|
1
|
Sousa JR, Afreixo V, Carvalho J, Silva P. Nutrition and Physical Activity Education in Medical School: A Narrative Review. Nutrients 2024; 16:2809. [PMID: 39203945 PMCID: PMC11357297 DOI: 10.3390/nu16162809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/10/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
This review explores the diverse landscape of integrating nutrition and physical activity education into medical school curricula, focusing on the imperative role of physicians in promoting health through lifestyle changes. By examining global medical education structures, we uncovered disparities in nutrition and physical activity training, and highlighted the need for a shared framework to address international and regional challenges. Despite acknowledging the importance of both nutrition and physical activity, studies have consistently uncovered deficiencies in medical school curricula, especially in skills related to providing lifestyle advice and behavioral counseling. Survey studies among medical students have illuminated various perceptions and knowledge gaps, emphasizing the need for more comprehensive and mandatory nutrition and physical activity training. While acknowledging progress, challenges, such as time constraints, resource availability, and faculty expertise, persist. Integrating lifestyle education results in resistance, a demand for strategic communication, and faculty buy-ins. These findings underscore the importance of a holistic approach that balances theoretical knowledge, practical skills, and confidence that medical students need to promote effective nutrition and physical activity in healthcare.
Collapse
Affiliation(s)
- Joana Rodrigues Sousa
- Laboratory of Histology and Embryology, Institute of Biomedical Sciences Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira n.° 228, 4050-313 Porto, Portugal
| | - Vera Afreixo
- Center for Research & Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Joana Carvalho
- Research Centre in Physical Activity, Health and Leisure of University of Porto, 4200-450 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Paula Silva
- Laboratory of Histology and Embryology, Institute of Biomedical Sciences Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira n.° 228, 4050-313 Porto, Portugal
- iNOVA Media Lab, ICNOVA-NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, 1069-061 Lisbon, Portugal
| |
Collapse
|
|
2
|
Ajabnoor SM, Zaher S, Malatani R, Jawa H. Exploring the practice of nutritional support during hospitalization across physicians, dietitians, and pharmacists based in Saudi Arabia. Front Nutr 2023; 10:1149727. [PMID: 37293671 PMCID: PMC10244628 DOI: 10.3389/fnut.2023.1149727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Nutritional support has a pivotal role in preventing and treating malnutrition. Recognizing the gaps in nutritional support practice can aid the development of tailored nutritional protocols. Therefore, this study aimed to assess the current practices, attitudes, and perceptions related to nutritional support for hospitalized patients in one of the largest Middle Eastern countries. Methods A cross-sectional study was conducted among different healthcare professionals currently working in hospitals in Saudi Arabia and involved in nutritional support practice. Data were collected using convenient sample via a self-administered web-based questionnaire. Results A total of 114 participants were included in this study. The majority were dietitians (54%), followed by physicians (33%) and pharmacists (12%), and were from the western region (71.9%). Various attitudes in many practices were observed among the participants. Only 44.7% of the participants had a formal nutritional support team. The mean confidence level of all respondents was significantly higher for enteral nutrition practice (7.7 ± 2.3) than for parenteral nutrition practice (6.1 ± 2.5) (p < 0.01). The confidence level for enteral nutrition practice was significantly influenced by nutritional qualification (β = 0.202, p < 0.05), type of healthcare facility (β = 0.210, p < 0.05), profession (β = -0.308, p < 0.01), and years of experience (β = 0.220, p < 0.05). Conclusion This study comprehensively assessed various aspects of nutritional support practice in Saudi Arabia. Healthcare practice of nutritional support should be guided by evidence-based guidelines. Professional qualification and training in nutritional support are essential for promoting practice in hospitals.
Collapse
Affiliation(s)
- Sarah M. Ajabnoor
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Zaher
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Rania Malatani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani Jawa
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
|
3
|
Zaher S, Ajabnoor SM. A Cross Sectional Survey-Based Study to Investigate the Availability and Utilisation of Home Nutrition Support in Saudi Arabia. J Multidiscip Healthc 2023; 16:41-50. [PMID: 36660035 PMCID: PMC9842512 DOI: 10.2147/jmdh.s398569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
Background and Aims Many patients require long-term nutrition support, typically in the form of home nutrition support (HNS). The availability and utilisation of HNS in Saudi Arabia is currently unknown; therefore, this study was conducted to assess the availability of HNS in Saudi hospitals and to explore factors associated with the availability of HNS in different healthcare facilities in Saudi Arabia. Methods A cross-sectional study was conducted among physicians, dietitians, and pharmacists working in Saudi Arabia with regular practice in nutrition support. Data was collected through self-administered web-based survey, which was distributed via social-media platforms. Results A total of 114 responses were received from healthcare providers involved in nutrition support across Saudi Arabia. Of the respondents, 55 (48.2%) indicated that nutrition support services were available at their facility. Regression analysis showed that other regions in Saudi Arabia had lower odds of having HNS compared with the Western region (OR=0.01; 95% CI=0.01-0.69). The university and specialised hospitals had lower odds of having HNS compared with Ministry of Health hospitals (OR=0.11; 95% CI=0.02-0.71, OR=0.11; 95% CI=0.02-0.56, respectively). Hospitals with capacities of 100-250 beds and 251-500 had higher odds of having HNS than smaller hospitals (OR=13.17; 95% CI=1.09-159.5, OR=3.11; 95% CI=2.04-248.77, respectively). Conclusion There is lack of published reports from hospitals with implemented HNS. Therefore, it is difficult to assess the current situation of HNS programmes. Future national studies focusing on HNS are warranted as there is a rising international trend in the number of patients requiring HNS.
Collapse
Affiliation(s)
- Sara Zaher
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia,National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi FDA), Riyadh, Saudi Arabia,Correspondence: Sara Zaher, Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Saudi Arabia, Email ;
| | - Sarah M Ajabnoor
- National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi FDA), Riyadh, Saudi Arabia,Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
|
4
|
Hanninen S, Rashid M. Assessment of Students' Perception of the Nutrition Curriculum in a Canadian Undergraduate Medical Education Program. J Can Assoc Gastroenterol 2018; 2:141-147. [PMID: 31294377 PMCID: PMC6619412 DOI: 10.1093/jcag/gwy043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Nutrition plays an important role in diseases, and physicians need to be proficient in providing nutrition counselling to patients. There is limited information regarding nutrition education in Canadian medical schools. Objective The objective of this study was to investigate students’ perspectives about nutrition training provided in the undergraduate medical education program at Dalhousie University. Methods All medical students in their second, third, and fourth years of training at Dalhousie University were surveyed online with a 23-item questionnaire that included 10 nutrition competencies. Results Of 342 students, 89 (26%) completed the survey. Using a five-point Likert scale, ranging from one, indicating ‘very dissatisfied/strongly disagree’ to five, indicating ‘very satisfied/strongly agree,’ the mean overall satisfaction with nutrition curriculum was 2.9 ± 0.81. Perceived competency in nutrition assessment had the highest mean satisfaction rating (3.98 ± 0.89). There was more variance on perceived competency, with other aspects of training including basic nutrition principles (3.51 ± 0.92), disease prevention (3.14 ± 1.12), disease management (3.48 ± 1.00), role of dietitians (2.97 ± 1.05), credible nutrition sources (3.14 ± 1.09), dietary assessment (2.82 ± 1.11), lifecycle nutrition (2.67 ± 1.09), food security (2.4 ± 0.95) and malnutrition (2.74 ± 0.93). Med-4 students agreed significantly more than Med-2 students regarding confidence about their understanding of the role of dietitians. Students recommended a longitudinal nutrition program, inclusion of dietitians as educators, and provision of evidence-based resources in the curriculum. The majority (79%) agreed that more nutrition instruction is needed. Satisfaction with nutrition education has not improved since 2010, despite curricular changes. Conclusions Medical students’ satisfaction with nutrition education remains problematic. They want more nutrition training. Ongoing assessment and student feedback is important to make changes and improvements in the nutrition curriculum.
Collapse
Affiliation(s)
- Stacy Hanninen
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohsin Rashid
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
|
5
|
Micic D, McDonald EK, Stein AC, Semrad CE. How to Obtain Training in Nutrition During the Gastroenterology Fellowship. Gastroenterology 2018; 154:467-470. [PMID: 29337152 DOI: 10.1053/j.gastro.2018.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Edwin K McDonald
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois
| | - Adam C Stein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Carol E Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Illinois.
| |
Collapse
|
|
6
|
Koch TR, Shope TR, Gostout CJ. Organization of future training in bariatric gastroenterology. World J Gastroenterol 2017; 23:6371-6378. [PMID: 29085186 PMCID: PMC5643262 DOI: 10.3748/wjg.v23.i35.6371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/18/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
A world-wide rise in the prevalence of obesity continues. This rise increases the occurrence of, risks of, and costs of treating obesity-related medical conditions. Diet and activity programs are largely inadequate for the long-term treatment of medically-complicated obesity. Physicians who deliver gastrointestinal care after completing traditional training programs, including gastroenterologists and general surgeons, are not uniformly trained in or familiar with available bariatric care. It is certain that gastrointestinal physicians will incorporate new endoscopic methods into their practice for the treatment of individuals with medically-complicated obesity, although the long-term impact of these endoscopic techniques remains under investigation. It is presently unclear whether gastrointestinal physicians will be able to provide or coordinate important allied services in bariatric surgery, endocrinology, nutrition, psychological evaluation and support, and social work. Obtaining longitudinal results examining the effectiveness of this ad hoc approach will likely be difficult, based on prior experience with other endoscopic measures, such as the adenoma detection rates from screening colonoscopy. As a long-term approach, development of a specific curriculum incorporating one year of subspecialty training in bariatrics to the present training of gastrointestinal fellows needs to be reconsidered. This approach should be facilitated by gastrointestinal trainees’ prior residency training in subspecialties that provide care for individuals with medical complications of obesity, including endocrinology, cardiology, nephrology, and neurology. Such training could incorporate additional rotations with collaborating providers in bariatric surgery, nutrition, and psychiatry. Since such training would be provided in accredited programs, longitudinal studies could be developed to examine the potential impact on accepted measures of care, such as complication rates, outcomes, and costs, in individuals with medically-complicated obesity.
Collapse
Affiliation(s)
- Timothy R Koch
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Timothy R Shope
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Christopher J Gostout
- Professor Emeritus, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
|
7
|
Hu J, Raman M, Gramlich L. Current Status of and Recommendations for Nutrition Education in Gastroenterology Fellowship Training in Canada. Nutr Clin Pract 2017; 33:191-197. [DOI: 10.1177/0884533617700852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jing Hu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Leah Gramlich
- University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| |
Collapse
|
|
8
|
Karim SA, Ibrahim B, Tangiisuran B, Davies JG. What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia. JPEN J Parenter Enteral Nutr 2015; 39:482-488. [PMID: 24590009 DOI: 10.1177/0148607114525209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/02/2014] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. METHODS A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. RESULT Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the "average" score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. CONCLUSION Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.
Collapse
Affiliation(s)
- Sarah A Karim
- Pharmacy Department, Penang General Hospital, Pulau Pinang, Malaysia
| | - Baharudin Ibrahim
- Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia
| | - Balamurugan Tangiisuran
- Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia
| | - J Graham Davies
- Institute of Pharmaceutical Science, King's College London, London, United Kingdom
| |
Collapse
|
|
9
|
Slattery E, Koskey J, Aylward A, Rabinowitz L, Seres DS. Starved for attention: the prevalence and quality of nutrition-related research in gastroenterology. Nutr Clin Pract 2015; 30:313. [PMID: 25829344 DOI: 10.1177/0884533615569315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
10
|
Wertheim ML, Nakada SY, Penniston KL. Current Practice Patterns of Urologists Providing Nutrition Recommendations to Patients with Kidney Stones. J Endourol 2014; 28:1127-31. [PMID: 24846196 DOI: 10.1089/end.2014.0164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Margaret L. Wertheim
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristina L. Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Department of Clinical Nutrition Services, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| |
Collapse
|
|
11
|
Duerksen DR, Keller HH, Vesnaver E, Allard JP, Bernier P, Gramlich L, Payette H, Laporte M, Jeejeebhoy K. Physicians' perceptions regarding the detection and management of malnutrition in Canadian hospitals: results of a Canadian Malnutrition Task Force survey. JPEN J Parenter Enteral Nutr 2014; 39:410-7. [PMID: 24894461 DOI: 10.1177/0148607114534731] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/15/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Since malnutrition is common in Canadian hospitals, physicians frequently encounter patients with significantly impaired nutrition status. The objective of this study was to determine physician attitudes and perceptions regarding the detection and management of malnutrition in Canadian hospitals. MATERIALS AND METHODS A survey based on a previously developed questionnaire that focused on guidelines for nutrition support of hospitalized patients was completed by Canadian physicians working on wards in the 18 hospitals participating in the Canadian Malnutrition Task Force study. Data were analyzed descriptively and according to ward (medical vs surgical) and hospital type (academic vs community). RESULTS The survey was completed by 428 of the 1220 physicians who were provided with a questionnaire and asked to participate (response rate 35%). While physicians believe that nutrition assessment should be performed at admission (364/419 [87%]), during hospitalization (363/421 [86%]), and at discharge (327/418 [78%]), most felt that this was not being done on a regular basis (admission, 140/423 [33%]; during hospitalization, 175/423 [41%]; at discharge, 121/424 [29%]). Similarly there was a gap between what was perceived to be the ideal management of hospital-related malnutrition and current practices. Physicians felt that the team's nutrition education and use of dietetic resources could be increased, and although their nutrition knowledge was limited, they felt that hospital-associated malnutrition was very relevant to the care they provided. CONCLUSIONS A multidisciplinary team is needed to address hospital malnutrition, and educational strategies that target physicians are needed to promote better detection and management throughout the hospital stay.
Collapse
Affiliation(s)
- Donald R Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather H Keller
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Elisabeth Vesnaver
- Department of Family Relations & Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | | | | | | | - Hélène Payette
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Manon Laporte
- Clinical Nutrition Department, Vitalité Health Network, New Brunswick, Canada
| | | |
Collapse
|
|
12
|
Lenders CM, Deen DD, Bistrian B, Edwards MS, Seidner DL, McMahon MM, Kohlmeier M, Krebs NF. Residency and specialties training in nutrition: a call for action. Am J Clin Nutr 2014; 99:1174S-83S. [PMID: 24646816 PMCID: PMC3985219 DOI: 10.3945/ajcn.113.073528] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite evidence that nutrition interventions reduce morbidity and mortality, malnutrition, including obesity, remains highly prevalent in hospitals and plays a major role in nearly every major chronic disease that afflicts patients. Physicians recognize that they lack the education and training in medical nutrition needed to counsel their patients and to ensure continuity of nutrition care in collaboration with other health care professionals. Nutrition education and training in specialty and subspecialty areas are inadequate, physician nutrition specialists are not recognized by the American Board of Medical Specialties, and nutrition care coverage by third payers remains woefully limited. This article focuses on residency and fellowship education and training in the United States and provides recommendations for improving medical nutrition education and practice.
Collapse
Affiliation(s)
- Carine M Lenders
- Division of Pediatric Nutrition, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, MA (CML); the Department of Community Health and Social Medicine, City College of New York, New York, NY (DDD); Harvard University Medical School, Boston, MA (BB); University of Texas Medical School, Houston, TX (MSE); the Vanderbilt Center for Human Nutrition, Vanderbilt University Medical Center, Nashville, TN (DLS); the Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (MMM); University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC (MK); and the Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO (NFK)
| | | | | | | | | | | | | | | |
Collapse
|
|
13
|
Spear S, Sim V, Moore FA, Todd SR. Just Say No to Intensive Care Unit Starvation. Nutr Clin Pract 2013; 28:387-91. [DOI: 10.1177/0884533613477136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Vasiliy Sim
- Brookdale University Hospital, Brookdale Plaza, Brooklyn, New York
| | | | - S. Rob Todd
- New York University School of Medicine, New York, New York
| |
Collapse
|
|
14
|
Delegge MH, Alger-Mayer S, Van Way CW, Gramlich L. Specialty residency training in medical nutrition education: history and proposal for improvement. JPEN J Parenter Enteral Nutr 2011; 34:47S-56S. [PMID: 21149835 DOI: 10.1177/0148607110378017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nutrition education among residents in training is at a critical juncture. There is a general lack of a unified curriculum, a lack of nutrition physician mentors, and a failure to properly train physicians about nutrition. In surveys, residents in training have acknowledged their minimal nutrition education. Published data and training experiences suggest the importance of creating physician mentors in nutrition who are embedded in residency training programs. The development of recurrent short-term nutrition credentialing courses and online nutrition tool kits is also thought to be important in future residency training.
Collapse
Affiliation(s)
- Mark H Delegge
- Department of Medicine, Medical University of South Carolina, 256 Courtenay Street, Charleston, SC 29425, USA.
| | | | | | | |
Collapse
|
|
15
|
Grant SM, Wolever TMS. Perceived barriers to application of glycaemic index: valid concerns or lost in translation? Nutrients 2011; 3:330-340. [PMID: 22254100 PMCID: PMC3257746 DOI: 10.3390/nu3030330] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/17/2011] [Accepted: 02/23/2011] [Indexed: 12/12/2022] Open
Abstract
The term glycaemic-index (GI) originally appeared in the literature in the early 1980s. GI categorizes carbohydrate according to glycaemic effect postprandially. Since its inception, GI has obtained and maintained interest of academics and clinicians globally. Upon review of GI literature, it becomes clear that the clinical utility of GI is a source of controversy. Can and should GI be applied clinically? There are academics and clinicians on both sides of the argument. Certainly, this controversy has been a stimulus for the evolution of GI methodology and application research, but may also negatively impact clinicians' perception of GI if misunderstood. This article reviews two assessments of GI that are often listed as barriers to application; the GI concept is (1) too complex and (2) too difficult for clients to apply. The literature reviewed does not support the majority of purported barriers, but does indicate that there is a call from clinicians for more and improved GI education tools and clinician GI education. The literature indicates that the Registered Dietitian (RD) can play a key role in GI knowledge translation; from research to application. Research is warranted to assess GI education tool and knowledge needs of clinicians and the clients they serve.
Collapse
Affiliation(s)
- Shannan M. Grant
- Department of Nutritional Sciences, University of Toronto, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, University of Toronto, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, 61 Queen Street East, Toronto, Ontario, M5C 2T2, Canada;
| |
Collapse
|
|
16
|
Gramlich LM, Olstad DL, Nasser R, Goonewardene L, Raman M, Innis S, Wicklum S, Duerksen D, Rashid M, Heyland D, Armstrong D, Roy C. Medical students’ perceptions of nutrition education in Canadian universities. Appl Physiol Nutr Metab 2010; 35:336-43. [DOI: 10.1139/h10-016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients routinely seek physicians’ guidance about diet and the relation between nutrition and the prevention and treatment of disease. However, the adequacy of nutrition instruction in undergraduate medical education is questionable. The purpose of this study was to investigate Canadian medical students’ perceptions of and satisfaction with their education in nutrition. At 9 universities across Canada, a 23-item survey questionnaire was distributed in English and French to undergraduate medical students after at least 8 months of medical school. Overall, 9 of 17 universities participated in the survey, and 933 of the 3267 medical students approached completed the survey (response rate, 28.6%). Mean satisfaction with nutrition instruction received during medical school was 4.7 (±0.06) on a scale of 1–10, where 1 is very dissatisfied and 10 is very satisfied, and there were significant differences among schools (p < 0.0001). Students were comfortable in their ability to counsel patients regarding basic nutrition concepts and the role of nutrition in prevention of disease, but were much less comfortable discussing the role of nutrition in the treatment of disease and nutrient requirements across the lifecycle, and in identifying credible sources of nutrition information. Of the 933 respondents, 87.2% believe that their undergraduate program should dedicate more time to nutrition education. The amount of nutrition instruction correlated with student satisfaction (p < 0.0001), but varied among schools. A significant number of students are dissatisfied with the nutrition education they receive and their ability to provide relevant and appropriate nutrition counselling. This study paves the way for further discussions and development of strategies to improve nutrition education in medical schools in Canada.
Collapse
Affiliation(s)
- Leah M. Gramlich
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Dana Lee Olstad
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Roseanne Nasser
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Laki Goonewardene
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Sheila Innis
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Sonja Wicklum
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Donald Duerksen
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Mohsin Rashid
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Daren Heyland
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - David Armstrong
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Claude Roy
- University of Alberta/Alberta Institute for Human Nutrition – 323 CSC, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada
- University of Alberta/Alberta Institute for Human Nutrition, Edmonton, AB T6G 2P5, Canada
- Regina Qu’Appelle Health Region/University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada
- Government of Alberta, Canada; University of Alberta, Edmonton, AB T6G 2P5, Canada
- University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
|
17
|
Abstract
BACKGROUND Many people are afflicted with chronic diseases, in which nutrition plays a key role. The need for greater nutrition training among physicians, particularly gastroenterologists, is becoming increasingly evident. OBJECTIVES To determine the nutritional knowledge and perceived nutrition knowledge of gastroenterology fellows. METHODS Thirty-two gastrointestinal (GI) fellows currently enrolled in a GI fellowship program completed a needs assessment evaluating perceived nutrition knowledge and interest in the areas of nutrition support, assessment, obesity, micro/macronutrients, and nutrition in GI diseases. Additionally, an examination evaluating nutrition knowledge specific to gastroenterology fellows was administered. RESULTS Thirty-two GI fellows completed the needs assessment. Cronbach alpha of the needs assessment instrument was 0.72, indicating satisfactory internal consistency reliability. GI fellows perceived themselves to have the least knowledge in obesity and micro/macronutrients. They indicated a perceived greater knowledge base in nutrition assessment. The mean total test score was 50.04% (SD=7.84%). Fellows had the highest score in the subscale of nutrition assessment (80.64%; SD=19.05%), which was significantly higher than scores obtained in nutrition support (49.45%; SD=11.98%; P<0.05), micro/macronutrients (37.84%; SD=16.94%; P<0.05), obesity (40.11%; SD=20.00%; P<0.05), and nutrition in GI diseases (65.05%; SD=22.09%; P<0.05). A backward linear regression including hours of nutrition education received during GI fellowship, hours of nutrition education received during medical school, and year of GI fellowship accounted for 22.7% of the variance in test performance (multiple R=0.477). CONCLUSIONS Gastroenterology fellows think their knowledge of nutrition is suboptimal; objective evaluation of nutrition knowledge in this cohort confirmed this belief. A formal component of nutrition education could be developed in the context of GI fellowship education and continuing medical education as necessary.
Collapse
Affiliation(s)
- Maitreyi Raman
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | | |
Collapse
|
|
18
|
Abstract
BACKGROUND AND AIMS The degree of nutrition training in gastrointestinal (GI) fellowship programs has not been reported previously, but it is thought to be inadequate. The aim of this study was to determine GI fellows' exposure to nutrition and to assess nutrition knowledge and practice behaviors before and after completing a live nutrition course. METHODS This course was geared specifically for GI fellows. Nineteen faculty members from the United States and Canada participated. Electronic surveys were sent to each fellow before and after the course. The curriculum consisted of 20 hours of live education. Curriculum was revised when the precourse survey identified a gap in medical knowledge or practice behavior. Knowledge change was assessed by a 20-question survey before and after the course. RESULTS Fifty-three fellows participated. Seventy percent reported no inpatient nutrition rotation. Seventy percent had never written a total parenteral nutrition or total enteral nutrition orders, and 12% had treated a home enteral or parenteral patient. Ninety percent had no outpatient nutrition or obesity rotation experience, and 59% had no core nutrition lecture series at their program. Eighty-seven percent had never been assessed for competency in nutrition, and 9% had completed a nutrition research project. Too few mentors, poor exposure, and a predominant focus on endoscopy were reasons cited for not pursing nutrition training. Knowledge change after the course was assessed; the mean correct response rates were 58% before and 88% postcourse. CONCLUSION There is a considerable deficiency in nutrition training in GI programs. The established American Gastroenterological Association nutrition curriculum guidelines and core competencies are not being fulfilled in most programs. The curriculum of this course resulted in increased knowledge and improved nutrition practice behavior. There is a need for more nutrition training for our GI fellows.
Collapse
|
|
19
|
Nguyen GC, Laveist TA, Brant SR. The utilization of parenteral nutrition during the in-patient management of inflammatory bowel disease in the United States: a national survey. Aliment Pharmacol Ther 2007; 26:1499-507. [PMID: 17931346 DOI: 10.1111/j.1365-2036.2007.03547.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Parenteral nutrition has a limited role in the in-patient management of inflammatory bowel disease. AIM To determine nationwide patterns of in-patient parenteral nutrition utilization and its demographic determinants and impact on outcomes. METHODS We identified inflammatory bowel disease discharges in the Nationwide Inpatient Sample between 1998 and 2003 and determined rates of parenteral nutrition utilization among US census regions, in-hospital mortality and hospital resource utilization. RESULTS The parenteral nutrition utilization rate among hospitalized inflammatory bowel disease patients was 6%. Only 64% of Crohn's disease and 55% of ulcerative colitis discharges who received parenteral nutrition had malnutrition, fistulizing or obstructive Crohn's disease, or surgery as an indication. The adjusted odds ratio of receiving parenteral nutrition were 0.36 (95% CI: 0.26-0.51) for the mid-west, 0.47 (0.37-0.56) for the south and 0.70 (0.56-0.89) for the west, compared to the north-east. Use of parenteral nutrition was associated with higher in-hospital mortality (OR 2.5; 95% CI: 1.93-3.24), length of stay (13.7 vs. 5.7 days, P < 0.001) and hospital charges ($51,729 vs. $19,563, P < 0.001). CONCLUSIONS In-patient utilization of parenteral nutrition for inflammatory bowel disease varies markedly by census region, expends significant resources, and leads to potentially significant adverse outcomes. These findings underscore the need for guidelines for judicious parenteral nutrition use in inflammatory bowel disease.
Collapse
Affiliation(s)
- G C Nguyen
- Mount Sinai Hospital IBD Centre, University of Toronto School of Medicine, Toronto, ON, Canada.
| | | | | |
Collapse
|
|
20
|
Mullin GE. Got nutrition? Gastrointest Endosc 2007; 66:772-3. [PMID: 17905021 DOI: 10.1016/j.gie.2007.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/07/2007] [Indexed: 02/08/2023]
Affiliation(s)
- Gerard E Mullin
- Integrative GI Nutrition Services, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| |
Collapse
|