Across the medical training continuum, nutrition education efforts often fail to deliver practical knowledge and current practice, with professional and accrediting organizations recommending expansion of nutrition education within...
moreAcross the medical training continuum, nutrition education efforts often fail to deliver practical knowledge and current practice, with professional and accrediting organizations recommending expansion of nutrition education within undergraduate and graduate curricula. Conclusions from a review of recent nutrition education efforts strongly recommend that programs "be creative and think out of the box when developing a nutrition curriculum". Why the Idea or Change was Necessary Understanding barriers to change is fundamental to patient counseling. While physicians routinely "prescribe" dietary interventions; no studies describe medical students' nutrition awareness or knowledge of adherence barriers to dietary change. Therefore, this report describes an innovative nutrition experience, "thinking out of the box", to enhance: (1) medical students' food awareness and (2) recognition of barriers to dietary change. What was Done As one topic in a required first-year course, 98 medical students received instruction for completing their own 3-day dietary intake food records. One week later, students were randomly assigned to either a low carbohydrate(Atkins) or low fat(Ornish) diet for three days and 3 day dietary intakes again recorded. The following week students met in nine-member, two hour groups led by nutritionists and family practice physicians. Discussion questions examined: changes in awareness of food intake and eating habits as a result of the diet records; ability to analyze intake in comparison to the Food Guide Pyramid recommendations (study was done prior to the MyPyramid guidelines); sense of controversy surrounding current dietary recommendations; experiences in modifying diet; responses to diet modification; and, changes in personal perspectives or understanding of patients. Evaluation of the Results Sixty three percent of the students completed the three-day diet records and 25 each tried the low carbohydrate and high carbohydrate diet, respectively. In group discussions, students indicated that they became more aware of personal diet and eating habits through record keeping. Most found that their diets needed improvement (e.g., inadequate fruits and vegetables). Many did not understand the controversy over recent dietary recommendations. This provided a teachable moment for nutritional principles such as changes in calcium intake, good fats-bad fats, and consumption of whole grains in relation to glycemic index. Students recognized a primary barrier of complexity, expressing concern that "if they had trouble with understanding these changing recommendations then the general public must be very confused." Other barriers recognized were: "being overwhelmed with school; lacking time to follow the diet or prepare foods; limited food choices at school; emotional and energy level changes related to the diet; and, disliking food choices." Students discussed the challenge of change in conflict with circumstances, in their case during examinations, highlighting the importance of timing and social stressors. Students found the exercises to be a worthwhile, helping prepare them for patient-centered care. Although these assessments are largely subjective, they were gathered systematically, represent this particular student population, and were similar across groups. It appears that students may develop a greater sense of empathy and patient understanding when they experience firsthand their own nutritional inadequacies and challenges.
