editorial
Helen
A.
Guthrie,2
Ph.D.
and
Carol
education-a L. Teply,3
Concern over the lack of nutrition training in academic programs for physicians is being constantly voiced in both the lay press and professional literature. While the situation is still far from ideal from a nutritionist’s point of view, it has been improving steadily in the past few years with a recent survey (1) showing that 19 of 102 respondents offered a required course in nutrition, 72 an elective and 94 indicated that it was integrated in other disciplines. At least some of this activity can be attributed to recommendations from the Chicopee and Williamsburg conferences (2, 3) which urged that physicians master the sociology as well as the science of nutrition. A continuing series of conferences and reports have all identified the same problems and have come up with essentially the same recommendations (4-6). A recent symposium chaired by Vitale and Hodges (7) focused on problems of incorporating nutrition into medical education and the feasibility of approaches to resolving them. While participants discussed nutrition in preclinical years, clinical years, medical and surgical internships, residencies, and during postgraduate training, they totally overlooked the possibility of encouraging including nutrition during premedical training. While it can be argued that such an approach is inefficient since a large number of students do not go on to medical school, it must be conceded that some nutrition knowledge would serve a useful purpose regardless. The advantages of utilizing this period are many. First, there is usually more flexibility in schedules for those 4 years. Second, most introductory human nutrition courses cover the topics and answer the questions to which medical students repeatedly seek answers. The
American
Journal
of Clinical
Nutrition
32: AUGUST
M.S.,
premedical
R.D.
Additionally, in many instances these courses are taken primarily by nutrition and/or dietetic students. By sharing this learning experience early in his career, a medical student should gain an appreciation and respect for the expertise which these qualified professionals can bring to the medical team. Furthermore, many students are finding that medical admission committees look with favor on candidates with either courses or majors in nutrition. To determine whether nutrition education in the basic principles of nutrition in undergraduate programs was considered a viable alternative to postgraduate education by medical students we conducted a study4 of students in two medical schools to elicit their opinions. Although in interpreting the results, it must be recognized that only 32% of those contacted responded, those who did respond seem to have taken the task seriously with many writing thoughtful comments. Of the 248 respondents 58% were 1st and 2nd year medical students and 42% were in their 3rd or 4th year of medical school. Of these students 18% had taken a college course in nutrition primarily as an elective; about half before enrollment in medical school and half in their first 2 years of medical school. Nutrition courses had most commonly been offered in the undergraduate departments of Nutrition and Home Economics and those in
State
‘From the Department of University, State College, Professor of Nutrition.
Nutrition, Pennsylvania Pennsylvania 16802. Project Assistant.
The questionnaire elicited biographical information, an evaluation of nutrition courses they had taken and opinions as to if, when and in what context it should be included in the curriculum and by whom they should be taught. The questionnaire is available on request.
1979,
pp.
1557-1558.
Printed
in U.S.A.
1557
Downloaded from https://academic.oup.com/ajcn/article-abstract/32/8/1557/4692289 by East Carolina University user on 11 January 2019
Nutrition in medical alternative1
1558
GUTHRIE
TEPLY
required; but more in-depth study should be elective in nature.” One student suggested presenting nutrition “basics as an undergraduate and more specific and detailed information in medical school,” while another recommended that it “be available to undergrad premeds and others” and “be required for medical students.” Although there was not complete consensus, students supported our conviction that incorporating basic nutrition in a premedical program was a viable alternative to the dilemma of adding one more professional course in an already crowded medical curriculum. These should not substitute for the clinical approach in medical school but provide a foundation on which these can be built. It is recognized that substantive nutrition courses are not available in many schools that offer premedical preparation. For these the alternatives of available correspondence, programmed, and videotape courses should be considered. With increasing public awareness of nutrition, it is even more essential that the health professionals to whom a confused public turns for advice be prepared to offer sound consistent information on not only clinical nutrition issues but on basic questions relating to the selection of an adequate diet, food source of nutrients and the effects of processing. fl References 1.
2.
3.
4.
5. 6. 7.
C. K. Nutrition content in medical curricula. J. Nutr. Educ. 9: 17, 1977. Council on Foods and Nutrition, American Medical Association. Nutrition teaching in medical schools. J. Am. Med. Assoc. 183: 955, 1963. WHITE, P. L., L. K. MAHAN AND M. E. MOORE. Conference on Guidelines for Nutritional Education in Medical Schools and Post-Doctoral Training Programs, Williamsburg, Virginia. June 1972. Chicago: American Medical Association, 1972. FRANKLE, R. T. Nutrition education for medical students. J. Am. Dietet. Assoc. 68: 513, 1976. HALSTEAD. J. A. Getting nutrition into the medical school. Ann. Internal Med. 84: 334, 1976. DARBY, W. J. The renaissance of nutrition education. Nutr. Rev. 35: 33, 1977. VITALE, J., AND R. E. HODGES. Symposium: teaching nutrition in medical schools. Am. J. Clin. Nutr. 30: 793, 1977. CYBORSKI,
Downloaded from https://academic.oup.com/ajcn/article-abstract/32/8/1557/4692289 by East Carolina University user on 11 January 2019
medical programs in Behavioral Science and Biochemistry, the latter reflecting programs in the two schools studied. Nutrition had also been a component in other courses including internal medicine, pediatrics, pathology, and clinical clerkships. Nearly all of the students who had studied nutrition stated that it had already been useful to them both personally and professionally and that they anticipated that it would continue to meet their needs. For the 39% of the students who did not plan to enroll in a nutrition course during medical school, the lack of a course or scheduling conflicts were major reasons. All but 5% of the respondents believed that nutrition was important enough to request such a course. The majority believed that a clinical nutritionist should teach the course and an even larger number favored a multidisciplinary approach. Two-thirds of the students stated that they already had experienced the need for a basic course in nutrition and 50% either had or expected to feel handicapped, especially during their clinical rotations without a nutrition background. Of the respondents 98% indicated that they considered nutrition useful, important, or essential as part of their medical training. Of those who had not taken a nutrition course in their premedical training, 48% stated that they wished they had. More than 80% would recommend that premedical students enroll in a nutrition course with 62% recommending it in the medical curriculum, 32% recommending it in both undergraduate and medical school, and only 3% in the undergraduate years only. Forty-six percent suggested that it be a requirement, 29% an elective, and 25% that it be integrated into medical specialties. In responding to open-ended questions regarding the importance of nutrition, and when and how it should be included in the medical curriculum, students thought that nutrition courses should be “taught in a way that would not be merely didactic but would include practical information useful in practice” or that they be “clinically related.” Most favored a multidisciplinary approach and recommended that “general nutrition should be
AND
Helen
A.
Guthrie,2
Ph.D.
and
Carol
education-a L. Teply,3
Concern over the lack of nutrition training in academic programs for physicians is being constantly voiced in both the lay press and professional literature. While the situation is still far from ideal from a nutritionist’s point of view, it has been improving steadily in the past few years with a recent survey (1) showing that 19 of 102 respondents offered a required course in nutrition, 72 an elective and 94 indicated that it was integrated in other disciplines. At least some of this activity can be attributed to recommendations from the Chicopee and Williamsburg conferences (2, 3) which urged that physicians master the sociology as well as the science of nutrition. A continuing series of conferences and reports have all identified the same problems and have come up with essentially the same recommendations (4-6). A recent symposium chaired by Vitale and Hodges (7) focused on problems of incorporating nutrition into medical education and the feasibility of approaches to resolving them. While participants discussed nutrition in preclinical years, clinical years, medical and surgical internships, residencies, and during postgraduate training, they totally overlooked the possibility of encouraging including nutrition during premedical training. While it can be argued that such an approach is inefficient since a large number of students do not go on to medical school, it must be conceded that some nutrition knowledge would serve a useful purpose regardless. The advantages of utilizing this period are many. First, there is usually more flexibility in schedules for those 4 years. Second, most introductory human nutrition courses cover the topics and answer the questions to which medical students repeatedly seek answers. The
American
Journal
of Clinical
Nutrition
32: AUGUST
M.S.,
premedical
R.D.
Additionally, in many instances these courses are taken primarily by nutrition and/or dietetic students. By sharing this learning experience early in his career, a medical student should gain an appreciation and respect for the expertise which these qualified professionals can bring to the medical team. Furthermore, many students are finding that medical admission committees look with favor on candidates with either courses or majors in nutrition. To determine whether nutrition education in the basic principles of nutrition in undergraduate programs was considered a viable alternative to postgraduate education by medical students we conducted a study4 of students in two medical schools to elicit their opinions. Although in interpreting the results, it must be recognized that only 32% of those contacted responded, those who did respond seem to have taken the task seriously with many writing thoughtful comments. Of the 248 respondents 58% were 1st and 2nd year medical students and 42% were in their 3rd or 4th year of medical school. Of these students 18% had taken a college course in nutrition primarily as an elective; about half before enrollment in medical school and half in their first 2 years of medical school. Nutrition courses had most commonly been offered in the undergraduate departments of Nutrition and Home Economics and those in
State
‘From the Department of University, State College, Professor of Nutrition.
Nutrition, Pennsylvania Pennsylvania 16802. Project Assistant.
The questionnaire elicited biographical information, an evaluation of nutrition courses they had taken and opinions as to if, when and in what context it should be included in the curriculum and by whom they should be taught. The questionnaire is available on request.
1979,
pp.
1557-1558.
Printed
in U.S.A.
1557
Downloaded from https://academic.oup.com/ajcn/article-abstract/32/8/1557/4692289 by East Carolina University user on 11 January 2019
Nutrition in medical alternative1
1558
GUTHRIE
TEPLY
required; but more in-depth study should be elective in nature.” One student suggested presenting nutrition “basics as an undergraduate and more specific and detailed information in medical school,” while another recommended that it “be available to undergrad premeds and others” and “be required for medical students.” Although there was not complete consensus, students supported our conviction that incorporating basic nutrition in a premedical program was a viable alternative to the dilemma of adding one more professional course in an already crowded medical curriculum. These should not substitute for the clinical approach in medical school but provide a foundation on which these can be built. It is recognized that substantive nutrition courses are not available in many schools that offer premedical preparation. For these the alternatives of available correspondence, programmed, and videotape courses should be considered. With increasing public awareness of nutrition, it is even more essential that the health professionals to whom a confused public turns for advice be prepared to offer sound consistent information on not only clinical nutrition issues but on basic questions relating to the selection of an adequate diet, food source of nutrients and the effects of processing. fl References 1.
2.
3.
4.
5. 6. 7.
C. K. Nutrition content in medical curricula. J. Nutr. Educ. 9: 17, 1977. Council on Foods and Nutrition, American Medical Association. Nutrition teaching in medical schools. J. Am. Med. Assoc. 183: 955, 1963. WHITE, P. L., L. K. MAHAN AND M. E. MOORE. Conference on Guidelines for Nutritional Education in Medical Schools and Post-Doctoral Training Programs, Williamsburg, Virginia. June 1972. Chicago: American Medical Association, 1972. FRANKLE, R. T. Nutrition education for medical students. J. Am. Dietet. Assoc. 68: 513, 1976. HALSTEAD. J. A. Getting nutrition into the medical school. Ann. Internal Med. 84: 334, 1976. DARBY, W. J. The renaissance of nutrition education. Nutr. Rev. 35: 33, 1977. VITALE, J., AND R. E. HODGES. Symposium: teaching nutrition in medical schools. Am. J. Clin. Nutr. 30: 793, 1977. CYBORSKI,
Downloaded from https://academic.oup.com/ajcn/article-abstract/32/8/1557/4692289 by East Carolina University user on 11 January 2019
medical programs in Behavioral Science and Biochemistry, the latter reflecting programs in the two schools studied. Nutrition had also been a component in other courses including internal medicine, pediatrics, pathology, and clinical clerkships. Nearly all of the students who had studied nutrition stated that it had already been useful to them both personally and professionally and that they anticipated that it would continue to meet their needs. For the 39% of the students who did not plan to enroll in a nutrition course during medical school, the lack of a course or scheduling conflicts were major reasons. All but 5% of the respondents believed that nutrition was important enough to request such a course. The majority believed that a clinical nutritionist should teach the course and an even larger number favored a multidisciplinary approach. Two-thirds of the students stated that they already had experienced the need for a basic course in nutrition and 50% either had or expected to feel handicapped, especially during their clinical rotations without a nutrition background. Of the respondents 98% indicated that they considered nutrition useful, important, or essential as part of their medical training. Of those who had not taken a nutrition course in their premedical training, 48% stated that they wished they had. More than 80% would recommend that premedical students enroll in a nutrition course with 62% recommending it in the medical curriculum, 32% recommending it in both undergraduate and medical school, and only 3% in the undergraduate years only. Forty-six percent suggested that it be a requirement, 29% an elective, and 25% that it be integrated into medical specialties. In responding to open-ended questions regarding the importance of nutrition, and when and how it should be included in the medical curriculum, students thought that nutrition courses should be “taught in a way that would not be merely didactic but would include practical information useful in practice” or that they be “clinically related.” Most favored a multidisciplinary approach and recommended that “general nutrition should be
AND
