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Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training^1,2,3

¹ From the Division of Health Promotion Sciences, University of Arizona, College of Public Health, Tucson; the Department of Family and Community Medicine and the Division of Academic Resources, University of Arizona, College of Medicine, Tucson; Pima Community College, Tucson; and the Kaiser Center for Health Research, Portland, OR.

Background: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills.

Objective: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students.

Design: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate.

Results: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (±1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 ± 0.9% compared with 50.6 ± 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%).

Conclusion: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.

Key Words: Medical education • nutrition education • curriculum evaluation • medical school curriculum

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