American Journal of Clinical Nutrition, Vol. 72, No. 3, 882S-889s,
September 2000
© 2000 American Society for Clinical Nutrition
Integrating nutrition as a theme throughout the medical school curriculum1,2,3
Clifford Lo
1 From the Harvard Human Nutrition Program; the Division of Nutrition, Harvard Medical School; the Department of Nutrition, Harvard School of Public Health; and the Clinical Nutrition Service, Division of Gastroenterology and Nutrition, Children's Hospital, Boston.
2 Presented at a symposium held at Experimental Biology '99, in Washington, DC, April 17, 1999.
3 Address correspondence to C Lo, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail: lo{at}a1.tch.harvard.edu.
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ABSTRACT
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More than one-third of adult Americans are obese. A major portion of the diseases that cause the highest morbidity and mortality, eg, heart disease, cancer, diabetes, stroke, and hypertension, can be attributed to diet. Yet, despite the demand for more nutrition education, few medical schools have an adequate nutrition curriculum. Many medical schools are reducing the number of lecture hours in favor of problem-based tutorial discussions, so an addition of another mandatory lecture course is not likely. The organization of nutrition as a theme throughout the 4-y medical school curriculum can pull together many hours of nutrition information taught during various courses, eg, biochemistry, physiology, pathophysiology, clinical clerkships, and electives. Emphasis should be placed on the identification of available resources (eg, faculty throughout the medical school and affiliated hospitals, textbooks, research, and clinical experiences) and applied to practical clinical situations so that students are able to identify, assess, and appropriately manage the frequent nutritional problems seen in outpatients and inpatients. Strategies and techniques such as curriculum analysis, computer-aided instruction modules, Internet Web sites, case-based tutorial discussions, use of physician nutrition specialists and dietitians, administratively separate nutrition units, observed structured clinical examinations, and faculty development are listed and discussed in this article.
Key Words: Nutrition • medical education • nutrition education • medical school curriculum • education • nutrition curriculum
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INTRODUCTION
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There is an increasing awareness of the importance of nutrition in the maintenance of health and the prevention of disease; diet has a major role in the pathogenesis of heart disease, cancer, stroke, liver disease, osteoporosis, dental caries, and accidental deaths (1). Obesity now affects nearly one-half of adult Americans, with an increasing incidence of diabetes and its complications. Almost one-third of hospitalized patients meet the criteria for malnutrition (2), often aggravated by surgery or medical therapy.
Most physicians, however, do not feel comfortable discussing nutrition with their patients and most medical students readily admit that they do not get enough training in nutrition during medical school. Studies indicate that most US medical schools and teaching hospitals lack adequate nutrition-related training for students, postdoctoral residents, and practicing physicians (3). Medical students spend many hours memorizing the intricacies of cellular metabolism and function in health and disease, but very little effort is given to the practical application of these forgotten facts to assessing and managing the nutritional problems of patients.
Over the past 3 decades, many articles (4, 5), symposia (6–10), and even congressional hearings (3) have called for increased nutrition education for medical students. However, most (more than two-thirds) medical schools in the United States still do not have a specific nutrition course in their curriculum (11). Most students enter medical school eagerly expecting some attention to be given to nutrition (12), but most feel that their nutrition education is quite inadequate (13).
In 1995, the American Medical Association noted the necessity of drastic change in medical school curricula and thus called for the teaching of more nutrition in basic science lectures and clinical rotations (14). In response, health care educators are now trying to implement comprehensive nutrition curricula—a trend that reflects a growing awareness of the need for revised medical school programs to reflect society's increased emphasis on primary care and preventive medicine.
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NUTRITION OBJECTIVES AND PRIORITIES
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A long list of nutrition topics and objectives has been generated by medical educators and students (15–18) (Table 1
). These topics may change remarkably at different stages in the curriculum. For example, an interest in alternative medicine and vitamin supplements may be high at the beginning of medical school, coinciding with coverage of metabolic pathways in biochemistry, but by the third and fourth year, total parenteral nutrition in the intensive care units and transplantation services may be of more interest.
These lists include far too many subjects to cover in one separate lecture course, especially when certain disease-specific or nutrient-specific nutrition topics might be best covered at certain key learning points in other courses. The roles of thiamin and niacin may be emphasized in an introductory metabolism course, whereas learning about iron, folate, and vitamin B-12 would correspond well with the teaching of hematologic pathophysiology, and nutritional assessment would be a critical part of a history and physical examination course (Table 2).
Students should be encouraged to develop their own educational objectives, and to organize and explore the educational resources to be used over a lifetime. Educational objectives should be stated in terms of processes, not content. Emphasis should be placed on acquiring task-oriented skills rather than passive, content-oriented knowledge. Students should be trusted to independently explore areas of interest and be given the time to pursue these interests, and teaching should focus on students' preferences rather than on teacher's prescriptions. It is more important to teach students how to investigate an area of interest so that they can continue to learn in the future than to present a comprehensive but soon-outdated passive review of many areas of nutrition.
It is surprising how many students are tested on rote memorization of the glycolytic pathway, which is quickly forgotten if not used, without realizing the roles that specific nutrients, eg, thiamin, niacin, calcium, and phosphate, play. Because nearly half of adult Americans are obese and numerous surveys (2) have shown that as many as one-third of hospitalized patients meet the criteria for malnutrition, it is important for third-year medical students to collect and plot basic heights, weights, and body mass indexes or anthropometric percentiles of their patients rather than to accept missing data in lieu of the overused and often inaccurate description "well-developed, well-nourished." Indeed, with more medical schools curricula focusing on case-based learning in discussion groups rather than long hours of content-based lectures, the opportunities for introducing additional courses or lectures into the medical curriculum may be limited (19). There may be a lack of faculty who have the time and training in nutrition to conduct labor-intensive discussion groups. An estimated 20–40 tutors are needed for each of the 15 courses in the first- and second-year medical school curriculum, drawn from busy researchers and clinicians who are rarely paid for their efforts.
Therefore, new approaches to nutrition education in the medical school curriculum are needed to capitalize on the opportunities inherent in curricular reform without reverting to outdated and unworkable strategies, ie, more lectures. Kushner et al (20) outlined 5 steps to promoting nutrition education and implementing change in medical schools, which we also followed at Harvard Medical School (HMS): 1) know your curriculum, 2) identify nutrition faculty, 3) develop proposals for integrating nutrition into the medical curriculum, 4) watch for opportunities, and 5) make nutrition cross-sectional and longitudinal.
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ANALYSIS OF CURRICULUM
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The first step in integrating nutrition education into the medical school curriculum was a preliminary analysis of courses in the current curriculum. Although there was a required second-year course in nutrition and preventive medicine, nutrition was actually taught in many areas of the curriculum. Most medical students believed that they should receive training in nutrition and that nutrition was not taught adequately in medical school. However, when the students analyzed their curriculum, especially courses in metabolism, physiology, and pathophysiology (human systems), there were many hours of lectures and many case discussions that were devoted to subjects that form the essential background of nutrition science, eg, carbohydrate and fat metabolism, protein synthesis, nutrient absorption, regulation of mineral homeostasis, and nutritional anemias. More than two-thirds of the lectures and cases in biochemistry, and nearly half of the lectures and cases in physiology, pertained to nutritional subjects (Table 2
).
The problem was that the class material, rightly or wrongly, was not identified specifically as nutrition education, was often not integrated as practical knowledge to be used in clinical situations, and was seldom retained for clinical application after board exams. For example, students would sometimes not make the connection between dietary or intravenous sodium intake and the physiology of renal sodium reabsorption, pathophysiology of congestive heart failure, and the pharmacology of diuretics, sometimes leading to the inappropriate administration of extra sodium chloride and diuretics simultaneously. With the recent shift of emphasis on ambulatory care and prevention of chronic disease, ensuring that students can adequately identify and assess obesity and other nutritional risk factors has become much more important, in addition to appropriate patient counseling and referral skills (11).
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HANDBOOK OF NUTRITION RESOURCES AND WEB SITE
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To publicize the extent and goals of nutrition in the 4-y curriculum, the Handbook of Nutrition Resources at Harvard was published and distributed to the students and faculty. This handbook contained the following:
- A medical school curriculum map with nutrition content highlighted.
- Nutrition objectives for each year with the nutrition content of various courses and lectures listed.
- Suggested resource contacts of several broad nutrition areas.
- Nutrition advisory and curriculum board members.
- A list of >100 HMS faculty and staff engaged in clinical nutrition or nutrition-related research.
- A list of clinical clerkships, directors, and nutrition resources at each affiliated hospital.
- A list of nutrition seminars, rounds, conferences, electives, and courses at HMS, affiliated hospitals, and the Harvard School of Public Health. The first 2 editions of the handbook were printed as paper copies and then distributed to students as part of nutrition software on palm-top computers.
Several years ago an educational grant allowed the free distribution of individual palm-top computers to first- and second-year students at HMS. We initially developed several software programs for diet analysis, nutritional assessment, and calculations of ideal body weight, body mass index, basal metabolic rate, and parenteral and enteral nutrition calculations, as well as the nutrition handbook resources, which were distributed on a chip that could be inserted into the palm-top memory.
More recently, this information, as well as most of the students' class syllabi of the first 2 years, is being loaded onto an intranet Web site with a search engine that allows for cross-indexing with hypertext links and the immediate display of all nutrition or general topics covered in any course within the first 2 years. This will immeasurably aid the integration of theme material covered in several courses, both for faculty developing lectures and cases and for students.
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CASE-BASED CURRICULUM
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In 1985 HMS introduced the New Pathway, an innovative 4-y curriculum based on the acquisition of a flexible and integrated knowledge base, lifelong learning skills, and sensitivity to patients (21). The program uses a variety of active learning formats, including small-group, problem-based tutorials developed by interdisciplinary faculty teams with assistance from professional educators.
With the redesign of the entire medical school curriculum to a case-based, problem-oriented tutorial curriculum design, each existing course needed to be redesigned. Long hours of passive content-based lecture courses were redesigned in favor of patient case discussions in small tutorial groups. A goal of only 1–2 h of lectures/d were coupled with tutorials of 8 students discussing a patient case with questions, references, articles, and tutor guides (eg, curriculum reference materials). Tutors, aided by a written tutor guide, were coached to let students organize and lead discussions.
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NUTRITION AS A THEME
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Because there was even less time in the new curriculum for the addition of lectures or new courses, certain longitudinal curricular themes were introduced, eg, prevention, HIV and AIDS, ethics, addictions, geriatrics, nutrition, and environmental and occupational health. Theme leaders were designated to coordinate the amount of attention given to each subject at several points over the entire 4-y (or longer) medical school curriculum rather than limiting exposure to a single course. A curriculum map was drawn to highlight places in several courses in which nutrition would be discussed (Figure 1).
In year 1, the foundations of nutrition science are presented in cell biology and physiology lectures, in focused exercises, and in cases of nutritionally related diseases. In year 2, nutrition is a major part of a course in nutrition and preventive medicine, as well as in various parts of human systems blocks, particularly gastrointestinal, renal, and endocrine systems. Dietary and nutrition assessment should be part of the medical history and physical examination skills taught in patient-physician and introduction to clinical medicine sessions. Clinical clerkships, especially in surgery, ambulatory medicine, and pediatrics, should provide an opportunity for students to apply nutritional assessment skills to their patients. Fourth-year clinical nutrition and advanced biomedical science electives are available to students who are particularly interested in clinical or research nutrition.
An advisory committee of faculty, students, and medical educators has met regularly since 1993 to establish curriculum goals, analyze existing medical school nutrition curricula, and develop nutrition resources and materials for both faculty and students to promote learning and awareness of the importance of nutrition in health. An important part of the curriculum development has included programs for computer-based learning, particularly in developing nutrition programs for the palm-top computers that are used by most Harvard medical students. Advanced biomedical electives in the fourth year, electives or fellowships in clinical nutrition at several of the teaching hospitals, and advanced degrees in public health, nutritional epidemiology, or nutritional biochemistry are other pathways for further study in nutrition.
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NUTRITION COURSE
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A required second-year course in nutrition and preventive medicine serves as a bridge between the basic science approach teaching nutrition as metabolism and physiology in the first year, and the clinical application of nutrition in the third-year clerkships. The previous lecture-based course was totally redesigned by a committee that met weekly for several months each year. A life-cycle approach was implemented, which focused on patient cases of pregnant women, infants, school-aged children, adolescents, middle-aged adults, and elderly persons and incorporated discussions of numerous nutrition and preventive health issues, eg, folate supplementation, breast-feeding, failure to thrive, immunizations, eating disorders, obesity, screening, smoking, atherosclerotic heart disease, osteoporosis, and malnutrition. This course was bolstered by practical experience in nutritional assessment, nutrient requirements, dietary guidelines, and counseling. Students were encouraged to record and analyze their own diets and to counsel case patients with the aid of hospital dietitians who were invited to attend tutorials as resource persons.
Tutors were recruited among faculty members and fellows in the clinical areas of internal medicine, surgery, and pediatric and primary care; however, recruitment was not restricted to individuals with specific nutrition training. Although weekly faculty development workshops and discussions were held to share teaching techniques and experiences, the emphasis was on allowing students to discuss and research questions rather than rely on tutors as nutrition experts. Most tutors, however, had a wealth of clinical experience to draw upon when discussing common medical nutrition problems, eg, failure to thrive, hypertension, diabetes, and obesity. Indeed, most tutors did not realize how much knowledge of clinical nutrition they actually had and came to consider teaching medical students through this approach as a much more effective experience than simply attending a lecture-based nutrition continuing education course.
In 1995, The American Society for Clinical Nutrition's Committee on Clinical Practice Issues recommended the use of physician nutrition specialists who have experience teaching medical school courses or postgraduate seminars on key nutrition topics (22, 23). Although these physician nutrition specialists are crucial for the writing and organizing of curriculum materials, few medical schools will have enough designated nutrition experts to fill all tutorial needs, so training other physicians or dietitians in the case-discussion method may be an important part of faculty development.
The American Journal of Clinical Nutrition, in a special review of nutrition education in US medical schools, suggested the use of regional networks and groups of academic faculty with research interests or expertise in particular nutrition topics. Computer-based nutrition CD-ROM programs on nutritional anemias and nutrition and cancer have been used as supplementary resources in a number of courses, eg, Human systems-Hematology.
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CLINICAL CLERKSHIPS
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Highlighting nutrition in third-year clinical clerkships is a particular challenge in many medical schools because of the decentralization of clinical departments throughout several teaching hospitals. Course directors often have nearly complete autonomy in developing different teaching content at different sites, over and above the inherent variability in patient case experiences. Students may see mainly ambulatory patients in some clerkships, whereas students in other clerkships may see mainly critically ill intensive care patients (eg, burn, transplant, or cardiac surgery cases), yet it is important that they learn to consider the nutritional status and needs of all their patients. Efforts have been made to identify and contact key clerkship directors and clinical nutrition educators at each institution in the extensive HMS system, to survey the amount of specific nutrition emphasis provided, and to highlight the clinical nutrition services.
There is a specific focus on the third-year medicine clerkship at Beth Israel Deaconess Hospital, which offers special sessions on nutrition assessment (with the use of the palm-top computers) and provides visits to the obesity clinic.
Fourth-year clinical electives in clinical nutrition exist at several hospitals, usually involving the nutrition support service as well as an advanced biomedical science elective on nutrition and metabolism in which several students are given an intensive course on nutritional physiology. Several HMS students are awarded travel fellowships each year to visit foreign countries, such as Guatemala, where they are placed in clinical or research settings that allow them to see malnutrition in developing countries first hand.
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DIVISION OF NUTRITION
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Recently, a division of nutrition at HMS was established under W Allan Walker and George Blackburn to coordinate and extend nutrition education and research activities among the many faculty who engage in nutrition-related research or clinical nutrition. The Division of Nutrition and the Harvard Human Nutrition Program sponsors nutrition programs and orchestrates activities among HMS, teaching hospital clinical departments, the Harvard School of Public Health Department of Nutrition, and other schools of Harvard University and Boston-area universities. It facilitates collaboration between clinical and research faculty at various sites, promotes sharing of resources, and coordinates nutrition education and curriculum development efforts for medical students, practicing physicians, and other health care professionals.
There is close cooperation between the Department of Nutrition at Harvard School of Public Health, chaired by Walter Willett, which is particularly strong in nutritional epidemiology, with the Nurses Health Study, the Health Professionals Study, and the Women's Health Initiative. Several HMS faculty members have joint appointments and frequently collaborate during research, as well as teach and speak in classes or symposia at other Harvard institutions. One notable collaboration has been with the annual Private and Public, Scientific, Academic, and Consumer Food Policy Committee, a conference at the Harvard Business School at which academic, government, public, and food industry leaders discuss nutritional topics of international concern.
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NETWORKING HOSPITAL CLINICAL NUTRITION SERVICES
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Regular meetings of clinical nutrition faculty members include monthly joint Longwood Area clinical nutrition rounds (attendance of 40–50 members), monthly dinner speakers sponsored jointly by the Harvard Clinical Nutrition Research Center and the Tufts-US Department of Agriculture Human Nutrition Research/Obesity Center and held at the Massachusetts Institute of Technology Faculty Club. Annual continuing-education courses on hyperalimentation, obesity, hospital malnutrition, pediatric nutrition, and primary care are sponsored by the various Harvard clinical nutrition services (Figure 2).
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FIGURE 2. . Harvard Human Nutrition Program: Harvard Schools, departments, affiliated teaching hospitals, and other programs involved in nutrition.
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Annual sponsored symposia on topics such as nutrition and cancer and food safety include national and international invited speakers as well as speakers from the Harvard community. Videotaped proceedings will be disseminated on Internet Web sites (MEDVIEW). Numerous newsletters and nutrition textbooks have been published and are planned for faculty development and continuing-education of residents, fellows, physicians, nutritionists, and the public.
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EVALUATION
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Efforts toward the development of educational nutrition resources may be fruitless unless students make use of such resources and show measurable increases in their knowledge and ability to apply that knowledge to practical situations. Despite concerns to the contrary, the movement toward a case-based medical school curriculum has not shown any declines in objectively measured knowledge content scores and may show increases in students' abilities in practical application. It may be less important for students to recite memorized metabolic pathways than to be able to perform appropriate nutritional assessments of their patients, as long as they know where to find relevant references.
Fortunately, the nutritional content of national board exams was reported to have increased from 9% to 12% (24), so even evaluators acknowledge the importance of nutrition in medicine. Most national board and specialty board certification exams are now moving away from multiple-choice content questions, turning instead toward more clinical problem-solving situations.
HMS is now also requiring objective structured clinical examinations with patients, in which all second-, third-, and fourth-year students are evaluated on the basis of questions asked of patients during the medical history and maneuvers performed during the physical examination. Theme leaders are unanimous in their preference that students know when and how to ask appropriate questions during routine history and physical examinations (eg, dietary histories, weight, height, and nutritional counseling) rather than perform on multiple-choice, content-based examinations.
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SUMMARY
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Although there are many resources available and much progress has been made in advancing nutrition education at HMS, many problems still exist and much work remains to be done. Some of the ongoing problems and potential solutions include the following:
- Students still often do not know when they are receiving nutrition information or how to apply this information. This problem is best countered with active learning, case-based learning, and student-organized educational initiatives.
- A major problem is favorably influencing basic science course directors and clinical clerkship directors to include or emphasize nutrition course content. This problem needs continued advocacy of nutrition education by physician nutrition specialists, especially through curriculum committee membership and the fostering of personal relations throughout the medical school and affiliated hospitals.
- During times of curriculum change, it may be difficult keeping up with course curriculum changes. A good relationship with the medical education staff is very productive in terms of curriculum development and use of technical tools, eg, Web pages.
- One of the most important basic tasks is influencing department chairmen and deans to emphasize nutrition in the curriculum. Forming an administratively separate division of nutrition will do much to advance the visibility of nutrition but may require a considerable fund-raising effort, which may be facilitated by recent requests for proposals from the National Cancer Institute and other organizations.
- Faculty development is needed to ensure an available core of nutrition faculty or clinicians who are able to teach and practice nutrition. Dietitians, fellows, and primary care practitioners may be excellent nutrition teachers, especially if their clinical experience is emphasized. This may be supplemented by computer learning modules, nutrition symposia, continuing-education courses, and specific faculty educational development sessions.
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REFERENCES
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Willett W. Diet and health: what should we eat? Science 1994;264: 532–7.[Abstract/Free Full Text]
-
Hendricks K, Duggan C, Gallagher L, et al. Malnutrition in hospitalized pediatric patients. Current prevalence. Arch Pediatr Adolesc Med 1995;149:1118–22.[Abstract/Free Full Text]
-
Davis CH. A report to Congress on the appropriate federal role in assuring access by medical students, residents, and practicing physicians to adequate training in nutrition. Public Health Rep 1994; 109:824–6.[Medline]
-
White JV, Young E, Lasswell A. Position of the American Dietetic Association: nutrition-essential component of medical education. J Am Diet Assoc 1987;87:642–7.[Medline]
-
Winick M. Report on nutrition education in United States medical schools. Bull N Y Acad Med 1989;65:910–14.
-
Aronson S. Medical education and the nutritional sciences. Am J Clin Nutr 1988;47:535–40.[Free Full Text]
-
Swanson AG. 1990 ASCN nutrition educators' symposium and information exchange: nutrition sciences in medical-student education. Am J Clin Nutr 1990;53:587–8.
-
Nestle M. Nutrition in medical education: new policies needed for the 1990s. J Nutr Educ 1998;20:S1–29.
-
Vitale J, Hodges RE. Symposium: teaching nutrition in medical schools. Am J Clin Nutr 1977;30(suppl):793–24.
-
1987 ASCN workshop on nutrition education for medical/dental students and residents—integration of nutrition and medical education: strategies and techniques. Am J Clin Nutr 1988;47:534–50.[Free Full Text]
-
Feldman EB. Educating physicians in nutrition—a view of the past, the present, and the future. Am J Clin Nutr 1991;54:618–22.[Free Full Text]
-
Weinsier RL, Boker JR, Morgan SL, et al. Cross-sectional study of nutrition knowledge and attitudes of medical students at three points in their medical training at 11 southeastern medical schools. Am J Clin Nutr 1988;48:1–6.[Abstract/Free Full Text]
-
Weinsier RL, Boker JR, Feldman EB, Read MS, Brook CM. Nutrition knowledge of senior medical students: a collaborative study of southeastern medical schools. Am J Clin Med 1986;43:959–68.
-
Barzansky B, Jonas HS, Etzel SI. Educational programs in US medical schools, 1994–1995. JAMA 1995;274:716–22.[Abstract/Free Full Text]
-
Priorities for nutrition content within a medical school curriculum: a national consensus of medical educators. American Society for Clinical Nutrition Committee on Medical/Dental School and Residency Nutrition Education. Acad Med 1990;65:538–40.[Medline]
-
Chamberlain VM, Mays MH, Cummings MN. Competencies in nutrition that US medical students should acquire. Acad Med 1989; 64:95–8.[Medline]
-
Weinsier RL, Boker JR, Brooks CM, et al. Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators. Am J Clin Nutr 1989;50:707–12.[Abstract/Free Full Text]
-
Essentials of nutrition education in medical schools: a national consensus. American Medical Student Association's Nutrition Curriculum Project. Acad Med 1996:71:969–71.[Medline]
-
Swanson AG. Nutrition sciences in medical student education. Am J Clin Nutr 1991;53:587–8.[Free Full Text]
-
Kushner RF, Thorp FK, Edwards J, Weinsier RL, Brooks CM. Implementing nutrition into the medical curriculum: a user's guide. Am J Clin Nutr 1990;52:401–3.[Abstract/Free Full Text]
-
Tosteson DC. New pathways in general medical education. N Engl J Med 1990;322:234–8.[Medline]
-
The role and identity of physician nutrition specialists in medical school-affiliated hospitals. Committee on Clinical Practice Issues in Health and Disease. Am J Clin Nutr 1995;61:264–8.[Abstract/Free Full Text]
-
Bringing physician nutrition specialists into the mainstream: rationale for the Intersociety Professional Nutritional Education Consortium. Am J Clin Nutr 1998;68:894–8.[Abstract]
-
Hark L, Iwamoto C, Melnick DE, et al. Nutrition coverage on medical licensing examinations in the United States. Am J Clin Nutr 1997:65:568–71.[Abstract/Free Full Text]
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TOP
ABSTRACT
INTRODUCTION
