Nutrition in Medical Education, Metabolism Nutrition
Review articles
Nutrition in medical education
Diana Cárdenas, MD,1 Catalina Bagés, MD.2
El Bosque University
Summary
The importance of the role of nutrition in health and disease, the growing increase in malnutrition problems in the country and the need to address issues such as nutrigenomics. It has motivated the Colombian School of Medicine, since 2009, to integrate nutrition into the training curriculum of medical students.
A total of 90 theoretical hours were included in pre-existing subjects from III to XII semester.
The core thematic contents integrated into the curriculum are: Nutrition and life cycle, Nutritional assessment, Balanced diet, Public policies on nutrition, Obesity/malnutrition, Metabolic and nutritional therapy (enteral and parenteral nutrition).
The presence of a doctor and a pediatrician specialized in nutrition and two dietician nutritionists have favored the development of this topic at the faculty.
The creation of an independent nutrition and dietetics subject with thematic content based on a national consensus is recommended as the best strategy to improve Nutrition in Medical Education for medical students.
Keywords: Clinical nutrition, medical education, medical skills (Source: MeSH).
Abstract
The important role of nutrition in health and disease, increased levels of malnutrition in Colombia, and the need to address issues such as nutrigenomics, has led the Colombian School of Medicine to integrate nutrition into the curriculum for medical students since 2009.
A total of 90 classroom hours are included in from the third semester until the twelfth semester.
Topics integrated into the curriculum are nutrition and life cycle, nutritional assessment, balanced diet, nutrition policy for obesity and malnutrition, and metabolic and nutritional therapy (enteral and parenteral nutrition).
The presence of a physician and a pediatrician who both specialize in nutrition and of two nutritionists on the faculty has encouraged development of this subject within the school.
We recommend the creation of an independent course of nutrition based on a national consensus as the best strategy for improving nutrition education of medical students.
Key words: nutrition education; medical education; medical competence.
Introduction
Nutrition is currently a priority public health problem in Colombia.
The National Survey of the Nutritional Situation of 2010 (ENSIN 2010) showed a prevalence of obesity and overweight in adults of 52%. And an increase in obesity of 11% in young people aged 5 to 17 years compared to the ENSIN 2005. (1) On the other hand, the prevalence of malnutrition in hospitals according to different international studies is high, with figures between 32% and 50%.
In Latin America, according to the Latin American Nutrition Study (ELAN), 50.2% of hospitalized patients have some degree of malnutrition and 11.2% have severe malnutrition.(2)
In Colombia, three studies carried out in the departments of Valle and Antioquia show hospital malnutrition rates between 61% and 70%.(3) A recent study carried out in a university hospital in the city of Bogotá showed that 27% of hospitalized patients have a medium and high nutritional risk upon admission.(4)
In this framework, it is considered that doctors should play an important role in actions aimed at the prevention and management of malnutrition. As well as in the treatment of diseases associated with diet.(5) However, despite the fact that nutrition is perceived as a topic of fundamental importance for students and doctors. Nowadays, they think that their training in nutrition has been inadequate and they feel incapable of discussing these issues with their patients.(6-8)
On the other hand, the general population considers that the doctor is the most suitable interlocutor to treat these problems.(9) Less than half of doctors routinely discuss weight loss in obese patients or give dietary recommendations.( 10,11)
Different surveys have evaluated medical practice on nutritional issues.
In general, the results show that doctors think that nutrition is an important topic for clinical practice but do not feel prepared to discuss it with their patients.(12-15)
A survey carried out in 2010 at the Faculty of Medicine of the Universidad El Bosque in Bogotá. Regarding the attitudes and knowledge in nutrition of 384 students from VII to XII semester and first year of medical and surgical residencies, it showed that, in general, the topic of nutrition is of interest (95%) but that the training has been inadequate. or insufficient (86%).
The average of correct answers of the students was 53%.(16)
Other similar studies on knowledge in nutrition, carried out on students, residents and doctors who practice both in internal medicine and in other specialties, confirm inadequate training in nutrition with percentages of correct answers between 50% and 66%.(17-21)
Therefore, the Colombian School of Medicine (ECM) of the El Bosque University, aware of this situation and with the responsibility of training doctors capable of facing the country’s nutritional problems, has integrated thematic content specific to nutrition into the curriculum.
These topics are aimed at generating skills in future doctors who graduate from the ECM.
In this article we will show the competencies and core thematic contents that have been integrated into the ECM curriculum. As well as the difficulties and opportunities that have been given for its implementation.
Nutrition in medical education
Efforts in favor of Nutrition in Medical Education have been carried out for more than four decades in the United States (US). In 1983, Young EA, et al determined by consensus the nuclear powers core competencies in nutrition for medicine.
50 competencies were selected that served as a guide for undergraduate and graduate education. (22) Weisnier R, et al, in 1989 determined 26 priority topics considered essential to integrate into curricula. (23) Which were prioritized by determining a list of topics and subtopics considered core thematic contents (core content topics), which served educators and administrators as a guide in the implementation of nutrition courses in medical careers.
Medical students from the American Medical Student Association established the Nutrition Curriculum Project (NCP) with the objective of ensuring adequate training in nutrition and that it was integrated into clinical practice. A consulting committee determined 92 topics which were unanimously accepted in 1994.(24) These topics were organized into five main categories and served as a guide for their integration into the curriculum.
In the 1980s, the American Academy of Sciences (NAS) found deficiencies in the curricular content of medical schools in that country and recommended that nutrition become a necessary element in all schools with a minimum of 25 hours of the curriculum. dedicated to the topic of nutrition.(25)
Due to the failure of these recommendations The Nutrition Academic Award (NAA) created the National Heart, Lung and Blood Institute in 1998 whose purpose was to develop, implement, evaluate and disseminate Nutrition in Medical Education in medical school curricula. (26) The NAA brought together 22 US medical schools and colleges and developed the nutrition curriculum for doctors.
(Read Also: Medicine and nutrition at the Colombian School of Medicine)
Nutritional biochemistry and nutrition in relation to chronic diseases
The proposed topics range from the life cycle to topics such as nutritional biochemistry and nutrition in relation to chronic diseases. The curricular contents can be consulted at www.nhlbi.nih.gov/funding/training/naa.
In 1995, the Nutrition in Medicine (NIM) project at the University of North Carolina at Chapel Hill developed a core curriculum, core curriculum, in nutrition for medical students and free access for faculties.
This project strengthened the practice of nutrition in medicine at both undergraduate and graduate levels. The contents are available at https://www.med.unc.edu/nutr/nim/.(27,28)
Despite these efforts, nutrition education in US medical schools remains insufficient. Through several studies carried out between 1999 and 2009 by Adams K, et al, from the University of North Carolina group, the amount and type of education provided in medical schools in the US were examined.(28) Most of the Schools did not meet the minimum standard of 25 hours of nutrition suggested by the NAS (62% to 73% depending on the year). In the last study in 2009, it was found that students receive an average of 19.6 hours of nutrition during the four years of medical training.(29)
Importance of nutrition and the need to promote and standardize the training of doctors and other health professionals
This seems to be a situation not exclusive to the American continent. In 2006, only 26% of medical schools and colleges in Japan offered a separate nutrition subject. In France in 2009, a report from the Ministry of Health(30) recognized the importance of nutrition and the need to promote and standardize the training of doctors and other health professionals.
In Spain in 2003, only 25%(7) of medical schools had a mandatory nutrition subject compared to two in 1999, which shows an increase in interest in the subject.
However, most faculties resort to electives or the integration of human nutrition topics into the core subject program. Which is not considered a good alternative.(31)
In Latin America, experiences vary depending on the country.
In Mexico since 1991, progress has been made in the training of doctors in nutrition at undergraduate and postgraduate levels through the program to strengthen the teaching of nutrition in schools and medical faculties.
There is a specialty of clinical nutrition offered by the Salvador Zubirán National Institute of Medical Sciences and Nutrition. Endorsed by the Faculty of Medicine of the Autonomous University of Mexico.(32) The course lasts two years and candidates must have completed one of the four core medical specialties.
In Chile, in undergraduate courses, medical schools incorporate nutrition content as internal medicine modules and to a lesser extent in other subjects, which gives a partial vision of the discipline.(33)
In few cases it is a subject independent of the third or fourth year subject, in both situations less than 30 hours are designated for its teaching. In Brazil, since the 70s, different scientific societies have developed quality nutrition and nutritional therapy.(34)
Authors
- 1 Diana Cardenas, MD. Medical University El Bosque, Master of Science and Clinical Nutrition from the University of Paris VII Director of the Nutrition, Genetics and Metabolism Research Institute, El Bosque University.
Correspondence: cardenasdiana@unbosque.edu.co - 2 Catalina Bagés, MD. Pediatrician from Universidad El Bosque, Specialist and Master in Clinical Nutrition from the University of Chile.
Received: May 2011
Accepted for publication: May 2011
RMNC 2011; 2(1): 34-44.
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