Experts recommend a set of nutritional competencies for medical students and physician candidates

A professionally diverse panel of medical and nutrition experts recommended a set of recommended nutritional competencies for medical students and trainee doctors. The study addresses a long-standing concern that most doctors in the United States are not equipped to advise patients on nutrition and food choices.

The proposed mandates are a call to action in response to the U.S. House of Representatives’ bipartisan resolution, H. Res. Law 1118 calls for “meaningful physician and health professional education in nutrition and diet.” The decision expressed concerns about the increasing prevalence of diet-related diseases and Medicare costs, which totaled $800 billion in 2019. Congressional annual funding for medical interns in U.S. hospitals was estimated at $16.2 billion in 2020.

The lack of nationally required nutrition competencies in medical education is shocking. This is a surprising and important gap, given the epidemics of obesity, diabetes, and other diet-related chronic diseases in this country and their increasing financial and societal costs. “My guess is that most patients assume that their doctors are trained to advise them on nutrition and food choices, but this is not part of their required education.”

David Eisenberg, head writer, assistant professor of nutrition and director of culinary nutrition at the Harvard TH Chan School of Public Health

The research will be published on September 30 JAMA Network Open.

Researchers; Eisenberg, Alexis Cole of Tufts University and UK-based Sprink Ltd. Edward Maile and Matthew Salt of the consultancy; They compiled a list of 354 nutrition competencies found in the academic literature and assembled an expert panel consisting of: 37 medical educators, nutrition scientists, practicing physicians, medical specialty directors, and registered dietitian nutritionists from across the country. Over four rounds, panelists ranked competencies and offered comments and ideas.

After analyzing the survey results, researchers identified 36 nutritional competencies that the panel agreed upon and are recommended for undergraduate and graduate medical school and education. Competencies cover six categories: basic nutritional knowledge (“Demonstrates knowledge of the nutritional content of foods, including the major nutritional sources of macronutrients and micronutrients); assessment and diagnosis (“Assesses the nutritional status of a patient with a brief dietary and nutritional history/questionnaire, anthropometric measurements and appropriate laboratory tests”); communication skills (“Listens carefully, compassionately, and non-judgmentally when taking a nutritional history”); public health (“Demonstrates knowledge of public health nutrition, including the social determinants of health”), and how to reduce the burden of disease and adequately “how to improve access to healthy food”); collaborative support and treatment for specific conditions (“Works with other health professionals to provide a multidisciplinary approach to nutritional care”); and referral indications (“Makes appropriate referrals to a variety of professionals to support the patient in achieving health goals” ).

Additionally, 97% of panelists called for formal nutritional testing in licensing and certification exams for future physicians. Other highlights were:

• 95% of panelists agreed that institutions should report on their teaching regarding nutrition competencies.
• 92% agreed that surveys should be used to assess students’ competence and confidence in this area.
• 73% of panelists recommended including a competency on the impact of food choices on the environment and planetary health.

The research team also identified 12 potential gaps that were not addressed in the proposed competencies because they were not identified in a review of existing medical literature. These included topics such as when and how to discuss glucagon-like peptide 1 (GLP-1) agonists (anti-obesity drugs) with patients and how to use AI responsibly to provide patients with practical advice on nutrition and food choices.

“The competencies represent the largest effort to date to address H. Res. 1118, and their adoption will undoubtedly significantly improve public health,” Eisenberg said. “Ensuring that physicians are equipped with the knowledge necessary to advise patients in practical terms about nutrition and food choices will increase referrals to and collaboration with diverse nutritionists and programs, promote health equity, and improve the health of the planet.”

The researchers noted that the international generalizability of the qualifications may be limited because the panel was based in the United States. However, the consensus-building approach by which the proposed competencies were developed may shed light on similar efforts by medical educators and regulators worldwide, as nutrition-related health issues and limited nutrition education for physicians are global issues.

The study was funded by the Vitamix Foundation, the David R. and Margaret C. Clare Foundation, the Shaich Family Foundation, and the Ardmore Health Institute. These philanthropic donations were provided to and administered by the Teaching Kitchen Collaborative.