Introduction to Nutrition Education in Training Medical and Other Health Care Professionals^,

INTRODUCTION

Advances in science increasingly provide robust evidence documenting the centrality of good nutrition and healthy lifestyle practices in the prevention of chronic diseases to benefit all patients in the health care system. Federal policies such as the Patient Protection and Affordable Care Act (ACA) of 2010 and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, as well as calls for action by professional societies, have endorsed the importance of nutrition in promoting better health outcomes. The recent report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines includes specific recommendations for diet and lifestyle changes that require fundamental knowledge and understanding of nutrition and physical activity for effective implementation (1). Physicians play a key role in the health care system both individually and as team members along with other health care professionals in the delivery of quality health care. With each patient encounter, physicians are positioned on the front lines to increase awareness and personalize the importance of adopting good nutrition and lifestyle practices for the prevention and treatment of disease. They also are very credible advocates for other health care professionals and policy makers in achieving the integration of nutrition throughout the health care system. A core tenet of this supplement issue is that deeper, more systemswide knowledge of nutrition and competency in its application are fundamental to effective team-based patient care. Although the importance of nutrition may be acknowledged, the education and training needed to effectively influence patient care within and between disciplines is lacking (reviewed in reference 2).

To initiate systemswide change, the current model for nutrition education of health care professionals must be modified. This supplement issue proposes a framework developed by a multidisciplinary team of health and nutrition educators, clinicians, policy makers, and analysts designed to implement and evaluate a contemporary, synergistic nutrition education curriculum for health care professionals. It advocates for common core nutrition knowledge and practice competencies and recognizes and differentiates the unique skills and talents inherent among the broad range of relevant health care professionals. Consistent with current trends in medical education, nutrition education and training must include an appreciation for team-based, interprofessional patient care.

Finally, there is a need for research to evaluate the effectiveness of innovative teaching strategies and how best to implement the new curriculum and assess its effects on patient and population health. The success of this endeavor depends on active engagement and deep commitment of all stakeholders accompanied by resources and incentives to drive this needed change.

Numerous organizations and agencies have ongoing activities that advocate for changing the curriculum for health care professionals. The impetus for this supplement issue was a meeting entitled “Future Directions for Implementing Nutrition across the Continuum of Medical Education, Training, and Research,” which was convened by the National Heart, Lung, and Blood Institute (NHLBI), Division of Cardiovascular Sciences, and cosponsored by the NIH Office of Disease Prevention and Division of Nutrition Research Coordination in September 2012. An important outcome of the meeting was that recommendations were made to implement nutrition across the continuum of medical and health care profession education, training, and research. Working groups met to discuss how best to effectively implement nutrition education for medical and all health care professions. This supplement issue is the result and presents our view of the needs and best practices for thoughtful and culturally sensitive change across the continuum of health care education.

SUPPLEMENT ARTICLES

The first article in the supplement issue (2) summarizes the status of nutrition and physical activity education for health care professionals and underscores the need for change. Changes needed include improved education and training programs of health care professionals to enhance the impact on disease prevention, treatment outcomes, and population health. In addition, cross-cutting and similar nutrition competencies need to be updated and strategically aligned across health care disciplines.

The article by Kushner et al (3) calls for a reform in medical education. Medical schools have begun to reform the curriculum to integrate nutrition and physical activity principles, develop interdisciplinary team-based skills, and provide longitudinal active learning environments. The authors recognize the need for additional content experts, champions, and mentors to sustain the new curriculum.

Lenders et al (4) focus on residency and fellowship education and training and make recommendations to improve medical nutrition education and practice. The authors review information that is germane to medical nutrition education and recommend that The Accreditation Council for Graduate Medical Education assume a leadership role in ensuring nutrition competencies of specialists and subspecialists in conjunction with the various specialty boards.

The article by DiMaria-Ghalili et al (5) describes the importance of implementing nutrition across the continuum of medical and health profession education, training, and research. The article presents opportunities and challenges that confront the individual health care professions and highlights the need for the development of interprofessional nutrition competencies.

Levy et al (6) discuss how the changes in the government and institutional policy environment support preventive health care and underscore the need to improve education and training of health care professionals in nutrition and physical activity. Recommendations are made for policy changes to improve the training of health care professionals.

On behalf of all coauthors of articles in this supplement issue, we deeply appreciate the generous support and encouragement from the NIH Office of Disease Prevention, the NHLBI, the NIH Division of Nutrition Research Coordination, and ASN for initiating the activities that led to this supplement issue. We are unified and committed to driving this initiative forward toward a successful outcome that benefits patient care and population health.