The White Paper

I. The Problem

The importance of nutrition to the practice of medicine is supported by numerous studies that clearly illustrate the vital role of nutrition for optimum human health, disease prevention, and medical nutrition management.

Despite this knowledge base, nutrition as a required stand alone-course is offered at only 22% of US medical schools nationwide. This percentage has dropped from a peak of 36% in 1982.

We can postulate that two potential reasons exist for this discrepancy: 1) medical school administrators or faculty do not view nutrition as an essential element of the medical school curriculum, or 2) the same individuals view nutrition as essential, yet have not developed an appropriate strategy for incorporating nutrition into their institutional administrative and academic paradigm.

Solving the first issue is more problematic and will require a concerted intersociety medical-political initiative. Solving the second issue is more readily attainable and is the problem we will currently address. That is, there may be a lack of knowledge regarding how to incorporate nutrition into the medical curriculum. Solutions to this problem must take account of the competing demands for faculty time and expertise and the already overloaded medical curriculum. Yet the renewed national call for innovative coursework, interdisciplinary learning, and enhanced public awareness of the role of nutrition in optimal human health and disease prevention makes it imperative that the task be accomplished.

While many medical and nutrition societies have provided discipline-specific recommendations on nutrition curriculum for medical schools, there are no comprehensive documents that have synthesized this information into a separate, useable document. Thus, a difficult job is made more difficult by knowledge explosion, and a lack of centralized available resources and support personnel.

II. The MNECD Subcommittee on Curriculum Coverage of Subject/Content

Mission: To serve as the interdisciplinary and intersociety liaison that will promote a comprehensive nutrition curriculum in medical school education programs.

Long-Term Goal: To improve the quality and quantity of nutrition education curriculum at US medical schools and increase the percentage of schools that require or include nutrition in medical education.

Short-Term Goal: To develop a comprehensive curriculum guideline document that encompasses all aspects of nutrition education in the undergraduate and graduate medical school curriculum, and provides a “how to” approach which is sensitive to the diversity of medical school educational and administrative paradigms. The guideline will address necessary nutrition concepts for inclusion in the curriculum at a number of levels.

III. The ACN MNECD Document

Included within this document will be:

  1. A discussion of why nutrition should be included as part of the medical school curriculum.
  2. Recommended topics for inclusion of medical nutrition education in the wide spectrum of the inclusive undergraduate and graduate curriculum.
  3. A “how to” guide, based on the institutional structure of the school, and a description of how and where to include nutrition in the curriculum.
  4. A comprehensive list of materials published to serve as resources for medical nutrition education.
  5. An intersociety and interdisciplinary listing of resource persons who will consult and assist in developing and enhancing medical nutrition education at interested schools.

IV. Our Target: Medical School Departments

Undergraduate Medical Education

  1. Basic Medical Sciences
    1. Stand-alone traditional lecture course
    2. Integrated with other disciplines (physiology / biochemistry)
    3. Problem-based learning programs
  2. Clinical Rotations
    1. Outlined by clinical departments
    2. As a stand-alone clinical course or courses
  3. Other Undergraduate Courses
    1. Community science
    2. Epidemiology
    3. Electives
    4. Research

Graduate Medical Education

  1. Residency Programs
    1. Outlined by residency departments
    2. As a stand-alone course

Post-Graduate Medical Education

  1. CME Physician Training
    1. Outlined by clinical departments
    2. Outlined by specialty and sub-specialty
    3. As a stand-alone course

V. Specific Tasks and Assignments for the Subcommittee on Curriculum Coverage of Subject/Content

– First reports submitted to committee chair by May 30, 1999.
– Initial draft circulated to committee members by July 31, 1999.
– Comments returned to committee chair by August 31, 1999.
– Document offered for discussion/refinement at 40th ACN meeting.
– Comments for final document to chair by August 31, 2000.
– Document updated and distributed on CD ROM at 41st ACN meeting.

Task 1. Construct a convincing evidence-based rationale for why nutrition should be included and expanded in US medical schools, which includes benefits to the school, patient populations, and physicians in training.

Task 2. Contact medical societies and compile their specific recommendations on nutrition education for medical schools.

Task 3. Contact nutrition related societies and compile recommendations on nutrition education for medical school education. These have largely been published.

Task 4. Contact nutrition-related basic science societies and document nutrition education topics included in those disciplines (e.g., physiology, biochemistry, and pharmacology).

Task 5. Contact AAMC and LCME to determine medical school organizational structure, to ascertain a profile of US medical schools.

a. Departments and division organization within medical schools
b. Definition of curriculum: traditional/transitional/problem-based
c. Definition of nutrition strategies: stand-alone nutrition/integrated nutrition

Task 6. Contact publishing companies and compile a list of nutrition-related resource materials appropriate for medical education.

Task 7. Identify representatives of the various nutrition and medical societies who are willing to serve as representatives to this endeavor and serve as consultants / liaisons to the committee.

Task 8. Identify a point person in each medical school to establish a network of nutrition educators who can comprise a long-term working group.

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