Written by: Wanja Nyaga
Reviewed by: Dr Luke Buckner, Sally Ayyad, Ebiambu Agwara, and Prof Sumantra Ray
Nutrition Implementation Coalition
The Nutrition Implementation Coalition was formed in 2019 as a collaborative group convened by NNEdPro and including Nutritank, ERimNN and Culinary Medicine UK. Together, these organisations bring a variety of educational, professional and research experiences, sharing the same vision to advocate for a greater focus on nutrition education for healthcare professionals. This coalition fully supports the implementation of the newly launched national nutrition curriculum in the UK but recognises that the most challenging step is still to come in implementing this into medical school training.
October 2021 marked the launch of the new Association for Nutrition (AfN) convened Curriculum in Nutrition for medical graduates (co-created with a nationally representative Inter-Professional Group in the UK). NNEdPro colleagues took part in the process of formulating and launching the curriculum.
This nutrition curriculum provides undergraduate students with the knowledge, understanding and skills required to support them in being safe practitioners before they move on to the next stage of their medical training. The Undergraduate Curriculum in Nutrition for Medical Doctors supports the development of 13 core nutritional competencies for all undergraduate medical students at the point of graduation, assessed through the achievement of 11 graduation fundamentals. The curriculum supports the understanding and skill development of the core competencies and has 8 key curriculum statements. The curriculum statements are supported by teaching points which can be integrated across foundation courses (or introductory learning) where the principles of basic nutrition underpinning good health across the life course can be incorporated alongside basic biochemical and physiological principles, within public health teaching, and within clinical teaching by speciality. Thus, ensuring students understand the importance of nutrition in the prevention and both the progression and management of disease and conversely how disease can exert an effect on the nutritional state.
In February 2022, the Nutrition Implementation Coalition coordinated and chaired a roundtable with approximately 29 representatives from 14 medical schools. The aim of the Roundtable was to bring together medical schools and interested nutrition educators in the UK, providing a ground for discussion on how different curriculum developers can envision accommodating greater focus on nutrition for medical students.
What did we learn from the roundtable?
Below is our capture of key points shared by various members during the roundtable highlighting where they felt it is important medical students are competent and confident on graduation.
Medical Attitudes in Nutrition Care
Acting as role models to doctors and other health professionals
Recognising how all members of the Multidisciplinary team (MDT) have a role in developing and supporting good nutritional care
Understanding the role of food and nutrition in the management of NCD, and other disease states/health issues
Understanding nutrition science and recognise how they contribute to: - Identifying those at risk of malnutrition/or are malnourished through history taking, screening, routine blood tests
Thinking about drug-nutrient interactions when prescribing/reviewing
It was agreed that doctors are an important part of the MDT and should act as role models in ensuring the identification, first-line treatment and monitoring of nutrition status. It is also important they are confident to use all the resources available to them, including clinical and social prescribing and referring to registered dietitians and nutritionists where appropriate.
Further feedback highlighted how this may be incorporated into medical curricula:
Integrating nutrition where relevant rather than a standalone subject may help to demonstrate relevance to students and can be added in short regular additions to current teaching.
Medical students would value more practical consultation skills and a chance to practice in simulated patient consultations.
Clear signposting where nutrition teaching is placed ensures teaching is explicit via learning outcomes and linked to examination.
Linking knowledge directly to patient care- A case-based approach seems to be easier for students to identify with.
Doctors are not nutritionists but can benefit from learning more detail on nutrition interventions where relevant.
Collaborating with nutrition faculty and dietetic colleagues helps to provide teaching expertise and can assist medical schools in lecture delivery and course development.
In summary, there is recognition that nutrition training for doctors needs improvement, but is unlikely to get large amounts of extra time. Hence, there was a focus on greater emphasis on existing content, signposting to further reading, and practical training with clear translation to clinical care. It is also highlighted that doctors should not be expected to be nutritionists and so will need to recognise the capabilities of their training and use experts such as dietitians and trained nutritionists.
In a few words, share ideas on how to improve the implementation of nutrition education.
Do you perceive barriers to implementing more nutrition at your medical school, and if possible, please share in the text below. Yes. No. Why?
Give two examples of where you have already changed (or plan to change) your medical school nutrition training.