23 September 2019

Students hungry for more nutrition training

Education Nutrition

Medical students around the world feel they aren’t learning enough about nutrition, despite more deaths being attributable to poor diet than to any other risk factor.

A systematic review in Lancet Planetary Health analysed 24 studies of nutrition in medical education undertaken since 2012, which measured a variety of outcomes including number of contact hours and students’ dietary knowledge and their own habits, as well as their perceptions of their nutrition training and their confidence and perceived competency in providing nutrition care.

The authors, led by Dr Lauren Ball of Griffith University in Queensland, wrote that “despite the centrality of nutrition to healthy lifestyle, graduating medical students are not supported through their education to provide high-quality, effective nutrition care … Medical students do not feel prepared to manage situations in which definitive nutrition therapy has the most potential to affect patient outcomes, and the nutrition knowledge deficits continue into medical practice.”

The Global Burden of Disease Study 2017 attributes 11 million deaths and 255 million DALYs annually to dietary risk factors, chiefly high sodium and lack of whole grains and fruits.

Timothy Gill, professor of public health nutrition and research programs director at the Boden Institute at Sydney University, said the findings would not shock anyone who worked in the field.

“I’ve never heard anyone disagree that nutrition should be an important aspect of medical training, yet it never gets any attention,” Professor Gill told The Medical Republic.

He said training was focused on dietitians and was tightly controlled by that profession, rather than on training doctors to improve patient health, especially GPs who managed a lot of chronic disease.

Undergraduates had a lot on their plates already, and because it was hard to cut anything out of the crowded curriculum, some universities were slipping nutrition lectures into other subjects such as diabetes or hospital care.

Professor Gill said while the basics could be taught at university, the practical aspects of diet management – such as a patient’s resources and culture – needed to be learned postgraduate and in continuing professional development.

“Even if we were able to get more nutrition in medical school, that wouldn’t necessarily deal with the problems that GPs would have,” he said. “And that’s probably an issue, that the colleges don’t define it as a high priority.”

RACGP president Harry Nespolon said there was abundant nutrition in GP training and in CPD, and that just as in medical schools, every discipline thought more of their subject should be taught.

“Join the queue: dermatologists don’t think we do enough skin, ophthalmologists don’t think we do enough eyes,” he told TMR. “And medical schools are asked to do a bit of everything. You might ask whether a pathologist or a non-patient-facing specialist needs to learn a lot about nutrition.”

Margaret Allman-Farinelli, professor of dietetics at Sydney University’s Charles Perkins Centre, said the need for better understanding of nutrition by medical practitioners was undeniable, and some medical schools in Australia were working towards a solution.

“We do not have to expect medical practitioners to give detailed dietary counselling, but they need to be alert to the role that diet plays in disease aetiology and later management of chronic diseases … We could not expect a doctor to have the same knowledge as is gained in a five-year degree pathway to become a dietitian, obviously.”

She said postgraduate study might be a better context: “It might be easier to learn about nutrition support when you see an emaciated patient with cancer, or to consider the role of diet when you are studying endocrinology, or enteral feeding when you are a training as a GI surgeon, rather than a grad student.”

Lancet Planet Health, September 2019