At a time when obesity and diabetes are on the rise, medical schools have not provided the recommended amount of nutrition training. But Texas medical schools and residency programs are getting ahead of the curve in addressing this issue, according to Texas Medicine magazine, published by the Texas Medical Association.
On average, U.S. medical schools teach 19 hours of nutrition-related education across the four-year undergraduate medical curriculum — six hours less than the National Academy of Sciences’ recommended minimum of 25 hours. And most of this training takes place in science-based courses and not in a clinical setting with patients.
“When I was in medical school, we had one two-hour course on nutrition, and essentially all it was about was what vitamins do for you, how bad salt is, and the proper ratio of protein to carbohydrates. And the food pyramid we had then doesn’t exist anymore,” said Darrin C. D’Agostino, DO, chair and associate professor of internal medicine at the University of North Texas Health Science Center (UNTHSC) Texas College of Osteopathic Medicine (TCOM) in Fort Worth. “Now, 20 years later, we have grown in our understanding of dietary and nutrition science, and medical schools have identified that nutrition is critically important in medical education. It's a thread that moves through a lot of diseases, so we are integrating the information [into the curriculum] as best we can.”
Educators agree it's not about the quantity of time schools pour into nutrition education, rather the quality of the ingredients. And Texas medical schools are finding innovative ways to integrate the topic into required and elective courses so that it translates better to patient care.
For instance, TCOM’s curriculum teaches students about interrelationships between various systems in the body and how nutrition affects each system. Medical students also interact with trainees in other health professional schools on UNTHSC’s campus, where nutrition comes up in the context of learning collaborative practice skills.
Last spring, TCOM introduced an elective culinary medicine course that links cooking to nutrition science and teaches teamwork. Students trade their white coats for aprons and learn to cook healthy dishes for chronically ill patients with poor diets.
In Lubbock, Texas Tech University Health Sciences Center’s (TTUHSC’s) Family Medicine Residency Program included a nutritionist on its faculty, and residents spend time learning what it feels like to get and record finger sticks using a glucometer – something diabetic patients must do routinely – and understanding and eating different diets their patients might get in the hospital.
In Houston, Baylor College of Medicine’s curriculum includes lectures on the importance of personal nutrition and incorporates nutrition into courses on disease and preventive health. And three years ago, Baylor medical students themselves designed an elective to enhance the school’s nutritional curriculum. The Baylor CHEF (Choosing Healthy, Eating Fresh) course targets second-year students as they transition into working with patients, teaching them to cook while learning from physician faculty and nutritionists about personal health, nutrition basics, and the impact of nutrition on maternal and cardiovascular health.
The goal of these integrated courses, Dr. D’Agostino said, is not to turn future physicians into dieticians. Instead, he said, it’s “to prepare our students as best we can to take care of patients, and nutrition, medication, and lifestyle all have to be brought in. Nutrition is going to be one of the most critical elements of value-based care going forward.”