Nutrition education is key component of health professional students' training

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As Hippocrates once so famously said, "let food be thy medicine, and medicine be thy food." If the father of medicine already understood the important role food played in health, then why isn't nutrition education an integral part of all health care professional students' education?

As diet-related disease continues to rise, we need our nurses, doctors and other health care providers to not only understand the role nutrition plays in chronic disease prevention and treatment, but also how to propose nutrition interventions that are realistic for their patients.

A 2014 report from the Bipartisan Policy Center found more than two-thirds of physicians feel they received inadequate training in counseling patients on diet or physical activity. Fewer than 30 percent of U.S. medical schools meet the minimum recommendations for training medical students in nutrition counseling recommended by the National Academy of Sciences.

OHSU is taking steps to change that.

Medical students graduating this academic year are the first cohort to be part of the YOUR M.D. curriculum throughout their time at OHSU. This transformed curriculum weaves nutrition throughout the first 18 months of medical education. In addition to teaching the fundamentals of nutritional science and its role in chronic disease, students learn to identify individuals and families at nutritional risk and to talk with patients about strategies to eat a varied and balanced diet.

"Good nutrition is the foundation for health," said OHSU Moore Institute Associate Director for Nutrition, Diane Stadler, Ph.D., R.D. Stadler chairs the Moore Institute Nutrition Education for Health Professional Students Committee and was involved in the curriculum update. "We want students to appreciate how important nutrition is in the care of their future patients and feel confident and competent in starting that conversation with them," she added.

In addition to the core curriculum, electives allow students to explore their individual interests in more depth. Interprofessional electives give students from all health professional programs the opportunity to interact and learn from one another, much as they will do during their careers. This past academic year saw the launch of the "Introduction to Culinary Medicine" elective. This class, created by Stadler, Brian Frank, M.D., a physician at OHSU Family Medicine at Richmond and others, aimed to bring together students from multiple health professional programs to get hands on cooking skills and a better understanding of their patients' unique needs.

Students met monthly to learn about the health promoting benefits of different foods, the relationship between food, culture and nutritional health and how food can serve as part of a medical intervention to improve health. Students learned to put these messages into practice by cooking and eating meals together. They tracked their carbohydrate intake to better understand what they would be asking their diabetic patients to do. They went grocery shopping on a budget, and they analyzed the caloric and nutritional content of the meals they cooked together.

For second year medical student Alexandra Ninneman, the cooking on a budget lesson really resonated. Students had no time to plan menus in advance. They were put into teams of four and dropped at the local grocery. Each team had six dollars to spend on ingredients, similar to what a patient on SNAP benefits might have to feed a family of four. Each meal had to include a full cup of vegetables.

"It was a challenge," Ninneman said. "It created some interesting conversations. We realized that being able to buy in bulk and do the math on why that is cost effective makes sense, but patients on a fixed income may not be able to do this."

That's one of the key lessons the class creators were hoping students would take away from this class –what it really takes to develop a workable nutrition plan for a specific patient.

"It isn't enough to simply tell a patient to eat better, to lower their sodium or cholesterol, said Frank. "Health care providers need to be able to talk about what that means, why it is important and help develop practical and sustainable interventions for patients."

Ninneman agrees. She learned firsthand during a preceptorship she completed with Frank. She recalled an older man with diabetes she was able to work with to develop a concrete eating plan he could follow and how it felt to be able to put the work from the class to use.

"When we are asking patients to make these lifestyle changes, now we have a better idea of what it looks like in practice," she said.

Stadler and Frank have been in discussions with the School of Medicine Alliance, a service-oriented group that supports the OHSU School of Medicine, to fund a condensed version of the class for medical student enrichment weeks. These weeks are held in between each of the course blocks and allow students to take short courses on specific topics of interest to them. If sustained funding and resources can be put in place, the class will become a regular fixture.

"All of the major diseases of the 20th Century are diet-related," said Frank. "Unless we equip health care professionals with the tools to combat these diseases, we are resigning ourselves to more of the same: increased health care costs, and poor health outcomes."