“Leaves a lot to be desired”: Current medical training lacks nutritional education, notes Lancet study

04 Nov 2019 --- Lacking nutritional training in medical studies results in physicians missing out on possibilities to provide patients with comprehensive counseling on nutrition and dietary behavior. This is according to a joint study analyzing several articles on medical students’ nutrition expertise. NutritionInsight spoke with two of the study’s researchers who highlight that adequate nutritional education would improve physicians’ nutritional and dietary counsel with their patients, in great need as the study emphasizes how poor diets continue to contribute to global deaths annually.

The study was carried out by three researchers from the University of Auckland, New Zealand, Griffith University, Australia and Wageningen University and Research, the Netherlands. They found that deficits in nutrition education affect students’ knowledge and confidence to ensure that patients receive the nutritional counseling they need to balance their diets and improve their overall wellbeing. To tackle the issue, the researchers say that nutritional training and education should be incorporated into medical studies globally.

When doctors are better informed about nutrition and its critical role in human health, they are able to provide better counseling to their patients.“Historically, medical nutrition education has not been seen as a priority in medical studies. When students do not witness nutrition counseling by senior doctors, it does not become part of holistic patient care and continues into their medical practice,” says Dr. Jennifer Crowley, Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, The University of Auckland. 

“In our review, future physicians themselves said that their training left a lot to be desired. They reported little priority given to nutrition education, an absence of scientific rigor in the curriculum and a lack of faculty devoted to the subject,” Professor Gerrit Jan Hiddink, Emeritus Professor, Nutrition Communication through Health Professionals, Wageningen University and Research, explains.

Published in the Lancet Planet Health journal, the study identified 66 studies researching nutrition education in medical studies and systematically reviewed articles published since 2012 that investigated nutrition education provided to medical students. The literature review found that this field of expertise was greatly neglected on a global scale – regardless of country, setting, or year of medical education. Moreover, the researchers found that graduating medical students consistently reported that they have insufficient nutrition knowledge and skills required to support dietary behavior change in their patients effectively. 

The study review showed that despite the fundamental centrality of nutrition to people’s healthy lifestyle, it is clear that graduating medical students are not supported through their education to provide high-quality, effective nutrition care to patients. The study deemed this a situation that “has gone on for too long.” 

A risk to public health
Dr. Crowley emphasizes that doctors’ thorough nutrition education leads to their own confidence to counsel their patients. Consequently, this increases their capability, motivation and opportunities to initiate conversations with patients on diet and lifestyle. However, when they fail to do so, it poses a risk to the public’s health.

“Doctors should know the basics of nutrition and recognize when referral to nutrition experts, such as dietitians, is required for more detailed nutrition care. In some regions, doctors may be patients’ sole source of trusted nutrition information,” she affirms. As millions of global deaths annually are attributable to dietary factors, people in almost every region of the world could benefit from an increased understanding of a healthy diet by increasing their consumption of key nutrients and foods. 

Medical students may be the key drivers of necessary change within medical studies' curricula.“A poor diet now has become a leading cause of death globally, before smoking. Improved diets could prevent more than one in five deaths worldwide every year. Therefore, the public expects the best possible treatment and prevention nutrition advice from their physicians,” Professor Hiddink says.

Mandatory in medical studies
Both researchers urge for more time dedicated to nutrition in medical studies’ curricula and more significant institutional commitment to nutrition education. More importantly, they both advocate for more nutrition experts to teach and serve as role models for students. 

Dr. Crowley has high hopes for the future of nutritional education within medical studies. From her perspective, the establishment of a required level of nutrition knowledge for medical graduates as a global benchmark for universities is needed first and foremost. Medical universities should integrate nutrition into their existing curricula and avoid lengthening medical studies by integrating nutrition into the existing curricula. Moreover, she hopes for early integration of nutritional clinical applications in the basic sciences and institutional commitment to provide nutrition education to medical students.

Professor Hiddink calls upon both medical universities and national governments to make nutrition education compulsory in medical training. “Medical nutrition education can also be enhanced on competency-based curricula, by interprofessional and team-based education, by information technology-empowered learning and through a shift toward early integration of clinical applications in the basic sciences.”

As disruptive change must stem from within the system, Professor Hiddink also identifies medical students themselves as the key to tackling this problem. “Students as stakeholders in nutrition education can provide valuable insights to improve the learning curriculum. It will take advocacy from students’ organizations and the combined efforts of medical students for nutrition training to become mandatory in medical studies. Their initiatives will improve nutrition in medical training to support future doctors for the 21st century.”

He hopes that “all the recommendations we gave in our review come true, for the benefit of all,” he concludes. 

By Anni Schleicher