A Survey of Nutrition in Medical School Curricula
Today's Dietitian
By LuAnn Soliah, PhD, RD
Vol. 6 No. 2 p. 20

In 1990, the United States Congress mandated that nutrition education become an integrated component of medical education.4 In 1994, the National Academy of Sciences called for improved nutrition education in all U.S. medical schools.3,5 The Healthy People 2010 report also identified the need for physician counseling and education that relates to diet and disease.6

Furthermore, physicians and medical students have stated that they need more general training in nutrition theory and specific training in medical nutrition therapy.7,8 In particular, pediatricians have reported in a Health and Human Services study that they need help dealing with overweight children and unmotivated, uninvolved parents.9

Despite the acknowledgment that physicians are frequently asked to provide guidance and information in nutritional aspects of disease and frequently request such training, nutrition has not been consistently emphasized in medical school curricula.10,11,12 Because of this deficiency, most physicians in the United States enter their professional field without the skills or knowledge necessary to apply nutrition information in their medical practice.

The purpose of this study was to survey all of the accredited medical and osteopathic colleges in the United States to determine the present state of nutrition training in the curriculum. The titles of the actual courses offered and the credit hour(s) were also appraised.

Justification
Nutrition is a key element in attaining and maintaining an optimal health state. Poor diets combined with insufficient exercise are known risk factors for chronic diseases and death (cardiovascular disease, stroke, diabetes, and some cancers). Collectively, these disorders account for two-thirds of all deaths in the United States.13 For these reasons, renewed interest has emerged in nutrition education, and several medical schools are including nutrition in the curricula. Table 1 lists seven reasons to justify changing medical school curricula to place more emphasis on nutrition.

Methods
The 2003 Princeton Review, a comprehensive directory of medical schools, was used to obtain the addresses of all of the accredited medical and osteopathic colleges in the United States.16 The survey was mailed in February 2003 to the 122 accredited medical schools and the 19 accredited osteopathic colleges in the United States. The survey recipients had the option of completing and returning the survey via mail or e-mail.

The survey asked two basic questions: 1) Does your school require nutrition courses in the medical curriculum? 2) If nutrition is not a requirement, is it offered as an elective course? Each of the two questions also asked for the course title and how many credit hours each course contained.

If the medical curriculum advisor did not respond to the survey, the information about the medical curriculum was provided by the 2003 Association of American Medical Colleges (AAMC) database.17 Thus, results were available for all of the medical schools in the United States. The osteopathic colleges were not included in the AAMC database.

Results and Discussion
Approximately 40% of all medical schools and osteopathic colleges provided a separate, required course in nutrition (see Sidebar). Several of the survey respondents provided quantifiable descriptions of the nutrition classes. At schools where nutrition was required, the mean number of credit hours was 2.5 with a range of one to 10 credits. It was rare for medical programs to require more than one nutrition course or for the course to exceed three credits.

Several medical schools and osteopathic colleges offered nutrition as an elective course (see Sidebar). Preclinical or clinical nutrition elective courses are often excellent, but these courses must frequently compete with other equally valid electives such as medical ethics, medical Spanish, geriatrics, and occupational health. The range of responses for the elective courses varied from 1% to 70% selection; however, the typical enrollment was quite low (generally below 25% enrollment for a two-credit course).

Nutrition is often incorporated into other courses (see Sidebar) such as biochemistry, physiology, pharmacology, or pathology. The schools that offered nutrition as an integrated subject matter provided this through class lectures, seminars, clinical rotations, independent study, or computer modules. Too often in science courses, nutrition is cited, but the primary emphasis is on the major discipline. For example, in a biochemistry course, nutrition may be covered in the metabolism unit. Therefore, it is possible to complete the course and not even realize that nutrition was covered. Nutrition taught in this manner is both unsuccessful and irrelevant. The nutrition component of today’s major public health problems (hypertension, diabetes, obesity, anorexia, cancer, and obesity) must be the focus of the material covered.

Prestigious medical colleges such as Harvard, Boston; Vanderbilt, Nashville, Tenn.; Case Western Reserve, Cleveland; and the Mayo Medical School, Rochester, Minn., require nutrition as a part of the medical school curriculum. This is a noteworthy observation because esteemed programs frequently set the pace for other medical programs.

In a 1997 to 1998 survey, the AAMC reported that a nutrition course was required in 26% of the programs, an elective course in 48%, and 26% of the schools lacked nutrition instruction.5 In 2003, this study determined that a nutrition course was required in 40% of the medical and osteopathic programs, an elective course in 13%, and 24% of the schools integrated the subject in other courses. Approximately 23% lacked nutrition instruction of any type or were unable to specify the amount of nutrition courses offered.

Even though it is favorable to know that several medical schools and osteopathic colleges offer a nutrition course, it is still minimal. Most programs (roughly 60%) do not require nutrition. Most dietitians would agree that 100% of medical schools need to teach nutrition to achieve nutrition literacy among future physicians. Nutrition literacy means more than knowing technical aspects of nutrition; it means incorporating nutrition information into therapeutic care. (See Table 2 for reasons why some physicians minimize nutrition information in their current medical practices.)

The American Dietetic Association (ADA) has stated that nutrition is an essential component of medical education. In 1994, it issued a formal position statement on this topic: “The position of the American Dietetic Association is to support the inclusion of education in nutrition as an essential component at all levels of medical education.”3 The ADA has identified five key periods when nutrition could reasonably be included in medical education. They are: 1) during the undergraduate years (premedical education), 2) medical school—preclinical stage, 3) medical school—clinical stage, 4) graduate residency, or 5) continuing medical education.

There is agreement among physicians that nutrition comprises an essential aspect of healthcare. Sixty percent of physicians reported a positive attitude toward nutrition, and they also valued nutrition as a subject matter.3,5,10 These are very encouraging trends. Similarly, the results from this study confirm the diversity, but definite presence, of nutrition education in medical schools and osteopathic colleges. If this momentum continues, nutrition education in all medical programs will become a reality within a few decades.

— LuAnn Soliah, PhD, RD, is a professor at Baylor University in Waco, Tex. She also directs the undergraduate nutrition sciences program. She expresses gratitude to Jen-Yu Wei and Keely Wild for their assistance in data collection and preparation of this manuscript.

References
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13. Wardlaw GM, Hampl JS, DiSilvestro RA. Perspectives in Nutrition. 6th ed. Boston: McGraw Hill; 2004:3.
14. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Vital Statistics Reports. Deaths: Preliminary data for 2000. 2001:49.
15. Wardlaw GM, Hempl JS, DiSilvestro RA. Perspectives in Nutrition. 6th ed. Boston: McGraw Hill; 2004:20.
16. The Princeton Review, The Complete Book of Medical Schools. New York: Random House, Inc.; 2003.
17. Association of American Medical Colleges, Curriculum Management and Information Tool (CurrMIT) online database. Division of Medical Education & Online Resources; 2003.

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