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6
Conclusions and
Recommendations
In considering strategies to improve current nutrition
programs in U.S. medical schools, the committee was mind-
ful of the enormous body of knowledge and continuous ac-
cretion of scientific information that must be conveyed to
medical students in a relatively short time. It conclud-
ed, however, that the core curriculum outlined in Chapter
5 can be readily incorporated into the curricular design
of a medical school currently without such a program.
After reviewing all the data collected through inter-
views and surveys and considering a number of various
alternatives, the committee made the conclusions and
recommendations summarized in this chapter.
· The teaching of nutrition in most U.S. medical
schools is inadequate. The committee recommends that U.S
medical schools examine the nutrition component of their
curriculum and, as explained below, take steps to remedy
the deficiencies identified.
.
· Nutrition is not taught as a separate subject in the
majority of schools surveyed by the committee. Although
some nutritional concepts are taught in conjunction with
other courses, they are frequently not identified as such
and their impact and importance are accordingly diminished.
All students should be given a course or its equivalent
in the fundamentals of nutrition during the same years in
which other basic sciences are offered. These concepts
should be reinforced during later clinical clerkships as
students see and experience the application of nutrition
to patient care.
95
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96
· There is considerable variation among schools in the
scope of subject matter and the thoroughness with which it
is taught. In the committee's judgment, based on its
review of existing courses and the experience of its mem-
bers, the nutrition curriculum should include at least the
following topics: energy balance; role of specific nutri-
ents and dietary components; nutrition in the life cycle;
nutritional assessment; protein energy malnutrition; the
role of nutrition in disease prevention and treatment; and
risks from poor dietary practices stemming from indivi-
dual, social, and cultural diversity.
· More than half the medical schools surveyed by the
committee teach less than 20 hours of nutrition, and 20%
of them teach less than 10 hours. The committee finds
this amount of time inadequate for the effective teaching
of the most basic nutrition principles. It therefore
recommends that a minimum of 25 to 30 classroom hours in
nutrition be required of all students during the pre-
clinical years. In the committee's judgment, this is the
minimum amount of time required to teach the core concepts
described in Chapter 5. Of equal importance, additional
clinical teaching of nutrition must be reinforced through-
out clerkships, electives, and postgraduate training.
.
The committee's survey and consultation with
selected faculty members indicate that the success of a
nutrition program depends heavily upon the willingness of
faculty to commit time to initiate and develop a program.
Moreover, there must be a faculty member with ability to
demonstrate the application of nutrition principles to
clinical practice. On the basis of its surveys and inter-
views, however, the committee found that faculty responsi-
bility for nutrition varies widely, thus undermining
chances for success. Therefore, the committee recommends
that a faculty member with a scholarly commitment to
nutrition and its application to clinical medicine be
designated to lead and develop a nutrition program at each
medical school. A clinically active physician who can
serve as a prominent role model for the students should
be considered for this position.
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97
· Research programs foster the discovery of new
knowledge, secure the position of the faculty, enhance
their credibility, and provide the scientific rationale
for the inclusion of nutrition in medical practice.
Strong research programs should therefore be established
to complement the teaching of nutrition. The committee
recognizes, however, that research alone does not ensure
that nutrition will be taught.
· The committee observed a distinct lack of organiza-
tional structure and administrative support for nutrition
programs in the schools they surveyed. This environment
was found to be counter-productive in efforts to foster
the long-term survival of a program. To ensure perma-
nence, the committee recommends that the responsibility
for the nutrition program be vested in a separate depart-
ment or a distinct division of the medical school. In
addition, each medical institution should allocate specif-
ic funds for the support of at least one faculty position
in nutrition. To assist in relieving the financial burden
attendant on meeting these goals, medical schools might
explore the feasibility of generating nutrition-related
income from clinical support services within the hospital.
· The committee's review of the National Board exami-
nations indicates that there is an inequity in the distri-
bution of nutrition topics among questions relating both
to the basic sciences and to various medical specialties.
Certain aspects of nutrition were strongly emphasized,
whereas others were ignored. The committee also observed
that there is no mechanism in place to ensure that the
quantity or degree of challenge associated with nutrition-
related questions is satisfactory.
It therefore recommends that the scope of the
nutrition-related questions on the National Board ex~mina-
tions be broadened to reflect more accurately current
knowledge in nutrition. To improve the coverage, the
National Board of Medical Examiners should consider the
recruitment of a scholar in nutrition to join its roster
of consultants. It should also consider appointing an
advisor to review the examinations for balance of
nutrition-related questions and to propose questions for
committee consideration.
· The resources available for teaching nutrition in
medical schools are insufficient. Faculty members who
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98
teach nutrition concur that nutrition textbooks, although
plentiful, are inadequate to meet their instructional
needs. Thus, they must prepare their own syllabi. In
addition, those schools that lack an appropriate faculty
member teach only a minimum amount of nutrition.
The committee recommends that the federal government
and private foundations provide assistance for the
development of appropriate teaching materials. In addi-
tion, there is a need for an adequately trained cohort of
nutritional scientists with skill in the clinical applica-
tion of nutrition. The committee acknowledges the federal
government's support for the training of faculty in nutri-
tion and recommends that such funding be continued and
increased. For example, the committee recommends that
NIT consider increasing the funding for such programs as
the Clinical Nutrition Research Units, which focus on
training, research, and nutrition education activities.
To meet intermediate needs, the committee encourages
short-term institutional sharing of faculty and other
resources; however, long-term survival of nutrition
programs is dependent an increase in funds from federal
and private sources.
· The committee concludes that there is no reliable
mechanism for monitoring the changes that may occur in
nutrition research and education over the next several
years. It therefore recommends that the annual question-
naire prepared by the Association of American Medical
Colleges' (AAMC) for the Liaison Committee on Medical
Education (LCME) include more exploratory and relevant
questions concerning the nutrition curriculum. To obtain
a more valid assessment of current nutrition programs and
to assist in future program needs, these questions should
be directed to those faculty who can characterize the
nutrition program. Since accreditation is one important
way to encourage nutrition teaching, the LCME should
consider placing stronger emphasis on nutrition in its
periodic accreditation procedures.
The committee further recommends that each medical
school assess the changes that may occur within its own
institution and that in 5 years the Food and Nutrition
Board of the National Research Council or another authori-
tative body reexamine the status of nutrition in medical
schools.
Representative terms from entire chapter:
nutrition programs
