Nutrition to Become Major Focus of UR's Medical School Curriculum

January 04, 1999

Poor nutrition is the number two cause of death in America - second only to cigarette smoking - yet nutrition is not part of the standard curriculum at U.S. medical schools. Responding to this problem, the University of Rochester’s School of Medicine and Dentistry (URSMD) and School of Nursing (URSN) are changing their curriculum with a major government grant and a sweeping redesign of the way the Medical School teaches new physicians.

With a $750,000, five-year Nutrition Academic Award from the U.S. Department of Health and Human Services and the participation of the Wegmans supermarket chain, faculty leaders at the University will teach students the many intersections of good health and nutrition throughout their course of study. UR is one of 10 centers throughout the country that have received funds from the National Institutes of Health to test new nutrition curricula.

"Patients have to ask themselves, ‘Is my doctor or nurse giving me the best advice about my diet?’ and of course, the answer is ‘Not always’," said Thomas A. Pearson, M.D., professor and chair of the Department of Community and Preventive Medicine at the University of Rochester School of Medicine and chief architect of the new approach to teaching nutrition. "But, how can they teach us about nutrition? We never taught them."

The problem

Researchers have long understood that diets too rich in sodium, cholesterol and fat, while lacking vitamins and fiber, lead to a host of chronic diseases - especially heart disease and hypertension. In a 1993 survey, more than 75% of nearly 3,500 primary care physicians reported that they did not feel well prepared to provide nutritional counseling to their patients. Another survey of 11 medical schools found that the vast majority of students were very unsatisfied with their nutritional education. At the same time, surveys of the general public show that physicians and nurses are considered the leading sources of nutrition information.

"There is a major gulf between what the public needs and what we’re prepared to provide," Pearson said. "Is there any question why the public is so baffled? Without a bedrock of professional knowledge, we’ve left the public prone to profiteers selling quick-fix nutrition fads."

Part of a Fundamental Change

The task of Pearson and his UR colleagues is to develop a nutrition curriculum that provides the scientific basis of nutrition, yet teaches behavioral change skills and emphasizes self-discovery through instructional meals and dietary self-assessments. "We’ll format our teaching experience to suit the way adults learn. We know people learn best when they feel a need to know something rather than being told what to learn, and when they learn it through experience rather than dictum," he said.

Consequently, instead of simply adding lecture courses on nutrition, the University’s approach will be in keeping with the Medical School’s newly created "Double-Helix Curriculum." Traditionally, medical schools required students to complete two years in the classroom learning basic science through lectures, followed by two years of hands-on experience in clinical settings in which students applied the knowledge and skills learned in the first two years. The double-helix model integrates basic science with clinical experience during all four years of medical school, interweaving the two throughout the students’ experience like the interconnected strands that make up DNA. Besides "shuffling the deck" of the traditional curriculum to weave basic science and clinical learning together, certain topics, such as nutrition, are becoming core themes throughout the curriculum instead of isolated courses.

"In the past, we force-fed facts to students then required them to recall and apply these facts when faced with a real-life, clinical problem two years later," said Edward M. Hundert, M.D., senior associate dean of the School of Medicine and Dentistry. "With the double-helix model, we challenge students with a problem and teach them how to activate their knowledge or seek new knowledge." Hundert says this process is closer to the daily experience of practicing physicians, teaching students to be life-long learners.

"The traditional teaching model was an impediment to effective nutrition education," Pearson said. "Since nutrition is tied to so many aspects, such as behavior, biology and more, it makes sense to treat it as a cross-cutting theme and integrate it fully across the curriculum." When the students learn about pregnancy, they are taught about the importance of nutrition – such as why pregnant women need extra folic acid. When studying conditions of the elderly, they will learn about the need for vitamin B12. "But this curriculum isn’t just about what vitamin affects what condition," Pearson said. "The focus will be much broader than that. Good nutrition is the key to the prevention of disease."

Whetting the Appetite of Students

First-year medical students will be asked to fill out four days of dietary diaries, which will be analyzed by computer. "The idea is to let them see nutrition through their own experience," Pearson said. Wegmans is also eager to collaborate on other teaching materials and methods, such as using the grocery store as a venue for nutrition teaching, he said.

The double-helix curriculum will be launched in August and phased in with that entering class over each of the next four years. In that curriculum, in addition to nutrition, four other cross-cutting "themes" will be woven into every course rather than taught in a isolated course: prevention, ethics and law, health care financing and organization, and diversity. Pearson and his colleagues are also developing courses for residents and doctors in practice, to make nutrition a core part of life-long education for physicians.

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