, and basic vitals. Students will also be given a series of
references alongside their textbook to examine. With this information
each group will analyze the patient determining if they are suffering
from one or more conditions ranging from disease to nutrient
deficiency. They will also have the opportunity to request lab tests to

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be run on the patient where they will receive a sheet with the
resulting lab values. Upon making their diagnosis, they will create a
dietary guideline for the patient to follow including example meals to
help the patient meet that guideline. Lastly, they will also include any
medications that might be required depending on the severity of the
condition.
a. Materials required will include textbook, reference articles,
imaginary patient backgrounds, and lab values of relevant tests
prepared
Student Assessment Methods
1. Written tests using short answer and multiple choice questions will be
used to assess student knowledge of particular nutrients and disease
states. Short answer questions will involve imaginary patient
backgrounds and require students to diagnose and develop treatment
plans. Short answer questions will be used to assess more specific
knowledge regarding particular aspects of diseases or nutrients.
2. Peer evaluations upon completion of group problem based learning will
assess each students ability to work as a team and properly seek out
and integrate information. Final assessments of patients will also be
taken into account with how well the team was able to analyze the
patients condition and develop a treatment plan.
3. Students will also be tested on mock patient interactions which will be
observed and assessed by both teachers and the mock patients.
Teachers will assess technique and bedside etiquette while mock

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patients will fill out questionnaires on clarity of information provided

and perceived support from physician. These interactions will assess
students ability to convey information to patients for their personal
use and the ability to show compassion and care for patients.
Implementation Process
The first step in incorporating this curriculum into practice will be
gather support to incorporate this curriculum into the school. Support will be
needed of both the professors and those in charge of the budget of the
college requiring many examples to convey the curriculums value. First
could be the support expanding preventative care has in the passing of the
Affordable Care Act and the Institute of Medicine for both its value and as a
sign this is where medicine is heading. Next, a range of research supporting
nutrition as a part of evidence based practice and the biochemical
background that much of it is based on could be used to further explain its
merit. Surveying the current medical class with their opinions of nutrition and
how competent they felt counseling patients throughout the various classes
could also show the support that added nutrition curriculum could have.
The second step will be determining the background knowledge of current
faculty within nutrition as well as their availability to instruct this new
material. Based on current knowledge of staff, new faculty would need to be
hired to teach this new subject matter or previous professors would likely
need to be refreshed on nutrition and its role in medicine.

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Next resources required for instruction would need to be obtained

including the time for instruction, mock patients for exercises, and funding
for faculty to be trained or hired. Space for classes and exercises would
already be available as instruction would fall in line with the same types
other blocks of the current subjects use. Similarly, current mock patients
could be trained in the disease states to be coved in their relation to
nutrition. For initial incorporation of time allotted to nutrition, aspects of the
curriculum will be placed alongside associated disease sections being
covered. For example, diseases like celiac disease and other autoimmune
diseases that are associated with malabsorption and special diets will be
incorporated into time devoted to immunology. Furthermore, initially placing
nutrition aspects alongside associated material and grounding it in the
biochemical aspects behind it could help to improve receptivity to focusing
more on this material.
Gaining time specifically devoted to an independent nutrition black
would likely require further support at the state or national level. In
particular, having portions of the STEP test devoted to testing nutrition
information would likely be needed to fully motivate stakeholders of medical
schools to support this addition. In this way, there would be more
marketable results in drawing in new medical students with a curriculum that
adequately prepares them for this new section. As more time is opened up
to specifically focus on nutrition this curriculum will be expanded and

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changed to better develop each students ability to counsel patients and be
updated as more studies are done regarding nutritions role in wellbeing.
Program Evaluation Methods
Early on it would be extremely helpful to gauge the current state of
medical students nutrition knowledge by both surveying each of the current
classes. As each new class comes through the program assessments could
be made on each classs confidence in various aspects of the new
curriculum, their ability to convey this information to patients, and how they
feel about the current amount of time provided to the subject. It would also
be helpful to use curriculum mapping to measure the amount of time spent
on the various aspects of nutrition and related diseases aiming for the goal
of a minimum of 25 hours to meet the Institute of Medicines
recommendation. It would also be extremely beneficial to have someone
with extensive nutrition background either currently on staff or to hire to
develop a short standardized assessment for current students. The results of
this test could then be compared to the understanding displayed by
subsequent years on how the program is progressing from prior to its
implementation. This overall assessment could possibly be replaced by STEP
results should nutrition be incorporated into the test in coming years;
however, this overall test would provide a good assessment of long term
retention of information of nutrition information while it is mixed in alongside
the current curriculum.

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References
Adams, K. M., Kohlmeier, M., & Zeisel, S. H. (2010). Nutrition education in US
medical schools: latest update of a national survey. Academic
medicine: journal of the Association of American Medical Colleges,
85(9), 1537.
Centers for Disease Control and Prevention. (2014a). Heart Disease Facts.
Retrieved from http://www.cdc.gov/chronicdisease/overview/index.htm
Centers for Disease Control and Prevention. (2014b). Adult Obesity Facts.
Retrieved from http://www.cdc.gov/obesity/data/adult.html
Centers for Disease Control and Prevention. (2014c). 2014 National Diabetes
Statistics Report.
http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html
Centers for Disease Control and Prevention. (2014d). Heart Disease Facts.
Retrieved from http://www.cdc.gov/heartdisease/facts.htm
Daley, B. J., Cherry-Bukowiec, J., Van Way, C. W., Collier, B., Gramlich, L.,
McMahon, M. M., & McClave, S. A. (2015). Current Status of Nutrition
Training in Graduate Medical Education From a Survey of Residency
Program Directors A Formal Nutrition Education Course Is Necessary.
Journal of Parenteral and Enteral Nutrition, 0148607115571155.
Hardman, W. E., Miller, B. L., & Shah, D. T. (2015). Student Perceptions of
Nutrition Education at Marshall University Joan C. Edwards School of

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Medicine: A Resource Challenged Institution. Journal of Biomedical

Education, 501, 675197.
Kris-Etherton, P. M., Akabas, S. R., Bales, C. W., Bistrian, B., Braun, L.,
Edwards, M. S., ... & Van Horn, L. (2014). The need to advance nutrition
education in the training of health care professionals and
recommended research to evaluate implementation and effectiveness.
The American journal of clinical nutrition, 99(5), 1153S-1166S.
Kushner, R. F., Van Horn, L., Rock, C. L., Edwards, M. S., Bales, C. W.,
Kohlmeier, M., & Akabas, S. R. (2014). Nutrition education in medical
school: a time of opportunity. The American journal of clinical nutrition,
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Nowson, C., Wells, J., & Perlstein, R. (2015). Mapping Nutrition Competencies
Across the Medical Curriculum in an Entry Level Medical Course. The
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