Elsevier

Journal of Nutrition Education and Behavior

Volume 44, Issue 6, November–December 2012, Pages 653-657
Journal of Nutrition Education and Behavior

Research Brief
How Medical Students’ Behaviors and Attitudes affect the Impact of a Brief Curriculum on Nutrition Counseling

https://doi.org/10.1016/j.jneb.2011.08.006Get rights and content

Abstract

Objective

To evaluate a nutrition curriculum and explore the influence of medical students’ own nutrition practices on its impact.

Methods

An anonymous survey was given to first-year medical students attending a required course immediately prior to and 2 weeks after a 2-hour interactive nutrition curriculum intervention in a large private urban medical school in New York, New York. Main outcomes included self-reported nutrition counseling confidence, ability to assess diet, and nutrition knowledge measured using 4-point Likert scales.

Results

One hundred eleven students completed surveys pre-curriculum (69%) and 121 completed them post-curriculum (75%). The authors found overall pre-post differences in dietary assessment ability (2.65 vs 3.05, P < .001) and counseling confidence (1.86 vs 2.22, P < .001). In addition to the curricular impact, students’ nutrition-related behaviors and attitudes were positively associated with outcomes.

Conclusions and Implications

A nutrition curriculum for medical students improves students’ nutrition counseling-related confidence, knowledge, and skills even when controlling for personal nutrition-related behaviors.

Introduction

Almost 70% of American adults are overweight or obese.1 Despite “Heal-thy People 2010 recommendations”2 and the positive impact of physician nutrition counseling on patient outcomes, physicians rarely counsel patients about their diet.3, 4 The most important physician barriers to coun-seling are lack of knowledge,5 skills, and confidence in nutrition counseling,6, 7 and poor attitudes toward counseling, including low outcome expectancy.8 The origin of these deficits may begin in medical school, where studies have identified that few United States medical schools required a nutrition course.9 There is clearly a great need to enhance effective physician nutrition education.9, 10

There is little published evidence that a nutrition curriculum in medical school improves students’ counseling competence.11, 12 However, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sponsored and organized the “Primary Care Nutrition Training Program” for practicing health care providers. Rigorous focus group methodology with key informants was used to develop the curriculum, which focuses on clear, concise messages that providers can easily deliver to patients within short periods of time. The curriculum, delivered to a large cohort of urban health physicians and other health care professionals, showed self-reported physician change in nutrition knowledge, counseling confidence, and nutrition counseling practices and referral patterns.13

In addition to education and training, physicians’ and students’ attitudes and personal habits may have an impact on their nutrition and lifestyle counseling.14, 15, 16 Interventions aimed at improving medical students’ lifestyle habits have been shown to improve nutrition counseling prac-tices.17, 18 Students are more likely to find nutrition counseling highly relevant and to report counseling more often if they consume more fruits and vegetables and less fat, independent of other predictors.19 There is emerging evidence that physicians with more healthful dietary and exercise habits and more positive attitudes toward healthful eating prioritize health promotion counseling in patient encounters.20 However, little is known about the relative contribution of physicians’ personal behaviors and attitudes to the quality of their dietary assessment, nutrition counseling, and knowledge.21, 22

The authors sought to determine the feasibility and impact of a brief medical student nutrition-counseling curriculum on nutrition knowledge, confidence, attitudes, and practices and to explore the relative contribution of the nutrition curriculum as compared with students’ own behaviors and attitudes on these outcomes. The authors hypothesized that (1) these outcomes would change with introduction of the nutrition curriculum and (2) students’ nutrition-related behavior and attitudes would be associated with their self-reported nutrition counseling competence.

Section snippets

Participants and Recruitment

Participants were recruited from a cohort of 162 first-year medical students (Class of 2011) enrolled in a required nutrition curriculum in April 2008. The study was reviewed by the New York University School of Medicine Institutional Review Board and was exempted from written informed consent because participation was voluntary and anonymous and data were to be analyzed in the aggregate.

Procedures

Medical students were surveyed immediately before and 2 weeks after the nutrition curriculum intervention

Results

One hundred eleven of 162 students (69% of the entire class, 93% of those attending the session) completed the pre-intervention survey and 121 (75% of entire class, 96% of those who attending session) completed the post-curriculum survey. Overall, the class of 2011 is 50% (81/162) female.

Table 1 provides baseline information about the students’ dietary stage of change, self-efficacy, current behaviors, and intentions. Of note, most students felt a need to change their diet, and a majority

Discussion

The present findings suggest that a nutrition counseling curriculum for medical students improves students’ nutrition-related knowledge—a barrier to nutritional counseling,5 skills, and attitudes. It had an impact in several areas, including students’ comfort with the plate method, confidence in knowing when to make dietitian or nutritionist referrals, and self-reported ability to assess diet for common unhealthful behaviors and dietary knowledge.

This modified NYC DOHMH “Primary Care Nutrition

Implications for Research and Practice

The present study supports the feasibility of implementing a brief, low-intensity nutrition curriculum as a method of significantly improving medical students’ dietary assessment knowledge, behaviors, and confidence. The present findings also suggest that a short nutrition curriculum may have an impact on students’ nutrition counseling behavior regardless of their current own dietary practices. Further examination is needed of medical students’ real-time and/or simulated dietary counseling

Acknowledgments

This study was supported by the Academic Administrative Unit Grant (HRSA# D54HP05446 PI Gourevitch) and Faculty Development Grant (HRSA #5 D55HP05158-02-00).

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