Mireille Boutry, MD
Pediatrics, UHC RB&C
email Dr. Boutry
phone: 844-3752

Abstract.

The goal of this curricular project is to develop a problem-based course in Clinical Nutrition. This course would integrate and build on students' knowledge of basic medical information, pathophysiology, prevention, epidemiology, interviewing skills, nutritional assessment and behavior change techniques. These disciplines will be used in clinical situations presented as problem-based learning.

To meet this goal, a series of cases will be examined, spanning the life cycle from pregnancy and infancy to the elderly. Sessions will be developed for discussion in small group tutorials. These sessions will be complemented by large group lectures. Small groups and lectures will be performed with the cooperation of faculty from the Nutrition Department. Students will take an active part in the course in the form of preparation with assigned reading material and participation in tutorial discussions. At the conclusion of the course, students will perform an assessment of their own dietary habits in context of familial risk factors and develop a personal plan for health improvement.

Scholarly project description.

Goal: Building an Integrated Nutrition Curriculum

Rationale:

Why is an Integrated Nutrition Curriculum needed?
Although the importance of proper nutrition for human health is widely recognized, the teaching of nutrition competency to medical students and residents leaves a lot to be desired in the majority of US medical schools. At CWRU, primary and secondary appointed faculty of the Department of Nutrition assume the teaching of basic nutrition to second-year medical students as part of the Gastroenterology/Metabolism/Nutrition Committee, a CORE Committee. As a part of Curriculum Reform, the amount of time for each Core Committee has been reduced. The total number of hours for the nutrition module of GI/Metabolism/Nutrition has been reduced from 38 to 23. During the third and fourth years of the curriculum, there is no formal teaching of nutrition, and the Department of Nutrition faculty is neither involved in, nor consulted about nutrition education. It is assumed that nutrition competency is to be learned through the interactions between students and preceptors in the clinical rotations. This assumption is anecdotally challenged by medical students.

In addition, the year 2000 AAMC questionnaire, filled by the graduates, included for the first time questions about clinical nutrition competency. More than one-half of the outgoing students stated that they had not been taught how to prescribe a proper diet for a cardiac, renal, or diabetic patient. The students were satisfied or very satisfied about all the other aspects of the medical curriculum. Although the level of satisfaction in nutrition education of the CWRU graduates was similar to the national average, we feel that it is way below the expectation of students and the standards of the institution.

Methods

The working group triad comprised of a faculty member, a second-year and a fourth-year medical student will meet monthly over this academic year to develop this project, in cooperation with other members of the faculty. Students will actively cooperate with the faculty leader to develop the content, the format and the evaluation of this project.
The first step calls for gathering information on other integrated nutrition programs across US. Information of particular importance will include (i) the strategies used by these schools to educate and obtain the collaboration of the clinical faculty across departments, and (ii) the modern teaching tools that facilitate nutrition training and its evaluation (Problem-based learning, instructional CD-ROMs with self examinations, interlinked web pages, etc). I have met with the physician in charge of the integrated Nutrition curriculum of Harvard Medical School, who gave me the material used in their curriculum This gives me a very helpful head start on this project.

The second part of the project is to prepare an outline of the various subjects to be included in the proposed integrated nutrition curriculum. Nutrition is a complex field that integrates medical basic science, epidemiology, evaluation skills in the psychological aspects of behavior medicine, anthropomorphic evaluation skills, nutrition intake assessment, familial risk factors and morbidity assessment, as well as counseling for behavior change, prevention and health maintenance. The group will explore ways in which these related topics can be integrated and organized (for instance, in a life-cycle presentation, from pregnancy and infancy to the elderly or around particular diseases prevention and management). This step will be the most work-intensive and will require extended consultations with various inter-departmental faculty.

A third step will be to develop an educational format. Teaching methods will be discussed to deliver content and context as a lively, adult learning experience. Focused lectures followed by problem-based small group sessions will be explored. Alternative means of delivering this curriculum, such as through an area of concentration, will depend on the success of the course delivery. Therefore, the final component of this project will be the design of a evaluation tools. Measurement tools are needed to assess whether the curriculum meets the learning objectives, and whether the students have met the academic requirements (pass/fail).