Welcome to Questions "About NIM"! Comments | nimtech@unc.edu | NIM Policy | Copyright, license and Disclaimer of warranty Questions "About NIM" Why a Medical Nutrition Curriculum? What is the Nutrition in Medicine Curriculum? Where did the Curriculum Begin? Who Developed the Curriculum? Funding the Project When Will the Curriculum be Available?   Why a Medical Nutrition Curriculum? Several important factors suggest that we are entering a window of opportunity for introducing an innovative nutrition curriculum into medical schools. The tremendous increase in consumer interest in the field has made it mandatory that physicians be able to give their patients sound advice. Changes in national and international priorities for health care that emphasize prevention are giving nutrition a more important role in medical practice. At the same time, many medical schools are revising their curricula to reflect newer theories of education and to incorporate an ever-expanding base of knowledge. All of these factors have convinced us we need a fresh approach to medical nutrition education. The physician is extremely influential in determining the priorities for the American health care system. Industry, governmental agencies, and consumers/patients look to the physician for guidance on how to treat diseases and maintain health. The public is regularly presented with confusing, and sometimes contradictory information about optimal nutrition. Four of the ten leading causes of death in the US are diet-related conditions (diabetes, heart disease, stroke, and cancer). Most Americans say they regard their physician as their primary source for reliable nutrition advice, yet many physicians are poorly trained in this area. The daily clinical practice for most physicians includes numerous patients with nutrition-related problems. The American public has begun to insist that health care costs be controlled; to do this physicians must shift their focus from the treatment of diseases to their prevention. The growing awareness of the importance of health promotion and disease prevention will only increase the need for inclusion of nutrition interventions in the physician's practice. Nutrition education for medical students has often been delivered in an unsystematic way by individuals without a comprehensive plan to teach the broad set of nutrition-related skills needed to develop well-trained physicians, physician-researchers, and physician-teachers. According to the December, 1990 Journal of the American Medical Association, US physicians were "widely believed to be poorly trained in human nutrition with only a few medical schools offering formal nutrition training as part of the required curriculum." In fact, the Association of American Medical Colleges reports that, of 129 US medical schools, only 29 (23%) have a required nutrition course. Thirty-two schools offer no formal nutrition at all. Of medical students graduating in 1990, 64% perceived that their nutrition training was inadequate. The American Society for Clinical Nutrition and the American Academy of Family Physicians have recognized this deficit and have established committees to develop recommendations. Unfortunately, the very nature of committees dilutes responsibility among many individuals, and despite significant efforts, a cohesive curriculum in nutrition has not been developed for medical students. As a consequence, physicians are not adequately trained to offer the public the advice about nutrition that they need. The federal government recently has developed comprehensive objectives for health care providers. To meet the changes recommended in the Surgeon General's Report on Nutrition and Health physicians need to receive improved training in the role of diet in health promotion and disease prevention and in the therapeutic aspects of nutrition intervention. The Public Health Service's Year 2000 Objectives for the Nation advocates that the proportion of primary care physicians who provide nutrition counseling and referral to qualified nutrition specialists increase to >50% of the physician pool. This report also calls for the provision and requirement of courses in human nutrition for all medical and dental students. The National Nutrition Monitoring and Related Research Act of October 1990 (section 302, Public Law 1101-445/ HR1608) provides that, within the year, the Secretary of the Department of Health and Human Services, in consultation with the secretaries of Agriculture, Education, and Defense, and the Director of the National Science Foundation must submit a report to Congress describing how the federal government can ensure that students enrolled in US medical schools and physicians in practice have access to adequate training in the field of nutrition and its relationship to human health. At the same time, ongoing changes within medical schools will enhance the importance of nutrition training. The Robert Wood Johnson Foundation's Commission on Medical Education issued a report in June 1992, which recognized the need to revamp medical education. New curricular emphasis on ambulatory care and prevention of diseases has required that most schools re-examine how teaching time is divided. It is clear that in the near future, there will be significant governmental pressure on medical schools to incorporate more nutrition in their curricula. Whereas a decade ago it was unlikely that the classical department-teaching structure could be modified, in today's environment most schools are considering significant revisions of their curricula. Return to top of Questions "About NIM" | Home What is the Nutrition in Medicine® Curriculum? Nutrition in Medicine® is a package of teaching materials designed to teach nutrition to medical students. The core of the package is a series of multimedia interactive computer programs. Each program presents basic nutrition science in the framework of a case study. Rather than covering one traditional topic, e.g. vitamins, in each program, a number of issues are used to teach the principles of nutrition and illustrate the interaction of nutrition and disease. In addition to the biochemical basis of nutrition, the programs cover nutritionally-related preventive health care. The case study puts a strong emphasis on teaching nutrition assessment in the history and physical. At the start of the program, the students log in with an identification number so that performance can be recorded. The student may return to the program for several sessions, and the computer will indicate how much of the material has already been completed. The opening menu also introduces the student to the resources that are available at any time. These include lists of nutrition assessment tools, diagnostic tests, nutrient requirements, and functions and pathways; and a library of reference material. Next the student is given a brief introduction to the case study. Four of the ten leading causes of death in the US are diet-related conditions: diabetes, heart disease, stroke, and cancer. After this introduction, the student enters the lesson sections. These lessons cover a number of topics relevant to the case. For example, in the "Nutritional Anemias" program the biochemistry section focuses on vitamin B12, folic acid, and iron. The student must complete each module before continuing with the case study. Throughout the lessons, the student is asked questions to assess understanding of the material. When the student has completed the first section, the program suggests the user return to the case. The student then enters modules presenting information relevant to the patient's problem and appropriate assessment and treatment. In "Nutritional Anemias" for example, this includes discussion of vitamin and mineral deficiencies and pernicious anemia. At the end of the program the student is given an evaluation of performance on the test questions. The student can print handouts pertaining to the key concepts for each lesson. A measure of performance is available to instructors who are using the program as a course requirement, via three exams. Nutrition in Medicine® is used in a number of ways. In some schools it serves as a course pack for a required, pre-clinical nutrition course. The computer programs provide the basic information each student is expected to know upon completing the course. The faculty can expand on this foundation in lecture or small group settings with material considered important at their school. However, since few medical schools offer a required course in nutrition, many Nutrition in Medicine modules are being integrated into other pre-clinical courses and clinical experience. Supporting materials provided with the computer programs help schools use the programs in different settings and augment the instruction in the way most appropriate to their own curriculum. All materials developed for Nutrition in Medicine® are rigorously evaluated for their effect on student learning, ease of use by students and instructors, and accuracy and relevance of the content. Return to top of Questions "About NIM" | Home Where did the Nutrition in Medicine® Curriculum Begin? The Department of Nutrition at the University of North Carolina at Chapel Hill is developing Nutrition in Medicine®. The University has made a unique commitment to nutrition with the formation of a joint nutrition department in the School of Medicine and the School of Public Health. The Nutrition in Medicine® program is able to take advantage of the expertise in clinical teaching, preventive health care, and epidemiology offered by this department. Testing of the materials is ongoing in the School of Medicine at the University of North Carolina at Chapel Hill. A small group of medical schools have been identified as sites for more extensive evaluation of Nutrition in Medicine®. Currently, the curriculum is offered to any medical school able to make the commitment of time and resources to integrate the material into their own curriculum. With the introduction of the new computer authoring languages, modification of the computer programs will be quite simple. After all the computer programs have been completed, the University of North Carolina will continue to support the project by keeping the material up-to-date and acting as a clearing house for information about the use of the programs at other schools. Another advantage of the authoring languages is the ability to translate the material into foreign languages or adapt it for use in other settings. We hope to increase the funding for the project to allow development of programs for use in Europe and South America. This approach to teaching can also be used for continuing education of physicians, dietitians and other health care professionals. If funding is available, we intend to adapt our programs for this use. Return to top of Questions "About NIM" | Home Who Developed the Curriculum? The development team consists of faculty and staff from the Department of Nutrition at the University of North Carolina at Chapel Hill. The team, under the direction of Steven Zeisel, M.D., Ph.D., professor and chairman of the Department of Nutrition, includes physicians, nutritionists, registered dietitians, media specialists, and computer programmers. We also take advantage of the expertise of specialists on the University of North Carolina faculty and on the Board of Advisors. This Board is made up of nationally known educators in clinical nutrition. The Board meets annually to evaluate the progress of the project and advise the Development Team on the content and implementation of the curriculum. Return to top of Questions "About NIM" | Home Funding the Project In addition to support from the National Cancer Institute, NIH Office of Dietary Supplements, the United States Department of Agriculture and the University of North Carolina, we have received funding from several industry sources including Clintec International, Quaker Oats Foundation, Kellogg Company, The Dannon Institute, National Dairy Council, Wyeth-Ayerst Laboratories, the National Cattlemen's Beef Association, Bristol-Myers Squibb, Baxter Healthcare Corporation, Central Soya, Inc., Egg Nutrition Board, the Gatorade Company, Nestlé Clinical Nutrition, New York Community Trust, Perrigo of South Carolina, Ross Products Division of Abbott Laboratories. The American Institute for Cancer Research has also provided support. For more information about opportunities to help fund the Nutrition in Medicine® project, contact: Steven H. Zeisel, M.D., Ph.D., Professor and Chairman, Department of Nutrition, School of Public Health, School of Medicine, 2212 McGavran-Greenberg Hall, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400. Dr. Zeisel's telephone number is (919) 966-7218; his fax number is (919) 966-7216; his electronic mail address is steven_zeisel@unc.edu. Return to top of Questions "About NIM" | Home When Will the Curriculum be Available? The following modules are currently available: Nutritional Anemias Nutrition and Stress Nutrition and Cancer Diet, Obesity and Cardiovascular Disease Diabetes and Weight Management: Aberrations in Glucose Metabolism Maternal and Infant Nutrition Nutrition and Growth Nutrition for the Second Half of Life Dietary Supplements and Fortified Foods *Sports Nutrition: Physical Activity and Health (expected release: academic year 2003 - 2004) Current funding permits us to complete one to two programs and supporting materials each year over five years. With additional funding we hope to accelerate production and expand to address additional topics(*). Modules are distributed as they are completed. The entire curriculum is planned to be available to schools by the year 2003. Return to top of Questions "About NIM" | Home