The Lancet Planetary Health: Our new study finds medical education does not equip students to provide high quality nutritional care
Why is this study important?
Globally, 11 million deaths annually are attributable to poor diet, making it the leading risk factor for death across the world . Accordingly, many countries recommend that doctors apply nutrition knowledge in practice to support patients to manage lifestyle-related chronic disease and other diet-related conditions. A well recognised evidenced-practice gap exists between the nutrition knowledge, skills, and attitudes needed for nutrition care and the nutrition education provided to medical students.
What did the study investigate?
Our systematic review aimed to critically synthesise literature on nutrition education provided to medical students. It identified new insights into how medical nutrition education can be enhanced to ultimately improve dietary behaviours of individuals and populations worldwide.
The review looked at studies assessing recently graduated (ie, ≤4 years) or current medical students’ nutrition knowledge, attitudes, skills, and/or confidence in nutrition or nutrition counselling; the quality of nutrition curriculum initiatives for medical students; or recently graduated or current medical students’ perceptions of nutrition education.
We included 24 studies conducted between 2012-18, including 16 quantitative, three qualitative and five studies on curriculum initiatives. The studies came from USA (11), Europe (four), the Middle East (one), Africa (one), and Australasia (seven), and the methodological quality of the studies ranged from very low to high.
What did the study find?
The reviewed studies consistently found that medical students wanted to receive nutrition education to develop their skills in nutrition care but perceived that their education did not equip them to do so.
Students cited both quantity and quality of their education as reasons for this deficit – poor quality and underprioritisation of nutrition in the curriculum, lack of interest and expertise in nutrition among faculty members, and few examples of nutritional counselling during clinical years to serve as models for emerging doctors.
Students uniformly reported having a lack of required nutrition knowledge, which was also found through testing. For instance, one study found that when nutrition knowledge was assessed in a test, half of medical students scored below the pass rate.
What were the study limitations?
Some studies included in the review had limitations, such as the absence of control groups (for the curriculum initiatives), absence of validated survey instruments to test nutritional knowledge, poor response rates, small study samples, and insufficient representativeness of the study population.
What do the authors recommend for the future?
If this problem of inadequate medical nutrition education continues much longer, it is is likely to affect the standard of care doctors provide to patients, not least in preventative care. We recommend that nutrition education be made compulsory for all medical students, a global benchmark on the required level of nutrition knowledge for future doctors be established, and more funding be put towards developing new ways to teach nutrition in medical school.
1. Afshin, A., Sur, P. J., Fay, K. A., Cornaby, L., Ferrara, G., . . . GBD 2017 Diet Collaborators. (2019). Health effects of dietary risks in 195 countries, 1990–2017: A systematic analysis for the global burden of disease study 2017. The Lancet, 393(10184), 1958-1972. doi:10.1016/S0140-6736(19)30041-8