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Integrating Nutrition Education Across the Medical Student Curriculum

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Professor, Department of Family ... Participants will develop a preliminary plan for improving a nutrition curriculum ... C.3 Geriatrics. C.4 Women's Health ... – PowerPoint PPT presentation

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Title: Integrating Nutrition Education Across the Medical Student Curriculum


1
Integrating Nutrition Education Across the
Medical Student Curriculum
  • ATPM Teaching Prevention Institute
  • March 25, 2004
  • Arlo Kahn, MD
  • Professor, Department of Family and Preventive
    Medicine
  • University of Arkansas for Medical Sciences

http//preventivenutrition.uams.edu/
2
Workshop objective
  • Participants will develop a preliminary plan for
    improving a nutrition curriculum

3
  • What issues do you hope this workshop will
    address?

4
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum

5
Assessing the Curriculum
  • Describe your curriculum
  • How will you determine what needs to be taught?
  • Current or potential faculty
  • Existing courses and/or opportunities
  • Barriers
  • Greatest need

6
Help in Assessing Curriculum
  • AAMC Curriculum Management Information Tool
    (CurrMIT)
  • http//www.aamc.org/meded/curric/start.htm
  • School Curriculum Committee or Dean
  • Survey

7
What should medical students know about nutrition?
  • How to counsel any patient about healthy
    lifestyle, including eating a healthy diet and
    engaging in appropriate physical activity
  • How to positively influence the health of
    communities through better nutrition and
    increased physical activity

8
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9
Nutrition Academic Award (NAA)
  • 5-year grants awarded by the National Heart,
    Lung, and Blood Institute (NHLBI) to 21 U.S.
    Medical Schools (1998-2005)
  • To develop or enhance medical school curricula
  • Increase opportunities for students, house staff,
    faculty, and practicing physicians to learn
    nutrition principles and clinical practice skills
  • Emphasis on preventing cardiovascular diseases,
    obesity, diabetes, and other chronic diseases

http//www.nhlbi.nih.gov/funding/training/naa/
10
NAA Schools
University of Arkansas
University of Alabama University of Colorado

University of Iowa University of Maryland
University of
Nevada University of Texas, Houston
University of Texas,
Southwestern University of Vermont
University of
Washington University of Wisconsin Albert
Einstein College of Medicine
Brown University Columbia University
Harvard University Mercer
University School of Medicine
Northwestern University Stanford University
School of Medicine
Tufts University University of Rochester School
of Medicine University of
Pennsylvania

11
Table of Contents Preface/Users
Guide Dedication A. Practice Behavior Skills
Across the Curriculum A.1 Practice Behavior
Skills Across the Curriculum A.2 Attitudes Across
the Curriculum B. Overview and Nutrition
Basics B.1 Nutrition Principles B.2 Community and
Population Health B.3 Behavioral Science
Principles B.4 Nutrition Assessment B.5 Physical
Activity C. Lifespan C.1 Pediatrics C.2 Young
Adulthood/Middle Age C.3 Geriatrics C.4 Womens
Health D. Cardiovascular System (See also
Physical Activity, Obesity, and Diabetes
Mellitus) D.1 Hyperlipidemia and
Atherosclerosis D.2 Hypertension D.3 Heart
Failure and Cardiomyopathy
http//www.nhlbi.nih.gov/funding/training/naa/curr
_gde/table_contents.htm
12
Table of Contents Continued E.
Metabolic/Endocrine Systems E.1 Obesity E.2
Diabetes Mellitus F. Other Organ Systems F.1
Gastrointestinal F.2 Hematology/Oncology F.3
Immunology F.4 Rheumatology F.5 Pulmonary F.6
Renal F.7 Bone G. Other Areas G.1 Nutrition
Support G.2 Contemporary Trends H.
Appendices H.1 Nutrition Academic Award Program
Principal Investigators H.2 Nutrition Curriculum
Guide for Training Physicians Contributors H.3
Description of How the Guide Was Developed
13
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum

14
Building the Case
  • AAMC Graduate Survey
  • USMLE sub scores
  • Obesity epidemic
  • NRC and other recommendations
  • Consultation from another school

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20
Obesity Trends Among U.S. Adults BRFSS, 1994
21
Obesity Trends Among U.S. Adults BRFSS, 2002
Source Mokdad A H, et al. JAMA 20032891
Source Mokdad A H, et al. JAMA
19992821620032891
22
Recommendations for Nutrition Curricula in
Medical Schools
  • National Research Council (1985, 1989) minimum
    of 25 hours
  • Healthy People 2000 US DHHS (1991)
  • NHLBI (1994)
  • USPSTF (1996)
  • NAA Collaborative Group (2001)

23
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum

24
Nutrition Academic Award
  • Spend a day with the NAA web sites
  • http//www.nhlbi.nih.gov/funding/training/naa/prod
    ucts.htm

25
University of Arkansas
http//preventivenutrition.uams.edu/
26
Brown University
http//bms.brown.edu/nutrition/index.htm
27
Columbia University
http//www.columbia.edu/itc/hs/medical/nutrition/
28
http//www.aecom.yu.edu/nutrition/default.htm
29
Mercer University
http//med2.mercer.edu/ncvd/naa/default2.htm
30
http//www.feinberg.northwestern.edu/nutrition/
31
Stanford University
http//summit.stanford.edu/ourwork/PROJECTS/NUTRIT
ION/stanford_naa_main.html
32
University of Pennsylvania
http//www.med.upenn.edu/nutrimed/index.html
33
University of Texas Medical School at Houston
http//www.uth.tmc.edu/courses/nutrition-module/
34
University of Wisconsin
http//www.medicine.wisc.edu/mainweb/DOMPages.php?
sectionnaapagenaamain
35
Nutrition in Medicine
  • CD-ROM Series produced at the University of North
    Carolina at Chapel Hill will be accessible over
    the web beginning fall 2004.
  • Principal Investigator Steven H. Zeisel, MD,
    PhD
  • Designed to teach nutritional science in a
    case-oriented format
  • Distributed free to all 126 US medical schools,
    most US osteopathic schools, and 99 international
    medical schools
  • To Contact NIM www.med.unc.edu/nutr/nim

36
Nutrition in Medicine Titles
  • The Disease Series Diet, Obesity, and
    Cardiovascular Disease
  • Nutrition and Cancer
  • Diabetes and Weight Management
  • Nutritional Anemias
  • Nutrition and Metabolic Stress
  • The Lifecycle Series Maternal and Infant
    Nutrition
  • Nutrition and Growth
  • Nutrition for the Second Half of Life
  • Special Topics in Nutrition Series
  • Dietary Supplements and Fortified Foods
  • Sports Nutrition

37
Use and Efficacy
  • Used in some way by 91 US medical schools an
    additional 33 are planning or evaluating use
  • Used by 26 international medical schools
  • Efficacy evaluations have shown good learning
    effects in first- and second-year medical
    students
  • Can be used in small or large groups or for
    independent learning

38
Teaching the science
  • Explain nutrient metabolism
  • Demonstrate nutrient action
  • Link nutrients to disease
  • Discuss nutritional risk factors
  • Show assessment methods

39
Clinical exercises
  • Emphasize clinical relevance
  • Practice nutritional assessment
  • Build dietary interview skills
  • Show clinical problem-solving
  • Demonstrate nutrition therapy

40
  • What resources have I missed?

41
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum

42
  • How would you begin the process of adding
    nutrition content to your curriculum?

43
Key Strategies for Integrating Nutrition Into the
Medical Curriculum
  • Know your own curriculum
  • Identify faculty with an interest and expertise
    in nutrition
  • Develop a proposal integrating nutrition into the
    medical curriculum
  • Watch for a window of opportunity
  • Make nutrition cross-sectional and longitudinal
  • Kushner, et al. Am J Clin Nutr 199052401-3.

44
Other Keys
  • Find co-champion (s)
  • Start early in the curriculum and warn the
    students that they are pioneers
  • Look for student contact in each year
  • Clinical reinforcement from residents and faculty
  • Emphasize office systems for clinical nutrition
    assessment and counseling

45
Opportunities in the curriculum
  • ICM courses
  • Basic science courses clinical correlations
  • Clerkships
  • Electives
  • Stand alone required courses

46
Evaluation strategies
  • Attitude Survey Development of a measure of
    attitude toward nutrition in patient care
  • Knowledge Tests Nutrition Knowledge Pretest
  • OSCE

McGaghie WC, et al. Am J Prev Med
20012015-20. Knopp R, et al. 1999,
rhknopp_at_u.washington.edu
47
Longitudinal integration building on previous
experiences
48
UAMS Curriculum
49
Supermarket Tour
  • Two hour tour covering
  • how foods prevent or promote disease
  • how people make food choices
  • how food is marketed and regulated
  • how foods are labeled
  • nutrients in specific food products
  • Live
  • Virtual PowerPoint with Audience Response System
  • Interactive CD-ROM
  • Web-based

50
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51
  • 6. Of the following which is the healthiest oil?
  • a. Corn oil
  • b. Olive oil
  • c. Peanut oil
  • d. Soybean oil
  • e. Sunflower oil

52
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54
  • 14. Who regulates milk and eggs?
  • a. Food and Drug
  • Administration
  • b. Department of Agriculture
  • c. Federal Trade Commission
  • d. Bureau of Alcohol, Tobacco
  • and Firearms

55
ICM 1 Paired Nutrition Assessment
  • Complete the Diet and Habit Assessment form
    with a classmate
  • Using the Diet and Habit Assessment form and
    the 2-day diet diary, complete the Nutrition
    Assessment form (calculate BMI from height and
    weight)
  • Complete the CHD Risk Factor Assessment form
    (include BP and lipids if known)

56
Diet and Habit Assessment
57
Nutrition Assessment
58
Coronary Heart Disease Risk Assessment
59
ICM 1 Standardized Patient Group Assignment
  • Student 1 complete the Diet Habit Assessment
    with the patient and figure the patients BMI.
  • Student 2 review the patients 2-day diet diary
    with the patient. The patient or the dietetic
    intern will answer questions about the diet
    diary.

60
ICM 2 Nutrition Counseling
  • Learn How to Counsel a Patient to Improve Diet
    and Reduce the Risk of Dying from Heart Disease

61
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62
The 4-A Technique
  • ASK
  • ADVISE
  • ASSIST
  • ARRANGE

63
Assist
  • How you assist depends on the patients readiness
    to change behavior
  • Pre-contemplation (not interested)
  • Contemplation (within 6 months)
  • Preparation (within a month)
  • Action (working on it)
  • Maintenance

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66
Counseling Practice Session
  • Objectives
  • Determine the patients stage of readiness to
    change
  • Provide brief, personalized advice explaining the
    behavior that should be changed and why
  • Assist the patient in a manner that is
    appropriate for the stage of readiness to change

67
FP Clerkship CHD Risk Factor and Nutrition
Assessment
  • Objectives
  • assess risk factors for diabetes, obesity and CVD
    with actual patients
  • discuss the prevalence of cardiovascular risks in
    a family practice setting
  • recommend dietary changes to reduce disease risks
    in a specific patient

68
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69
CHD Risk Factor Assessment
  • Assessment of cardiovascular risk factors seen
    in 10 patients at clerkship sites

70
  • Complete a nutrition assessment and determine
    readiness to change for 1 patient, with known
    cardiovascular risk factors
  • Recommend dietary and other lifestyle changes

71
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum

72
Strategies for Building and Maintaining Support
  • Faculty Development
  • Involve as many volunteers as possible
  • Use other disciplines (dieticians)
  • Create a demand
  • Community
  • Students
  • Patients

73
  • UAMS Preventive Nutrition Seminars
  • Statewide Presentations
  • Arkansas Preventive Nutrition and Physical
    Activity Summit
  • Act 1220, 2003

74
Arkansas BMI Initiative challenges and
opportunities
  • Weigh and measure 450,000 children
  • Educate parents and kids
  • Continuing Medical Education for providers
  • Establish data base on child weight in Arkansas

75
Workshop Agenda
  • Assessing the curriculum
  • Building a case
  • Resources
  • Implementing and Integrating
  • Maintaining the curriculum
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