Experts recommend a set of nutrition competencies for medical students and physician trainees

A professionally diverse panel of medical and nutrition experts has recommended a set of recommended nutrition competencies for medical students and physician trainees. The study addresses the long-standing concern that most physicians in the US are unable to counsel patients on nutrition and food choices.

The proposed capabilities are a call to action in response to the bipartisan resolution of the US House of Representatives, H. Res. 1118, which requires “meaningful physician and health professional education regarding nutrition and diet.” The resolution cited concerns about the increasing prevalence of diet-related diseases and Medicare costs, which amounted to $800 billion in 2019. The annual congressional financial support for medical trainees in US hospitals in 2020 was estimated at $16.2 billion.

It is surprising that no nutrition competencies are required nationally in medical education. This is surprising and important, given the epidemics of obesity, diabetes, and other diet-related chronic diseases in this country, as well as the ever-increasing financial and societal costs. I think most patients assume that their doctors are trained to advise them on nutrition and food choices, but this was not part of their required training.”

David Eisenberg, main author, associate professor of nutrition and director of culinary nutrition at the Harvard School of Public Health TH Chan

The study will be published on September 30 i JAMA Open Network.

The researchers—;Eisenberg, Alexis Cole at Tufts University, and Edward Maile and Matthew Salt, both at the UK-based consultancy Sprink Ltd.-; compiled a list of 354 nutrition competencies included in the academic literature and recruited an expert panel consisting of 37 medical educators, nutrition scientists, practicing physicians, medical residency directors, and registered dietitian nutritionists from around the country. Over the course of four rounds, the panelists ranked the competencies and provided opinions and ideas.

After analyzing the survey results, the researchers identified 36 nutrition competencies that the panel agreed upon and recommended for medical school and undergraduate and graduate training. The competencies comprise six categories: basic nutritional knowledge (“Indicates knowledge of the nutritional content of foods including the main dietary sources of macronutrients and micronutrients); assessment and diagnosis (“Assess the nutritional status of a patient on a short diet and he/she has a food history/questionnaire, anthropometric measurements, and appropriate laboratory tests”); communication skills (“Listen carefully, compassionately and non-judgmentally when taking a dietary history”); , and how he/she can assess disease burden reduce and improve access to adequate healthy food”); collaborative support and treatment for specific conditions (“Works with other health professionals to deliver a multidisciplinary approach to nutritional care”); and indications for referral (“Appropriate referrals are made to a range of professionals to support the patient in achieving their health goals”).

Additionally, 97% of the panelists called for formal nutritional testing on future physician licensing and certification exams. Other highlights included:

• 95% of panelists agreed that institutions should report on their teaching of nutrition competencies.
• 92% agreed that student surveys should be used to assess their competence and confidence in this area.
• 73% of panelists recommended competence related to the environmental impact and planetary health of food choices for inclusion.

The research team also identified 12 potential gaps that were not addressed in the proposed competencies, as these were not identified in a review of the current medical literature. These included topics such as when and how to discuss peptide 1 (GLP-1) agonists such as glucagon (anti-obesity drugs) with patients and how to use artificial intelligence responsibly to provide patients with practical advice on nutrition and food choices.

“The capabilities and efforts are the largest to date to address H. Res. 1118, and their adoption will undoubtedly contribute greatly to public health,” said Eisenberg. “Ensuring that physicians have the necessary knowledge to advise patients in practical terms about nutrition and food choices will increase referrals to and collaboration with a range of nutrition experts and programs, promote health equity, and it will improve the health of the planet.”

The researchers noted that the international generalizability of the competencies may be limited, since the panel was based in the US. However, the consensus-building approach through which the recommended competencies were developed could inform similar efforts by medical educators and regulators worldwide, given that nutrition-related health challenges and limited nutrition training are global problems. for physicians.

The study was funded by the Vitamix Foundation, the David R. and Margaret C. Clare Foundation, the Shaich Family Foundation, and the Ardmore Health Institute. These philanthropic grants were provided to, and administered by, the Teaching Kitchen Collaborative.