The paper, published in BMJ Nutrition, Prevention and Health, was undertaken by a team of nutrition professionals from across the UK including representatives from Brighton and Sussex Medical School (BSMS) and the Need for Nutrition Education Programme (NNEdPro) at the Global Centre for Nutrition and Health, Cambridge.
Information was gathered using surveys of from medical students and doctors between 2015 and 2018 and an evaluation of nutrition teaching in a medical school. Comparative analysis of the findings was undertaken to establish the perceived importance of nutrition in medical education and practice, adequacy of nutrition training, and confidence in current nutrition knowledge and skills.
Five sources of information combined to represent 763 participants. Most agreed on the importance of nutrition in health (>90%) and in a doctor’s role in nutritional care (>95%), with many saying they wanted more nutrition education (85% for doctors and 68% for medical students). Most felt their nutrition training was inadequate, with >70% reporting less than 2 hours training in this subject.
Interviews also revealed a preference for face-to-face rather than online training.
99% say nutrition is important to health
Nutritank, a student led information hub of food, nutrition and lifestyle medicine, surveyed 244 medical students and found that 99% of respondents felt that nutrition played a role in maintaining good health, 97.5% believed it played a role in the development of disease, 94.6% thought that it played a role in the management of disease and 88% felt that patients would expect them to have an understanding of nutrition as a doctor.
A significant 91% stated they would like to receive more teaching on nutrition as part of their medical training.
Only 45% of respondents received teaching on nutrition, and of these 71.5% reported less than 2 hours (including lectures, tutorials and e-learning) in the past academic year. Of the respondents, 85% would welcome more nutrition teaching.
26% feel confident to discuss nutrition
The student hub also surveyed 142 junior doctors and found that 92% of participants believed patients expect them to have an understanding of nutrition as a doctor, yet only 26% felt confident discussing nutrition. Of the participants, 74% stated that they only gave nutritional advice or discussed nutrition with patients once a month or less, citing lack of knowledge (75%), lack of time (64%) and lack of confidence (62%) as the main reasons for this infrequency. Additionally, 38% did not consider nutrition when making management plans and 28% preferred to get specialist advice.
In the doctor-led survey of 181 medical students, 96% agreed or strongly agreed that ‘doctors have a responsibility to provide evidence-based advice on food and nutrition in relation to health and disease’.
Only 14% agreed they were receiving a ‘comprehensive and relevant education in diet and nutrition in relation to health and disease at medical school’. Similarly, when asked whether their ‘medical school prepared (or is preparing) me well on how to advise patients on diet and nutrition in relation to health and disease’, only 12% agreed or strongly agreed.
In both questions, there was a significant difference between the responses of the clinical and preclinical student subgroups, with clinical students disagreeing more than preclinical students to both statements.
Face-to-face most effective
The NNEdPro-led student online survey of 40 medical students aimed to discover what sources medical students are currently using to learn about nutrition.
They found that 64% learn on their own, 38.5% with a textbook, 49% used websites, 23% use journal articles, 10% use review books, 8% use video courses and 8% did not use any resources.
A further 10% reported using ‘other’, which includes nutrition handbooks, news articles, lectures and time spent on placement with a dietitian.
When asked to score how difficult it was to locate resources to support their medical nutrition learning needs, the majority indicated that they found it difficult.
NNEdPro also held one-to-one interviews with 20 Cambridge junior doctors and found that the majority would prefer teaching to be given in person rather than online and included throughout the curriculum rather than a one-off session.
Workshops improve confidence
Education and Research in Medical Nutrition Network (ERimNN) undertook pre-teaching and post-teaching evaluations of a nutrition workshop within a single cohort of students (n=72). Prior to the taught session, 83% reported themselves as ‘not confident at all’ or ‘not very confident’, and none were confident in completing a nutrition assessment.
In a post-teaching questionnaire (n=42/72), 58.3% identified as being confident or very confident. What's more, nearly 40% of respondents said they had not realised how complex nutrition was and 50% could see how doctors could engage in nutrition-related decisions.
The respondents also indicated that they were more satisfied with content when it was delivered by a nutrition professional with clinical experience or with patients discussing their own experiences.
Currently there are collaborative efforts under way to improve nutrition education for medical students and doctors via the UK multiprofessional nutrition education working party.
Alongside this, national collaboration between organisations such as NNEdPro, Nutritank and ERimNN has coordinated efforts to increase capacity and to disseminate a clear message that further nutrition training in medical education is desired and necessary for safe medical practice. One such project is the Nutrition Education Policy in Healthcare Practice (NEPHELP) project developed by NNEdPro.