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Medical nutrition education found lacking
Medical programmes do not sufficiently integrate nutrition. As a result, physicians miss possibilities to provide their patients with adequate counselling on nutrition and dietary behaviour. This is not an issue exclusive to the Netherlands but is present globally and is independent of country, healthcare system and year of medical training. This is the conclusion of Gert Jan Hiddink, emeritus professor of Nutrition Communication through Health Professionals at Wageningen University & Research, and his international colleagues.
Although nutrition is a central component of a healthy lifestyle, the dietary patterns of the last fifty years have been characterised by low contents of key nutrients (such as protein) and foods (such as fruits and vegetables) and high contents of salt, sugar and fat that contribute to a poor nutritional intake in a large part of the world’s population. This has caused increasing public health ailments such as diabetes, obesity, and cardiovascular diseases, and it is leading to an increasing pressure on healthcare.
Globally, eleven million deaths annually are attributable to dietary factors, placing poor diet ahead of any other risk factor for death in the world. In many countries, physicians have the task of counselling their patients regarding proper nutrition. They are usually the most trusted source of health information for patients. But when graduates start their career as medical professionals, the question remains whether they are well prepared (and if so, to what extent) to discuss nutrition and dietary patterns with their patients.
Little progress in 50 years
Internationally, inadequate nutrition education, dissatisfaction with the nutrition education received, and feeling unprepared to counsel in nutrition have been themes that have appeared throughout medical nutrition education literature for more than five decades. And little progress has been made in recent years. Graduate medical students have consistently reported that they have insufficient nutrition knowledge and skills to effectively support dietary behaviour change in their patients.
Therefore, the researchers say, there should be an institutional commitment to make nutrition training mandatory. The already overloaded medical training programmes require innovative educational practices to incorporate the subject into the existing time frame. Furthermore, nutrition should be included in the medical training at an earlier stage and more extensively in the remainder of the programme. In this, there are roles reserved for medical nutrition experts and dietitians alongside other system specialists, such as cardiologists. Furthermore, there is a need for a consensus on the content of a nutrition curriculum and the level of nutrition knowledge of graduates.
No nutrition training in patient care
This lack of nutrition training for medical students impacts their knowledge, skills and self-confidence to incorporate nutrition counselling into patient care. This means that they miss out on opportunities in the cases in which such counselling could help. More generally speaking, the failure to prioritise nutrition during medical training means that the relevance of nutrition for a healthy lifestyle is not confirmed.
The fact that medical graduates do not feel adequately prepared to provide nutrition care to patients is in stark contrast with the expectation that physicians will provide nutritional information to patients to manage diet-related conditions for which poor nutrition is a major risk factor. In many countries, such nutrition care is recommended by both health authorities and the physicians’ professional bodies.
In order to provide even basic nutrition care, physicians require adequate nutrition knowledge and skills, and the necessary attitudes to support integration thereof into their routine clinical practice. They should also be able to refer other health professionals, such as dietitians or nutritionists.