Comprehensive integration of nutrition into medical training

Nutrition must be integrated into the medical school curriculum to train physicians who can effectively provide nutrition care for the prevention and management of chronic diseases. This article describes the comprehensive nutrition curriculum developed at the University of Colorado School of Medicine. Two fundamental principles have guided the school's approach to medical nutrition education: 1) nutrition content must be broad in nature and be vertically integrated across the preclinical and clinical years and continued through postgraduate training, and 2) active adult learning (eg, "learning by doing") should be practiced whenever possible. From our experience, we have identified several key elements important for the successful integration of nutrition into the curriculum. First, identifying a core group of committed faculty to advocate for nutrition and serve as role models and having a physician nutrition specialist at the helm provides constant momentum for the advancement of nutrition education. Second, establishing a network of linkages with other elements of the existing curriculum creates the opportunity to add nutrition content without necessarily adding time. The third key element is an emphasis on incorporating nutrition in clinical training. Students must be routinely exposed to physicians practicing nutrition for nutrition to become part of standard patient care. This can be accomplished through multiple exposures to nutrition throughout the curriculum (ie, vertical integration). Finally, a coordinator is needed to monitor the many "fronts" of the integrated nutrition curriculum and to continue networking and program implementation.     

Health promotion and disease prevention: integration into a medical school curriculum

Summary: Many authorities have identified deficiencies in the education of medical students in health promotion and disease prevention. This report describes an attempt to address this problem through the longitudinal integration of health promotion and disease prevention into several major courses in the student curriculum at Harvard Medical School. We used adult learning theory to develop the curricular approach, and designed educational experiences to match the professional development of the student at different phases of medical education. Primary, secondary, and tertiary prevention were particularly germane for students in the first, second, and third years, respectively. During clerkships in the third and fourth years, especially those with a focus on ambulatory patients, students built upon earlier experiences to integrate health promotion and disease prevention into clinical practice. By unifying the teaching of disease prevention with several major required courses, we aimed to create an environment in which students could experience their learning about disease prevention in the same manner that we aspired to have them practise it: integrated throughout clinical medicine.     

医学机能学和医学生物技术考试整合初探

医学机能学和医学生物技术是两门新兴的基础医学课程,既各有其特点又有共通之处。结合以往教学经验针对以上两门课程考试部分整合的初步构想进行探讨和分享。     

The integration of school nutrition program into health promotion and prevention of lifestyle-related diseases in Japan

After World War II, Japan has imported food from other countries to solve malnutrition, and then dietitians provided nutrition education to people for effective food utilization. Flour and skimmed milk imported from the United State were distributed to the school lunch program. Dietitians were trained to encourage the people to adapt western style dietary habits. The western style dietary habit issues have been brought since in 1980's as overeating and obesity have been considered as nation's health problems. In the 1990's, the prevention and treatment of lifestyle-related diseases became key objects for the nation. Government settled on "Healthy Japan 21" as a preventive policy of the lifestyle-related disease in 2000. In 2006, the middle survey for the effectiveness of the campaign was conducted, but it did not bring a good result as expected. The Ministry of Health, Labor and Welfare made the "Japanese Food Guide Spinning Top" for practical and easy mean to improve eating habits. Dietitians are in the process of developing new nutrition education using this tool. In 2005, the nine specific targets' Basic Law on Dietary Education "Shoku-Iku" was enacted to promote childhood dietary education. The Ministry of Education and Science started the new education to become a teacher called "diet and nutrition teacher" on the professional education programs of registered dietitian in university. "Diet and nutrition teachers" have already started teaching in some schools. From now, the roles of dietitians are not only supervising food preparation and planning meals but also nutrition education as teachers.     

Some new methods for the evaluation of medical school sex education curricula

This study proposes new ways of evaluating medical school sex education curricula which may be used not only to determine the best educational methods, but also to understand what skills and competence are important for a doctor to have in order to assist patients with their sexual problems. Since present evaluation tools are limited, the theoretical base from which human sexuality programmes are developed is based on unsupported personal judgment. Good research with improved techniques is a requisite for improving this situation.     

Improving nutrition components in medical and dental school curriculums

This article has presented an alternative approach to the traditional, freestanding, concentrated course in nutrition. The integration of nutrition into other courses, with continuous reinforcement throughout the 4-year curriculum, may result in better learning and retention by the student. However, the lack of an accurate curriculum representation presents a problem in selecting topics that integrate with other courses. The unobtrusive approach to nutrition curriculum improvement involves three key points: development of the Nutrition Curriculum Guide, which provides detailed information on what is currently being taught, comparison of what is actually being taught with a set of ideal objectives in order to identify redundancies or omissions, and orchestrating the efforts of faculty in courses throughout the 4-year curriculum to help students integrate nutrition-related topics from the various disciplines. When one makes practical application of the unobtrusive approach, the most difficult problem is defining which interdisciplinary topics are currently being taught. An education specialist and the Tracer Method are important resources for one who is seeking to ameliorate the problem.     

Back from basics: integration of science and practice in medical education

Context

In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success.

Scope of Review

In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula.

Conclusions

Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of ‘basic science’ relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science.     

An investigation into school children's knowledge and awareness of food and nutrition

With the diet and exercise behaviours of UK school children showing little improvement over recent years, the need for dietary change is clearly indicated. This study aimed to assess the nutritional knowledge and understanding of primary school children in order to identify the most effective format for future nutrition messages. A qualitative methodology was employed and 114 children, aged 7–11 years, took part in 23 focus groups separated by age, gender and socio-economic status (SES). Issues discussed included parental food rules, children's perceptions of `good' and `bad' foods, diet–disease links and food groupings.
Across the groups restrictive food rules were most frequently reported whilst between groups gender and SES differences were apparent in relation to parental control over food and children's nutritional knowledge. The limitations of the children's cognitive development could be seen in their conceptualization of food groups, where concrete grouping schemes were frequently used, and in the lack of understanding inherent in their food–health or food–nutrient associations. Taste and preference were confirmed as consistent influences in children's food classification.
Primary school children may be receptive to food based dietary guidelines based on familiar, concrete food classifications. These should be cognitively appropriate and possibly need to be gender specific.     

某医学院贫困大学生健康状况及营养膳食分析

目的了解贫困大学生的能量和营养素（膳营养素、营养制剂和食品营养强化剂）摄入量,判断机体营养健康水平,为大学生保健工作提供依据。方法选择山西大同大学医学院189名贫困大学生作为研究对象,其中男生85人,女生104人;采用问卷调查及膳食调查的方法,对贫困大学生健康及营养状况进行评价。结果贫困大学生膳食主要以谷物为主,鱼虾类、水果、奶类、蔬菜、肉类和蛋类明显少于参考摄入量标准,尤其是钙、锌和V-C的摄入量仅占参考摄入量的1/3。贫困大学生牙龈出血率为56.61%,口腔溃疡发生率为46.03%,皮肤粗糙出现率为33.33%,视力不良率为80.42%。结论贫困大学生的膳食结构及各种营养素的摄入不合理,应加强贫困大学生营养知识的宣传教育,改善贫困大学生膳食营养,从而提高贫困大学生的健康水平。     

Survey on international health related education in preventive medicine curricula of medical school in Japan]

A nation-wide survey of the 150 active members of the Japan Association of the Directors of the Departments of Hygiene and Public Health at Medical Schools (80 medical schools) in Japan was conducted regarding international health related education for the 1990 academic year. The survey questionnaire used 6 basic questions, including some space for free answers. There were 105 effective responses (70.0%). Among them 61 answered that educational courses related to international health were provided in their curriculum; 16 out of 39 (41.0%) in the department of hygiene, 34 out of 48 (70.8%) in the department of public health, and 11 out of 18 (61.1%) in others. However, there were 24 that had the same title of "International Health". The most prevalent key-word was WHO (41), with international exchange and cooperation (15), JICA (14), PHC (12), ILO (12) following in that order. These results suggest a need for curriculum improvement in the near future for implementing international health education. Some strategies for developing international health related education in the broader context of the whole medical curriculum in collaboration with other departments are discussed.     

Student learning outcomes,perceptions and beliefs in the context of strengthening research integration into the first year of medical school

Research integrated into undergraduate education is important in order for medical students to understand and value research for later clinical practice. Therefore, attempts are being made to strengthen the integration of research into teaching from the first year onwards. First-year students may interpret attempts made to strengthen research integration differently than intended by teachers. This might be explained by student beliefs about learning and research as well as student perceptions of the learning environment. In general, student perceptions of the learning environment play a pivotal role in fostering student learning outcomes. This study aims to determine whether a curriculum change intended to promote research integration fosters student learning outcomes and student perceptions of research integrated into teaching. To serve this purpose, three subsequent cohorts of first-year students were compared, one before and two after a curriculum change. Learning outcomes of these students were measured using scores on a national progress test of 921 students and assessments of a sample of 100 research reports of a first-year student research project. 746 Students filled out the Student Perceptions of Research Integration Questionnaire. The findings suggest that learning outcomes of these students, that is, scores on research related test items of the progress test and the quality of research reports, were better than those of students before the curriculum change.     

Position of the American Dietetic Association: integration of medical nutrition therapy and pharmacotherapy

It is the position of the American Dietetic Association that the application of medical nutrition therapy (MNT) and lifestyle counseling as a part of the Nutrition Care Process is an integral component of the medical treatment for management of specific disease states and conditions and should be the initial step in the management of these situations. If optimal control cannot be achieved with MNT alone and concurrent pharmacotherapy is required, then The Association promotes a team approach to care for clients receiving concurrent MNT and pharmacotherapy and encourages active collaboration among dietetics professionals and other members of the health care team. There are a number of medical conditions, many of them chronic, that will respond to MNT and, therefore, MNT should be the first intervention for these conditions. In addition to being a vital element of the optimal management and control of these conditions, MNT is also a cost-effective method of management. However, because of the long-term nature of these conditions, concurrent pharmacotherapy may become necessary to achieve or maintain optimal control. In cases where this is necessary, MNT should continue to be an integral component of the therapy because it may complement or enhance the therapeutic effectiveness of pharmacotherapy, thereby reducing or eliminating the need for multiple medications. The utilization of a coordinated multidisciplinary team approach is critical to the success of the concurrent use of MNT and pharmacotherapy because of the long-term duration of the treatments, the necessity of monitoring compliance and effectiveness, and the likelihood of multiple medication-nutrient interactions.