Charting a New Course: The NELICO Vision to Redefine Medical and Healthcare Nutrition Education – Insights from a Pilot Intervention in China

Authors: Helena Trigueiro, Xunhan Li, Halima Jama, Mei yen Chan, Pauline Douglas, Sumantra Ray 

Reviewer and Editor: Ramya Rajaram 

Copyeditor: Veronica Funk 

Special Acknowledgement for Funding in Part: Mary Lim (NNEdPro Southeast Asia)  

In the pursuit of optimal health and an enhanced quality of life, nutrition emerges as a linchpin, with health professionals wielding a profound influence on guiding patients toward holistic well-being. However, a significant disparity exists, as medical doctors, irrespective of geographical region or training year, often grapple with inadequate exposure to nutrition during their education2,3. Despite China's ambitious medical education reforms, the crucial aspect of nutrition training seems to have been overlooked.4,5. Recognising this critical void, to assess the specific nutrition understanding of medical doctors, as well as the effect of online nutrition education, the Nutrition Education Leadership for Improved Clinical Outcomes (NELICO) project developed this groundbreaking pilot study in China. This initiative sought to delve into the nutrition knowledge, attitudes, practices (KAP), and training requirements of medical doctors and students, unravelling the intricacies of this educational deficit. 

Eight Chinese doctors and medical students (mean age of 25.6±3.4 years), lacking prior nutritional training, participated in an 8-hour online course titled ‘Nutrition, Cardiometabolic Health, and COVID-19’. The objective was clear – to gauge the impact of this online nutrition education on the participants' understanding of nutrition and its application in clinical settings. Employing an online structured KAP questionnaire before and after the course allowed for a meticulous examination of the shifts in knowledge, attitudes, and practices. Descriptive statistics illuminated the demographic landscape of the participants, while the Wilcoxon signed-rank test became the lens through which pre and post-course KAP scores were scrutinized. 

The findings were illuminating. A significant 77% of participants showcased satisfactory knowledge levels, indicating a promising start. Upon closer inspection: 43% displayed satisfactory attitudes toward nutrition, while 73% demonstrated satisfactory nutrition-related practices. The study unearthed substantial knowledge gaps, notably in areas crucial for clinical practice – "key micronutrients for respiratory tract infection" (25%) and "nutrients of the primary energy source" (62.5%). Interestingly, the knowledge scores exhibited no significant difference before and after the course (p>0.05), possibly influenced by the course's brevity and its more generalized approach to the vast realm of nutrition. 

The silver lining emerged in the form of transformed attitudes and practices. Post-course, participants exhibited significantly improved attitudes (p<0.05) with a shift from 2.13±0.35 to 3.25±0.89. Similarly, nutrition-related practices saw a notable positive change (p<0.05), rising from 23.88±2.23 to 26.50±3.21. 

Most medical students and doctors expressed eagerness to expand their nutritional knowledge, attributing their newfound awareness to the NELICO project's results. The pilot project, in essence, planted the seeds of curiosity and enlightenment among the participants, fostering a collective interest in advancing nutritional knowledge. The NELICO project envisions this pilot initiative as more than a standalone endeavor. It aspires to be a catalyst, a "seed" with the potential to sprout, proliferate, and inspire similar nutrition education initiatives. The broader goal is clear – to influence and reshape the medical nutrition education curriculum for Chinese doctors – today and tomorrow. 

The stark reality of inadequate nutrition exposure for medical professionals echoes globally, transcending borders. In unravelling the nutrition landscape within medical education through this pilot study in China, the NELICO project has exposed both challenges and promises. 

The compelling outcome of this study serves as a call to action for a universal integration of nutrition in medical education. With most participants showing promise in knowledge acquisition, our pilot becomes a catalyst for change. The study's revelations, coupled with the enthusiastic response from medical students and doctors, mark the inception of a broader mission. The NELICO project envisions a future where nutrition education becomes integral, not just in China but across the globe, ensuring every medical professional is equipped to enhance patient care through comprehensive nutritional understanding. The NELICO project envisions a future where every doctor, regardless of geographical location, is equipped to harness the power of nutrition for the betterment of patient outcomes and, ultimately, the health of our global community.  

References

1 Diet, nutrition and the prevention of chronic diseases: report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series, No. 916. Geneva: World Health Organization; 2003. 

2 Crowley J, Ball L, Hiddink GJ. Nutrition in medical education: a systematic review. Lancet Planet Health 2019;3:e379–89.  

3 Lepre B, Mansfield KJ, Ray S, et al. Reference to nutrition in medical accreditation and curriculum guidance: a comparative analysis. BMJ Nutr Prev Health 2021;4:e000234.  

4 Wang, W. Medical education in China: progress in the past 70 years and a vision for the future. BMC Med Educ 21, 453 (2021). https://doi.org/10.1186/s12909-021-02875-6 

5 Qiao J, Wang Y, Kong F, Fu Y. Medical education reforms in China. Lancet. 2023 Jan 14;401(10371):103-104. doi: 10.1016/S0140-6736(22)02629-0. PMID: 36641195; PMCID: PMC9836400.