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October 22, 2015

Medical School and Nutrition Education

by Anne Paddock

Doctors…..cannot be expected to properly treat patients or guide the prevention of cardiovascular disease, obesity, cancer, diabetes, and metabolic syndrome if they are not trained to identify and modify the contributing lifestyle factors.  ~Kathaleen Briggs Early, Kelly M Adams, and Martin Kohlmeier

Recently, my friend (a doctor) told me her son graduated from University of Virginia’s medical school and had no more than a few hours of nutrition education throughout the four-year program. Although I heard that medical students are rarely required to take a course on nutrition, I didn’t know the specifics which led me to do some research which revealed the following information:

There are 172 accredited medical schools in the United States of which 141 award an MD degree and 31 a DO degree. A typical student entering medical school has a Bachelor’s degree. Medical school is four years with two years of classroom education followed by two years of clinical experience doing a rotation (although there is a 6-year combination education and training program which provides a compressed education program that covers both undergraduate and medical school). Next is a residency which can range from 3-7 years, depending on the specialization followed by a fellowship in a speciality like cardiology.

Beginning in the 1980’s, the National Academy of Sciences started recommending that medical students receive a minimum of 25 hours of nutrition science in the medical school curriculum. To put that in perspective, consider that JAMA (Journal of the American Medical Association) writes that medical students should have at least 30 hours per week of overall classroom and lab time (most have significantly more) which means less than one week is spent on educating medical students on nutrition science.

In 2010, the National Center for Biotechnology Information (NCBI) conducted a survey to quantify the number of required hours of nutrition education in medical schools in the US: only 28 or 27% of the 105 schools that answered the survey met the minimum. Overall, medical students received an average of 19.6 hours of nutrition education during their entire medical school career. In 2015, the Journal of Biomedical Education published a study which revealed that 85% of the DO schools responding to the survey offered less than 25 hours of nutrition education in the 4 year medical school program.

So, if your doctor(s) graduated from medical school in the past 30 years, chances are he/she knows very little about nutrition. Why is that? There are many reasons but the single most important reason is because the accreditation committees don’t require medical schools to include nutrition education in the curriculum. For example, the Liaison Committee on Medical Education (LCME) – the accreditation organization for medical schools providing an MD degree – reviews five areas for accreditation:

  • Institutional Setting
  • Medical Students
  • Faculty
  • Educational Resources
  • Educational Program for the MD degree

With the Education Program for the MD degree, I hoped to find a minimum standard for nutrition education but there isn’t one. Each accredited medical school forms their own curriculum based on the hundreds of standards adopted by the LCME and nutrition education is not deemed important enough to be part of the standards. After all,there are registered dietitians and nutritionists (the same ones responsible for hospital food) to handle nutrition issues, as if the food we consume doesn’t affect our health. The problem with that reasoning is that doctors -not registered dietitians and nutritionists – are treating our health issues. In essence, the health industry treats these two fields as if they are mutually exclusive and not intimately intertwined, which doesn’t make sense.

Nutrition is a core component of our health with what we eat ranking as one of the most important factors in disease prevention, health, and early death. The number one cause of death in our country is heart disease accounting for 25% of all deaths. So I ask, how can a student go through four years of medical school, a three to four-year residency and a three-year fellowship and not be required to learn about the number one lifestyle behavior that affects heart health?

Beyond heart disease, there is high blood pressure, diabetes, cancer, kidney disease, orthopedic problems and a host of other diseases that are greatly impacted by the food we consume. With 70% of the US population overweight or obese which contributes to these health problems, the answer should lie more with nutrition and less on prescriptions. Instead of treating the source of the problem, doctors are being trained to treat the effects of the problem which is one of the reasons the US spends more money on health care than any other society.

So, why are medical educators, accreditation committees, and doctors not making the connection between nutrition and health front and center? Some people say there is limited class time in medical school, the political influences of the livestock, agriculture, and dairy industry are too strong, and the inherent conflict between the average American diet (which is more forgiving in young healthy adults) and a heart healthy plant-based diet, but it’s also because most people grew up eating meat, dairy products, processed foods, and fast foods and don’t really see another way to live their lives. It’s easier to prescribe a pill or use a knife to deal with a problem than to have someone change their diet.

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