LeonieMilliner.jpegLeonie Milliner, Chief Executive of Association for Nutrition, talks about the importance of better nutrition education in medical schools and for doctors in training, and how a new group has assumed responsibility for driving forward the nutrition curriculum for undergraduate education.

Medical students are telling us they want to learn more about nutrition. They’re eager to play an active role in disease prevention, contribute positively to population health and ultimately help future patients live longer, healthier lives.

Clinicians on the ground are also much more aware of the need to be competent in nutrition and ensure the services and advice they provide to patients and the public is consistent, safe, evidence based and effective.

But many say they’re not equipped with the skills and knowledge they need to reach their potential in this area.

That’s why we’re working with experts and partners to help and encourage medical schools to embed the key content of the Undergraduate Curriculum in Nutrition.

In May, the Association for Nutrition (AfN), the charity responsible for regulating nutritionists in the UK, assumed responsibility for the curriculum.

We know medical schools already include nutrition in their education and training, and each has a different approach. Our aim is to help them build on that, in a non-prescriptive way, and we hope our curriculum supports this process.

Developed in 2013 by the Academy of Medical Royal Colleges Intercollegiate Group in Nutrition and the Medical Schools’ Council, the curriculum describes what all newly qualified doctors should be able to do in primary, secondary and tertiary care, including:

  • Understand how nutrition, diet and physical activity influence health and disease
  • Understand how disease and its management can compromise nutritional health
  • Recognise nutritional risk and assess nutritional state
  • Be safe and competent to advise on and, under supervision, manage nutrition, hydration and physical activity in health and disease

The transfer of the curriculum to AfN has provided a much-needed platform to drive improvements to the teaching and assessment of nutrition in medical training; how it’s reviewed, implemented and quality assured.  The General Medical Council’s role in this process has been central to achieving regulatory support. The curriculum dovetails with the GMC’s high-level Outcomes for graduates and provides a framework within which medical schools can integrate nutrition within their respective teaching, learning and assessment strategies.

Why is this important?

About three million UK residents suffer from malnutrition. The latest statistics from Public Health England show that nearly a third of children aged 2 to 15 are overweight or obese, and younger generations are becoming obese at earlier ages and staying obese for longer. [1]

A 2015 study [2] showed malnutrition cost the UK an estimated £19.6 billion in 2011-12, accounting for about 30 per cent of hospital admissions and 35 per cent of care home admissions.

Doctors can play a crucial role in the identification, prevention and treatment of malnutrition.

For example, the provision of timely nutritional care in intensive care has been associated with decreased morbidity and mortality, reduced ventilator days and decreased hospital stays. Separately, hypocaloric feedings (very-low calorie diets) have proven beneficial for some critically ill patients.

These examples highlight the complexity of medical nutrition therapy and reinforces the need for appropriate and adequate nutrition training and clinician’s continued professional development.

An emphasis upon learning about, from and with other healthcare professionals in medical education provides an ideal opportunity to improve the skills of the whole healthcare team in nutrition. Inter-professional education also strengthens communication and clinical skills in a safe and supportive environment, where public health, nutrition and healthy eating are common topics across professional disciplines.

The challenge now is to make sure medical schools embrace the curriculum and acquire the expertise to deliver it.

We’ve drawn together experts from across the field of nutrition to inform this work, and together with representatives from each of the medical royal colleges, the Medical Schools’ Council and the GMC, we have formed a ‘Nutrition Inter-Professional Group’ to provide oversight and to share best practice.

Our ambition is for this group to pursue four simultaneous strands of activity:

  • To lead on the review, implementation and quality assurance of the undergraduate curriculum, spearheading its use by medical schools
  • To provide a framework for better nutrition training during foundation years 1 & 2
  • To support medical royal colleges in developing specialty curricula to meet the GMC’s requirements for nutrition in doctors’ specialist training.
  • To assist medical royal colleges in the quality assurance of continued professional development in nutrition for scientifically sound evidence-based nutrition practice.

Our next task is to map current nutrition teaching and assessment in medical schools and, where necessary, amend the curriculum to ensure it is up-to-date and relevant. We will then examine medical royal college and faculty curricula to understand how firmly embedded nutrition is within specialty training.

For those clinicians already at the front line, AfN will soon offer an opportunity for GMC-registered doctors with a current licence to demonstrate their competence in nutrition by also registering with AfN as a registered nutritionist (Healthcare-Medical).

It’s heartening to hear so many medical students and trainees want to develop their skills and knowledge in this area. Their enthusiasm has provided the impetus to move this work forward and we hope it will lead to enhanced education and improved care for patients.

For more information on the work of the AfN Nutrition Inter-Professional Group and AfN Registered Nutritionist (Healthcare-Medical), please contact enquiries@associationfornutrition.org

[1] Health matters: obesity and the food environment.

[2] M Elia, for the British Association for Parenteral and Enteral Nutrition and the National Institute for Health Research Southampton Biomedical Research Centre, The cost of malnutrition in England and potential cost savings from nutritional interventions, 2015