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Doctor and Patient

Teaching Doctors About Nutrition and Diet

By PAULINE W. CHEN, M.D.

Published: September 16, 2010

Within days of being accepted into medical school, I started getting asked for

medical advice. Even my closest friends, who should have known better, got in on

the action.

“Should I take vitamins?”

“What do you think of this diet?”

“Is yogurt good for me or not?”

Each and every time someone posed such a query, I became immediately cognizant

of one thing: the big blank space in my brain. After all, even with medical

school acceptance in hand, I was no more a doctor than they were.

But I also soon realized that many of their questions had nothing to do with

medications or operations, or even diseases. With all the newspaper and

television reports about newly discovered carcinogens and the latest diets and

miracle nutrients, what my friends and acquaintances really wanted to know was

just what they should or should not eat.

Years later, as a newly minted doctor on the wards seeing real patients, I found

myself in the same position. I was still getting a lot of questions about food

and diet. And I was still hesitating when answering. I wasn’t sure I knew that

much more after medical school than I did before.

One day I mentioned this uncomfortable situation to another young doctor. “Just

consult the dietitians if you have a problem,” she said after listening to my

confession. “They’ll take care of it.” She paused for a moment, looked

suspiciously around the nursing station, then leaned over and whispered, “I know

we’re supposed to know about nutrition and diet, but none of us really does.”

She was right. And nearly 20 years later, she may still be.

Research has increasingly pointed to a link between the nutritional status of

Americans and the chronic diseases that plague them. Between the growing list of

diet-related diseases and a burgeoning obesity epidemic, the most important

public health measure for any of us to take may well be watching what we eat.

But few doctors are prepared to effectively spearhead or even help in those

efforts. In the mid-1980s, the National Academy of Sciences published a landmark

report highlighting the lack of adequate nutrition education in medical schools;

the writers recommended a minimum of 25 hours of nutrition instruction. Now, in

a study published this month, it appears that even two and a half decades later

a vast majority of medical schools still fail to meet the minimum recommended 25

hours of instruction.

Researchers from the University of North Carolina at Chapel Hill asked nutrition

educators from more than 100 medical schools to describe the nutrition

instruction offered to their students. While the researchers learned that almost

all schools require exposure to nutrition, only about a quarter offered the

recommended 25 hours of instruction, a decrease from six years earlier, when

almost 40 percent of schools met the minimum recommendations. In addition, four

schools offered nutrition optionally, and one school offered nothing at all. And

while a majority of medical schools tended to intersperse lectures on nutrition

in standard, required courses, like biochemistry or physiology, only a quarter

of the schools managed to have a single course dedicated to the topic.

“Nutrition is really a core component of modern medical practice,” said M.

, the lead author and a registered dietitian who is a research associate in

the department of nutrition at the university. “There may be some pathologists

or other kinds of doctors who don’t encounter these issues later, but many will,

and they aren’t getting enough instruction while in medical school.”

For the last 15 years, to help schools with their nutrition curriculum, the

University of North Carolina has offered a series of instruction modules free of

charge. Initially delivered by CD-ROM and now online, the program, Nutrition in

Medicine, is an interactive multimedia series of courses covering topics like

the molecular mechanism of cancer nutrition, pediatric obesity, dietary

supplements and nutrition in the elderly.

“Physicians have enough barriers trying to provide their patients with

nutritional counseling,” Ms. said. “Inadequate nutritional education does

not need to be one of them.”

Ms. and her colleagues believe that the fully developed online curriculum

helps address two issues that frequently arise: the relative dearth of faculty

in a medical school with appropriate expertise and the lack of time in an

already packed course of study.

The flexibility of the online program has already helped students at the Texas

Tech School of Medicine in Lubbock. Medical school teachers at Texas Tech, which

has one of the best nutrition education programs in the country, were finding

that they had difficulty maintaining the intensity and quality of instruction

once more senior medical students began working in hospitals scattered across

the school’s widely dispersed campuses. Students at a hospital that had the

luxury of a trained faculty member, for example, would be immersed in a diabetes

workshop that involved “becoming diabetic” for a week and regularly checking

blood sugar readings and self-administering “insulin” through a needle and

syringe, while students at another hospital would be left with no instruction at

all. The online Nutrition in Medicine course allowed all the students to

continue learning about diet and counseling patients despite their disparate

locations and resources.

“We didn’t have to reinvent the wheel at other campuses when we already had

these online courses that are so well done,” said Chauncey, a

registered dietitian and a professor of clinical family medicine at Texas Tech.

More recently, Ms. and her colleagues have begun working on online

nutrition education programs geared toward practicing physicians. “Many of them

are realizing that their training wasn’t adequate enough to make them feel

comfortable counseling patients,” Ms. said. Short, focused and relatively

easy to navigate, these courses are meant to help fill in those gaps in

knowledge for older doctors. Eventually, practicing physicians may even be able

to earn continuing medical education credits, a requirement of many hospitals,

state licensing boards and specialty boards.

“It’s extremely difficult to get people to change their diets and their habits

around food,” Ms. said. “Anything that improves a doctor’s confidence and

skill set will go a long way in helping patients.”

Added Dr. Chauncey: “You can’t just keep writing out script after script after

script of new medications when diet is just as important as drugs or any other

treatment a patient may be using.”

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