Abstract
History of Nutrition in Medical Education
American Medical Association
Medical education in the United States. Council on Medical Education of the American Medical Association. Chicago, IL: American Medical Association. https://www.ama-assn.org/about-us/council-medical-education-reports. Accessed March 26, 2017.
National Academy of Sciences, National Research Council Report
National Nutrition Monitoring and Related Research Act
Residency Training Requirements in Nutrition
American Academy of Family Physicians. Recommended core educational guidelines in nutrition (reprint no. 275) in 1989, 1995, and 2000. 1989, 1995, 2000. http://www.aafp.org/edu/guide/rep275.html. Accessed March 26, 2017.
Kolasa KK, Deen DD, eds. Physicians Curriculum in Clinical Nutrition: Primary Care. 3rd ed. Leawood, KS: Society of Teachers of Family Medicine, Group on Nutrition; 2001. http://resourcelibrary.stfm.org/viewdocument/physicians-curriculum-in-clinical-n. Accessed March 26, 2017.
Kolasa KK, Deen DD, eds. Physicians Curriculum in Clinical Nutrition: Primary Care. 3rd ed. Leawood, KS: Society of Teachers of Family Medicine, Group on Nutrition; 2001. http://resourcelibrary.stfm.org/viewdocument/physicians-curriculum-in-clinical-n. Accessed March 26, 2017.
Healthy People 2020
US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020. http://www.healthypeople.gov. Accessed March 26, 2017.
Nutrition Academic Award Program
National Heart, Lung, and Blood Institute. Nutrition Academic Award Program. http://www.nhlbi.nih.gov/research/training/naa/. Accessed March 26, 2017.
National Heart, Lung, and Blood Institute. Nutrition Academic Award Program. http://www.nhlbi.nih.gov/research/training/naa/. Accessed March 26, 2017.
National Heart, Lung, and Blood Institute. Curriculum Committee of the Nutrition Academic Award Program. Nutrition curriculum guide for training physicians: Practice behavior skills and attitudes across the curriculum. http://www.nhlbi.nih.gov/research/training/naa/products/curr_gde.pdf. Accessed March 26, 2017.
Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care
Bipartisan Polcy Center, American College of Sports Medicine, Alliance for a Healthier Generation. Teaching nutrition and physical activity in medical school: Training doctors for prevention-oriented care. http://bipartisanpolicy.org/library/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention/. Published June 2014. Accessed March 26, 2017.
American Heart Association Scientific Statement
- Hivert M.F.
- Arena R.
- Forman D.E.
- et al.
Focus on Topics Relevant to Patient Care
Growing Rates of Hospital Malnutrition
- Brantley S.L.
- Russell M.K.
- Mogensen K.M.
- et al.
- Brantley S.L.
- Russell M.K.
- Mogensen K.M.
- et al.
- Brantley S.L.
- Russell M.K.
- Mogensen K.M.
- et al.
Nutrition Risk Factors for Noncommunicable Diseases
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
Centers for Disease Control and Prevention, National Center on Health Statistics. Obesity and overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016. Accessed March 26, 2017.
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
Nutrition Guidelines for Diabetes, Cancer, Heart Disease, and Hypertension
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
Centers for Disease Control and Prevention, National Center on Health Statistics. Obesity and overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016. Accessed March 26, 2017.
Structure of US Medical Schools (Undergraduate Medical Education)
AAMC
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
LCME Curriculum Guidelines
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Results of Nutrition Coverage in US Medical School Surveys
AAMC All Schools Graduation Survey Results for Nutrition Content
Medical Educational Program Objectives
Self-Directed Nutrition Content
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
US Medical Licensing Examination
Initiatives to Review Nutrition Content on Step 1, 2, and 3 Examinations
US Medical Licensing Examination. USLME content outline. http://www.usmle.org/pdfs/usmlecontentoutline.pdf. Accessed March 26, 2017.
US Medical Licensing Examination. USLME content outline. http://www.usmle.org/pdfs/usmlecontentoutline.pdf. Accessed March 26, 2017.
US Medical Licensing Examination. USLME content outline. http://www.usmle.org/pdfs/usmlecontentoutline.pdf. Accessed March 26, 2017.
Summary of Nutrition Content Covered on the Step Examinations
Structure of Graduate Medical Education
American College of Graduate Medical Education
American Board of Medical Specialties. Steps toward initial certification and MOC. http://www.abms.org/board-certification/steps-toward-initial-certification-and-moc. Accessed March 26, 2017.
American Board of Medical Specialties. Steps toward initial certification and MOC. http://www.abms.org/board-certification/steps-toward-initial-certification-and-moc. Accessed March 26, 2017.
Developing Entrustable Professional Activities for GME
Association of American Medical Colleges. The core entrustable professional activities for entering residency. https://www.aamc.org/initiatives/coreepas. Accessed March 26, 2017.
Important Leadership Roles for RDNs in Medical Curriculum, Inter-Professional Education, and Team-Based Care
Leadership Role in Curriculum Development
Highlight Leadership Role of RDN at All Levels of Interprofessional Education
Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: Report of an expert panel. National Network of Libraries of Medicine website. https://nnlm.gov/bhic/2011/05/26/core-competencies-interprofessional. Published May 2011. Accessed March 26, 2017.
Examples of Nutrition Content in Medical Schools, Residency, and Fellowship Programs
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Teaching Strategies in Basic Science, Clinical Clerkships, and Hospital Settings
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Centers for Disease Control and Prevention, National Center on Health Statistics. Obesity and overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016. Accessed March 26, 2017.
Role of the Undergraduate and Graduate Dietetic Program Directors
Prepare RDNs to Teach and Train Other Health Professionals
Educate RDNs with Information about Reimbursement
Bipartisan Polcy Center, American College of Sports Medicine, Alliance for a Healthier Generation. Teaching nutrition and physical activity in medical school: Training doctors for prevention-oriented care. http://bipartisanpolicy.org/library/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention/. Published June 2014. Accessed March 26, 2017.
RDNs’ Role in Teaching Cultural Competency
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
Conclusions and Highlights
- •The information provided in this position paper encourages and promotes RDN involvement in educating physicians in training at the medical school, residency, and fellowship levels.
- •The more physicians in training and practice learn about the benefits of nutrition, the more likely they are to consult with RDNs and refer patients for nutrition counseling.
- •The training and experience of RDNs makes them uniquely qualified for the role of educating medical students about nutrition as it relates to health and disease.
- •Tools, language, and resources have been provided to emphasize to physicians in training about how nutrition counseling, conducted by an RDN, can benefit their hospitalized and ambulatory patients. These benefits include improving blood sugar and lipid levels and reducing their patient’s risk of hypertension, cardiovascular disease, obesity, cancer, and malnutrition.
- •Emphasis should be placed on the critical role of RDNs as members of the health care team in assessing malnutrition in order to reduce hospital readmission rates and short-term and long-term health care costs.
- •Many teaching settings and strategies have been provided for RDNs to take a leadership role in ensuring future physicians discuss nutrition and physical activity with their patients, consult with RDNs, and refer patients for MNT.
- •The more interprofessional education that occurs between medical students, other health professional students, and RDNs, the more likely all health care professionals will understand and value the role of RDNs in improving the quality of care provided to patients.69
- •The health of the nation depends on this important training at the medical school, residency, and fellowship levels to help patients improve their diets and lead an active lifestyle.
References
- 1987 ASCN workshop on nutrition education for medical/dental students and residents—Integration of nutrition and medical education-strategies and techniques.Am J Clin Nutr. 1988; 47: 534-550
- Nutrition Education of US Medical Schools.National Academy Press, Washington, DC1985
- American Medical Association concepts of nutrition and health. Council on Scientific Affairs.JAMA. 1979; 242: 2335-2338
- Priorities for nutrition content in a medical school curriculum: A national consensus of medical educators.Am J Clin Nutr. 1989; 50: 707-712
- Nutrition education in the medical school: Factors critical to the development of a successful program.J Am Coll Nutr. 1982; 1: 219-226
- National Dairy Council Award for Excellence in Medical/Dental Nutrition Education Lecture, 1995: Medical-nutrition education—Factors important for developing a successful program.Am J Clin Nutr. 1995; 62: 837-840
- Implementing nutrition into the medical curriculum: A user's guide.Am J Clin Nutr. 1990; 52: 401-403
National Nutrition Monitoring and Related Research Act of 1990. Pub L No. 1101-445/HR16081990.
- Taking a nutrition history: A practical approach for family physicians.Am Fam Physician. 1999; 59 (1531-1522): 1521-1528
Medical education in the United States. Council on Medical Education of the American Medical Association. Chicago, IL: American Medical Association. https://www.ama-assn.org/about-us/council-medical-education-reports. Accessed March 26, 2017.
- Skills necessary for contemporary health professionals.Med Educ. 1992; 26: 3-6
American Academy of Family Physicians. Recommended core educational guidelines in nutrition (reprint no. 275) in 1989, 1995, and 2000. 1989, 1995, 2000. http://www.aafp.org/edu/guide/rep275.html. Accessed March 26, 2017.
Kolasa KK, Deen DD, eds. Physicians Curriculum in Clinical Nutrition: Primary Care. 3rd ed. Leawood, KS: Society of Teachers of Family Medicine, Group on Nutrition; 2001. http://resourcelibrary.stfm.org/viewdocument/physicians-curriculum-in-clinical-n. Accessed March 26, 2017.
US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020. http://www.healthypeople.gov. Accessed March 26, 2017.
- Position Paper of the American College of Physicians on Nutrition.American College of Physicians, Philadelphia, PA1985
- Position of the American Dietetic Association: nutrition—An essential of medical education.J Am Diet Assoc. 1994; 94: 555-557
- Translation of nutritional sciences into medical education: The Nutrition Academic Award Program.Am J Clin Nutr. 2001; 74: 164-170
National Heart, Lung, and Blood Institute. Nutrition Academic Award Program. http://www.nhlbi.nih.gov/research/training/naa/. Accessed March 26, 2017.
National Heart, Lung, and Blood Institute. Curriculum Committee of the Nutrition Academic Award Program. Nutrition curriculum guide for training physicians: Practice behavior skills and attitudes across the curriculum. http://www.nhlbi.nih.gov/research/training/naa/products/curr_gde.pdf. Accessed March 26, 2017.
- Nutrition education in medical school: A time of opportunity.Am J Clin Nutr. 2014; 99: 1167S-1173S
- Hark L.A. Deen D.D. Morrison G. Medical Nutrition and Disease: A Case-Based Approach. 5th ed. Wiley-Blackwell Publishing, Malden, MA2014
- One programs’ experiences in nutrition in medical education.Top Clin Nutr. 1997; 12: 42-48
- The development of a case-based, integrated curriculum for medical students.Am J Clin Nutr. 2000; 72: 890S-897S
Bipartisan Polcy Center, American College of Sports Medicine, Alliance for a Healthier Generation. Teaching nutrition and physical activity in medical school: Training doctors for prevention-oriented care. http://bipartisanpolicy.org/library/teaching-nutrition-and-physical-activity-medical-school-training-doctors-prevention/. Published June 2014. Accessed March 26, 2017.
- Medical training to achieve competency in lifestyle counseling: An essential foundation for prevention and treatment of cardiovascular diseases and other chronic medical conditions: A scientific statement from the American Heart Association.Circulation. 2016; 134: 1-21
- Hospital-associated malnutrition: A reevaluation 12 years later.J Am Diet Assoc. 1993; 93: 27-33
- The prevalence of malnutrition in hospitals can be reduced: Results from three consecutive cross-sectional studies.Clin Nutr. 2005; 24: 1078-1088
- A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.JPEN J Parenter Enteral Nutr. 2002; 26: 1SA-138SA
- American Society for Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics: Revised 2014 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support.J Acad Nutr Diet. 2014; 114: 2001-2008
- Annual medical spending attributable to obesity: Payer-and service-specific estimates.Health Aff (Millwood). 2009; 28: w822-w831
Centers for Disease Control and Prevention. Chronic disease overview. https://www.cdc.gov/chronicdisease/overview. Updated February 23, 2016. Accessed March 26, 2017.
- Multiple chronic conditions among US adults: A 2012 update.Prev Chron Dis. 2014; 11: E62
Centers for Disease Control and Prevention, National Center on Health Statistics. Obesity and overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Updated June 13, 2016. Accessed March 26, 2017.
- Nutrition education in an era of global obesity and diabetes: Thinking outside the box.Acad Med. 2015; 90: 854-860
- Prevalence of obesity and trends in the distribution of body mFass index among US adults, 1999-2010.JAMA. 2012; 307: 491-497
- The obesity epidemic: Challenges, health initiatives, and implications for gastroenterologists.Gastroenterol Hepatol (N Y). 2010; 6: 780-792
- The economics of obesity.NBER Reporter. 2013; 4: 7-10
- 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S76-S99
- Sodium and potassium intakes among US adults: NHANES 2003-2008.Am J Clin Nutr. 2012; 96: 647-657
- Direct medical cost of overweight and obesity in the USA: A quantitative systematic review.Obes Rev. 2011; 12: 50-61
- A novel nutrition medicine education model: The Boston University experience.Adv Nutr. 2013; 4: 1-7
- Lessons learned from nutrition curricular enhancements.Am J Clin Nutr. 2006; 83: 968S-970S
Liason Committee on Medical Education. Functions and structure of a medical school: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. 2014. http://lcme.org/publications. Accessed March 26, 2017.
- Nutrition education in U.S. medical schools: Latest update of a national survey.Acad Med. 2010; 85: 1537-1542
- Status of nutrition education in medical schools.Am J Clin Nutr. 2006; 83: 941S-944S
- Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.Am J Clin Nutr. 2001; 73: 1107-1112
- Barriers to providing nutrition counseling by physicians: A survey of primary care practitioners.Prev Med. 1995; 24: 546-552
- Learner-directed nutrition content for medical schools to meet LCME standards.J Biomed Educ. 2015; (Article ID 469351:12)
US Medical Licensing Examination. USLME content outline. http://www.usmle.org/pdfs/usmlecontentoutline.pdf. Accessed March 26, 2017.
- Nutrition coverage on medical licensing examinations in the United States.Am J Clin Nutr. 1997; 65: 568-571
- A national survey of attitudes and practices of primary-care physicians relating to nutrition: Strategies for enhancing the use of clinical nutrition in medical practice.Am J Clin Nutr. 1993; 57: 115-119
- Residency and specialties training in nutrition: A call for action.Am J Clin Nutr. 2014; 99: 1174S-1183S
American Board of Medical Specialties. Steps toward initial certification and MOC. http://www.abms.org/board-certification/steps-toward-initial-certification-and-moc. Accessed March 26, 2017.
Association of American Medical Colleges. The core entrustable professional activities for entering residency. https://www.aamc.org/initiatives/coreepas. Accessed March 26, 2017.
Interprofessional Education Collaborative. Core competencies for interprofessional collaborative practice: Report of an expert panel. National Network of Libraries of Medicine website. https://nnlm.gov/bhic/2011/05/26/core-competencies-interprofessional. Published May 2011. Accessed March 26, 2017.
- Changing the future of health professions: Embedding inter-professional education within an academic health center.Acad Med. 2010; 85: 1290-1295
- A problem-based learning approach to incorporating nutrition into the medical curriculum.Med Educ Online. 2006; 11: 4611
- Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Eng J Med. 2001; 344: 3-10
- “Mediterranean” dietary pattern for the primary prevention of cardiovascular disease.Cochrane Database Syst Rev. 2013; 8: CD009825
- Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: The ENCORE study.Arch Intern Med. 2010; 170: 126-135
- Nutrition attitudes and knowledge in medical students after completion of an integrated nutrition curriculum compared to a dedicated nutrition curriculum: A quasi-experimental study.BMC Med Educ. 2011; 11: 58
- Accelerating Progress in Obesity Prevention.National Academies Press, Washington, DC2012
- Challenges and opportunities for nutrition education and training in the health care professions: Intraprofessional and inter-professional call to action.Am J Clin Nutr. 2014; 99: 1184S-1193S
- The value in interprofessional, collaborative-ready nutrition and dietetics practitioners.J Acad Nutr Diet. 2015; 115: 1578-1588
- Barriers to providing nutrition counseling cited by physicians: A survey of primary care practitioners.Nutr Clin Pract. 2010; 25: 502-509
- Achieving Cultural Competency: A Case-Based Approach.Wiley-Blackwell Publishing, Malden, MA2009
- Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: Application of a culturally sensitive model.Ethn Health. 2004; 9: 349-367
- The Nurse Practitioner’s Guide to Nutrition.Wiley-Blackwell Publishing, Malden, MA2012
- The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness.Am J Clin Nutr. 2014; 99: 1153S-1166S
Article info
Publication history
Footnotes
This Academy of Nutrition and Dietetics position was adopted by the House of Delegates Leadership Team on February 16, 2017. This position is in effect until December 2024. Position papers should not be used to indicate endorsement of products or services. All requests to use portions of the position or republish in its entirety must be directed to the Academy at [email protected]
Authors: Lisa A. Hark, PhD, RD (Wills Eye Hospital, Philadelphia, PA); Darwin Deen, MD, MS (City University of New York School of Medicine, New York, NY).
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
Reviewers: Sharon Denny, MS, RD (Academy Knowledge Center, Chicago, IL); Beverly W. Henry, PhD, RDN (Northern Illinois University, DeKalb, IL); Nutrition Educators of Health Professionals dietetic practice group (Lynn Janas, PhD, Rosalind Franklin University of Medicine and Science, North Chicago, IL); Mary Beth Kavanagh, MS, RDN, LD, FAND (Case Western Reserve University, Cleveland, OH); Dietitians in Nutrition Support dietetic practice group (Sarah Peterson, PhD, RD, Rush University Medical Center, Chicago, IL); Diane D. Stadler, PhD, RD, LD (Oregon Health & Science University, Portland, OR); Jane V. White, PhD, RDN, FAND, LDN (University of Tennessee, Knoxville TN).
Academy Positions Committee Workgroup: Ainsley M. Malone, MS, RDN, LD, CNSC, FASPEN, FAND (American Society for Parenteral and Enteral Nutrition, Silver Spring, MD) (chair); Rick Hall, PhD, RDN, FAND (Arizona State University, Phoenix, AZ); Kathryn Kolasa, PhD, RDN, LDN (East Carolina University, Greenville, NC) (content advisor).
We thank the reviewers for their many constructive comments and suggestions. The reviewers were not asked to endorse this position or the supporting paper.