means “nutrition is going to be one of the most critical elements of value- based care going forward.”


EXTRA HELPINGS, PLEASE Some recent studies have criticized medical schools for not including a big enough helping of nutrition instruction. Most U.S. medical schools — 71


percent — fail to teach the National Academy of Sciences’ recommended 25 hours of nutrition education across the four-year undergraduate medi- cal curriculum, according to a survey published in the Jan. 11, 2015, issue of Journal of Biomedical Education. (See “Different Ingredients,” page 39.) On average, U.S. medical schools offer 19 hours of nutrition-related educa- tion, most of which takes place during preclinical training — such as through science-based courses — versus clini- cal practice activities such as assess- ing or counseling patients. Research- ers also note the National Academy’s 1985 recommendation that 25 hours


“should be considered a minimum es- timate, developed at a time when the scope of medically relevant nutrition knowledge was only a fraction of what it is today.” Authors of a July 2015 Academic


Medicine perspective article find that among entering medical students, 71 percent think nutrition is clinically important. Upon graduation, fewer than half say nutrition is clinically rel- evant, and once in practice, fewer than 14 percent of physicians say they were adequately trained in nutrition coun- seling, the report shows. As with other subjects, accredi-


tation standards don’t prescribe a certain number of hours in nutrition education, says Dan Hunt, MD, Asso- ciation of American Medical Colleges (AAMC) senior director of accredi- tation services and national Liaison Committee on Medical Education co- secretary. Rather, schools must dem- onstrate their curricula adequately prepare students for clinical practice overall, with an expectation they’ll in-


clude nutrition education, he says. But it can fall into any number of areas. Most schools, for instance, incor-


porate nutrition into organ systems courses on cardiology or gastroen- terology versus stand-alone nutrition courses, Dr. Hunt says, adding that new electronic systems now make it easier for AAMC to track how school curricula cover the topic. On the oth- er hand, interprofessional education and evidence-based training — teach- ing students how to work with other health professionals and to find ad- ditional, reliable information sources on their own — are hard requirements that also impact nutrition training. Speaking on his own behalf, Dr.


Hunt agrees there is “no lack of evi- dence” that nutrition is an important part of medicine and medical educa- tion. Like any subject, however, “the education of the physician doesn’t stop with the MD degree,” he said. Meanwhile, medical schools continue to grapple with cramming more in- formation into core teaching materi- als. “We have to accept that no phy- sician will ever know enough about everything. It’s an ongoing challenge. But how much can you pour into four years?”


AN INTEGRATIVE APPROACH Educators agree it’s not about the quantity of time schools pour into nu- trition education, rather the quality of the ingredients. And Texas medical schools are finding innovative ways to integrate the topic into required and elective courses so that it translates into patient care. TCOM’s preclinical curriculum,


for instance, aims to help students un- derstand interrelationships between various systems in the body, and nu- trition is one of several topics that string them together, Dr. D’Agostino says. Rather than a two-hour isolated lecture on nutrition, courses on cardi- ology and kidney systems address it in the context of high-sodium diets; an endocrinology course tackles how dif- ferent nutrition molecules interact.


Fewer than 14 percent of physicians say they were


adequately trained in nutritional counseling.


November 2015 TEXAS MEDICINE 37


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