If you type the phrase “What do doctors know about nutrition?” into an Internet search engine, the most common result will be “not much.”
Some links will open on articles claiming that busy doctors have no time for diet advice during brief office visits. Other will lead to authors who chastise medical educators for drilling students on neurology at the expense of nutrition.
The National Academy of Sciences recommends that medical students get at least 25 hours of instruction about nutrition. Even though this advice comes from a highly respected group, the fact is that only 30 U.S. medical schools — roughly 25 percent of the national total — actually follow it.
At the new medical campus in Athens, Dean Barbara Schuster’s faculty has chosen a different route from what is supposed to be the norm on nutritional instruction. It’s not focused on devoting hours to formal nutrition courses.
She says the “case-based” approach used at Georgia Regents University-University of Georgia Medical Partnership (GRU-UGA) teaches students how to build nutritional considerations into treatment plans for their patients.
Dr. Schuster freely acknowledges that the school offers no freestanding courses on nutrition, but this does not trouble her. She resists the idea that nutrition is something to be taught in isolation.
Information about what constitutes healthy or unhealthy eating, and how nutrients can promote health and healing, is abundant in the school’s curriculum, she says. It’s incorporated into lectures, discussions and problem-solving exercises.
“We integrate all the information within our case-based structure,” Schuster said. “Elements of nutrition really are added across the curriculum into the cases.”
During a biochemistry learning module, for example, students might be required to examine a runner’s metabolism. They would analyze the athlete’s energy needs and consider how different types and quantities of foods could meets those needs. They’d work out how foods are transformed into energy, calculating how many calories the runner needs based on his or her body weight.
A practical approach to obesity
Knowledge about nutrition becomes even more important in the third year of medical schools, when students begin clinical rotations that take them into hospitals and doctors’ offices.
A student on a surgical track may need to look at the food intake of a patient recovering from an operation, with the goal of restoring normal metabolism as soon as possible. Those focusing on family medicine may see patients who have been obese for years, and the medical student may wrestle with the challenge of providing effective counseling in an office setting.
More than 78 million Americans face the life-threatening problem of obesity, and the rates are highest in the South.
Schuster’s philosophy, of course, is not to look at the problem in isolation.
What families choose to eat often depends on what they can afford. The Athens medical students are taught to consider diet in the context of a patient’s income and access to medical advice, two key factors in obesity. The students learn to take all these factors into consideration when calculating treatment plans for temporary illness, injury or chronic disease.
“We really try to intermingle aspects of poverty and a lack of medical care into the curriculum as well,” said Shuster. This is important because students learn to understand how complex a person’s overall well-being really is.
When researchers at the University of North Carolina at Chapel Hill examined trends in nutrition education at U.S. medical schools, they found that the number of hours usually falls short of the National Academy of Sciences recommendation. And the number of hours is actually dropping.
But hour totals are not necessarily an indication of how well the subject is being taught. In Athens, for instance, the case-based learning methods of the Medical Partnership are an “excellent way to integrate nutrition into medical education,” according to Dr. Mary Ann Johnson, a foods and nutrition professor at UGA and a national spokewoman for the American Society for Nutrition.
Johnson believes national guidelines can encourage medical schools to integrate nutrition education into their teaching, and she says technology is also changing the landscape as doctors use mobile devices to supplement their own memories.
“Health professionals should know where to access nutrition education and advocacy resources and should use innovative approaches, including online resources and case-based approaches to enhance learning,” she says.
Johnson believes that integrating learning about food, diet and nutrition into standard medical instruction is more important than setting aside a certain number of hours for nutrition classes.
This is what Schuster hopes that graduates of the GRU-UGA Medical Partnership will remember a decade from now, when they have their own patients to care for.
“Students may not have taken courses on food, but we’ve put all those areas of nutrition in throughout the curriculum just like everything else, so it’s not separate,” she says.