ArticlePDF Available

Planning Nutrition Education Interventions for the Medical Workforce: 'Nutrition Education Workshop for Tayside Doctors' (NEWTayDoc) - A pilot project to inform development of the Need for Nutrition Education Programme (NNEdPro)

Authors:
  • NNEdPro Global Centre for Nutrition and Health
Planning Nutrition Education Interventions for the Medical Workforce
1 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
Planning Nutrition Education Interventions for the Medical Workforce:
‘Nutrition Education Workshop for Tayside Doctors’ (NEWTayDoc) - A pilot
project to inform development of the Need for Nutrition Education Programme
(NNEdPro)
Dr Sumantra Ray1, Celia Laur1, Dr Minha Rajput Ray2, Dr Joan Gandy2, Dr Susie Schofield3
1Medical Research Council, Human Nutrition Research unit, Cambridge 2Need for
Nutrition Education Programme group, c/o British Dietetic Association 3Centre for Medical
Education, Dundee
Corresponding Author: Sumantra Ray, MRC Human Nutrition Research, Elsie
Widdowson Laboratory, Cambridge CB1 9NL; E-mail: Sumantra.Ray@mrc-
hnr.cam.ac.uk; Tel 01223 426356; Fax 01223 437515
Planning Nutrition Education Interventions for the Medical Workforce
2 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
ABSTRACT
Background: It is estimated that one in three hospital patients in the UK is affected by
malnutrition. Increased awareness of the problem could help prevent hospital
malnutrition and associated problems including delayed recovery, increased length of
hospital stay, worsening of prognosis and an increased risk of serious complications.
Evidence suggests there is a gap in nutrition teaching across a number of medical school
curricula and that this may be filled through an innovative approach to nutrition
education.
Aim: To conduct a pilot education intervention ‘Nutrition Education Workshop for Tayside
Doctors’ (NEWTayDoc) aimed at developing a wider reaching programme, targeting
later-stage medical students or junior doctors.
Study Design: An intervention was developed and piloted at Ninewell Medical School,
Dundee, with eight foundation year doctors working in NHS Tayside. A malnutrition
questionnaire was used pre and post intervention to assess knowledge. Two focus
groups were held, that evaluated using thematic analyses that explored related issues.
Results: Analysis of pre and post intervention questionnaires demonstrated a 24% (p
=0.001) increase in knowledge following intervention. Thirty per cent showed no
improvement in knowledge, while 34% maintained residual knowledge. Qualitative
results highlighted the potential to apply this innovative approach to educational
intervention, on a larger scale. Participant feedback also demonstrated the need to
deliver nutrition training earlier within the undergraduate medical curriculum.
Discussion and Conclusion: Based on objective responses from the tutors as well as
participants, this intervention was deemed successful. The strengths and limitations of
the NEWTayDoc education innovation pilot were reviewed and incorporated to form the
basis for a national initiative, the UK Need for Nutrition Education Programme
(NNEdPro), which is currently underway. Key suggestions from the tutor and participant
feedback incorporated into NNEdPro, included introducing nutrition earlier in medical
training and development of an evaluation questionnaire based on learning outcomes to
assess knowledge, attitudes and practices (KAP); as well as conducting post-training
evaluations after a three month interval to reduce recall bias.
Planning Nutrition Education Interventions for the Medical Workforce
3 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
PURPOSE OF THE STUDY
One in 3 patients in the UK is predicted to be at risk of malnutrition. [1-3]. Malnutrition
is defined as a state of nutrition in which a deficiency, excess or imbalance of energy,
protein, and other nutrients causes measurable adverse effects on tissue/body form
(body shape, size, composition) and function and clinical outcomes’ [1]. Increasing
awareness of this among health professionals could help prevent hospital malnutrition
and associated problems including delayed recovery, increased length of hospital stay,
worsening of prognosis and an increased risk of serious complications of illness [4].
These physical consequences of malnutrition contribute to an increased burden of
morbidity and premature mortality as well as incurring substantial costs.
It has been suggested that gaps in medical doctors’ knowledge and skills regarding
clinical nutrition may be having an effect on hospital malnutrition [5]. The Council of
Europe Alliance (CoE), and the General Medical Council (GMC) have recommended
nutrition education for all junior doctors [6]. Other pilot projects have not included junior
doctors and few initiatives have considered thescalability or affordability of training. A
number of training courses relate to the prevention of obesity but do not consider
hospital malnutrition [7-9]. Therefore the NHS Tayside Nutrition Standards Group piloted
the Nutrition Education Workshop for Tayside Doctors (NEWTayDoc) intervention in 2008
to determine if it could be scaled up to be a larger, more robust programme. The aim of
the NEWTayDoc was to conduct a pilot education intervention aimed at forming the basis
for developing a wider reaching programme, targeting late-stage medical students or
junior doctors.
STUDY DESIGN
Development, Approval and Recruitment
This pilot intervention was developed by the NHS Tayside Nutrition Standards Group, in
compliance with the ‘Quality Improvement Scotland’ Clinical Standards[10]. The teaching
team of seven tutors comprised of doctors, dietitians, and nurses who developed the
pilot intervention and delivered the teaching. The project was reviewed by Tayside NHS
Research Ethics Committee and exempted by the chairman from the requirement for
ethical approval, as it comprised delivery and evaluation of an educational course.
Recruitment took place through internal advertising, via NHS Tayside, the Graduate
School of the University of Dundee, College of Medicine, Dentistry and Nursing, as well
Planning Nutrition Education Interventions for the Medical Workforce
4 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
as the local deanery. Focus was placed on recruiting foundation year one (FY1) and two
(FY2) doctors. The pilot study had capacity for ten junior doctors from the Tayside
Region and eight foundation year doctors were recruited. The Foundation doctors’
attachments at that point in time, included general medicine, general practice, intensive
care, medicine for the elderly, orthopaedics and palliative care.
Intervention
The intervention consisted of a half day workshop delivered through a multi-speaker and
facilitator-led interactive workshop. This combined short lectures, interactive voter-pad
response system sessions, focus-group type breakout sessions and a sum up session.
The main aims were to:
Reiterate that nutrition forms an important part of a doctor’s responsibilities.
Educate foundation doctors about core principles of food, fluid and nutritional care
in hospital related to recognition, prevention and management of malnutrition.
Improve knowledge about ‘Quality Improvement Scotland’ Clinical Standards and
the NHS Tayside Nutrition Standards Project.
Ensure medical staff have working knowledge of the Malnutrition Universal
Screening Tool (MUST) scoring, recording this in medical notes and care plans, as
well as coding for malnutrition and including in discharge documents.
Promote protected patient mealtimes.
Evaluation
A questionnaire was administered pre and post intervention to assess knowledge of
clinical nutrition [5]. Each question carried a score of one with a maximum score of 20.
The data were assessed for normal distribution and pre and post intervention scores
were analysed in a parametric paradigm with a paired samples t-test in PASW Statistics
Data Editor 18.
The eight participants were split randomly into two equal focus groups. Each group was
facilitated by a set of two tutors who each made hand written notes during and
immediately after the session. The notes were transcribed and cross checked by both
sets of facilitators. Thematic analysis of the data was conducted by hand, split between
three individuals, including one tutor involved in the teaching intervention and two
others who were independent of the teaching.
Planning Nutrition Education Interventions for the Medical Workforce
5 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
RESULTS
Eight participants were recruited and completed the training, as well as the pre and post
questionnaires. Table 1 indicates the knowledge change based on the scores from the
questionnaires. Twenty nine per cent of responses demonstrated an increase in their
knowledge of malnutrition following the intervention. Thirty per cent showed no
improvement in knowledge, while 34% maintained residual knowledge.
Response
Knowledge Change (%)
Incorrect Scores Pre and Post Test (no improvement in
knowledge)
30.6
Incorrect Pre and Correct Post (increase in knowledge)
29.4
Correct Pre and Post (residual knowledge maintained)
34.4
Correct Pre and Incorrect Post
5.6
Table 1: Knowledge change based on number of correct/incorrect responses from pre
and post intervention examination of students.
Table 2 shows the scores of the pre and post-test of malnutrition knowledge. A mean
shift of 24% between the tests was seen that indicated an increase in knowledge after
the intervention.
Average Score
(Maximum score 20)
Percentage
P value
Pre Intervention
8
40
-
Post Intervention
13
64
-
Change
5
24
.001*
Table 2: Results of pre and post intervention questionnaires test, the change and
corresponding p value (N=8)
* t test for difference
Qualitative Evaluation
Qualitative data from the focus-group style breakout sessions representing the
application of knowledge based on facilitated discussions on how to overcome barriers to
implementation of good nutritional practice in NHS. These discussions focused on
Planning Nutrition Education Interventions for the Medical Workforce
6 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
knowledge acquired from the educational intervention. The major themes were identified
as:
Medical curriculum:
The medical curriculum requires an integrated nutrition component.
Nutrition is not typically taught explicitly in the curriculum.
Determining the correct point to place nutrition in the curriculum can be difficult,
but participants indicated it may be more appropriate during clinical training.
Transition from medical school to junior doctor status:
Nutrition may not be a priority in a local trust.
It is important to determine if local protocols exist; if yes locate and follow them.
It is important to determine how local protocols are implemented.
Clerking
Medical students/junior doctors are not typically taught to ask nutrition-related
questions when clerking in patients.
They may experience difficulties locating nutrition related factors in notes. For
this reason, there needs to be a way to record nutrition-related factors in a
manner which is accessible to all health care professionals.
Suggestions were recorded and used by the tutors to determine if the pilot should be
developed into a wider reaching project. A key suggestion from focus group discussions
highlighted that nutrition should be taught at an earlier stage in the medical training,
such as the latter phase of the undergraduate medical curriculum.
Planning Nutrition Education Interventions for the Medical Workforce
7 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
DISCUSSION
This pilot intervention was conducted in order to determine if and indeed how, it could be
rolled out into a wider reaching and more robust programme. The strengths and
limitations identified during this pilot were incorporated in making this decision.
Strengths
This pilot was innovative, as other similar projects conducted to access nutrition have
not included junior doctors or obtained detailed feedback from participants. Many of
these previous nutrition education pilots related to the prevention of obesity but did not
consider hospital malnutrition [7-9]. Differences also exist in the length of time required
to teach the material, as most relied on a longer timeframe than the NEWTayDoc pilot. A
pilot project completed at two UK Higher Education Institutes with second year nursing
students and third year medical students attempted to enhance inter-professional
collaboration and change attitudes, knowledge and skills [11]. Students were brought
together for four weeks of a variety of clinical practice, taught classroom sessions, self-
directed study and facilitated reflective sessions. Although the inter-professional
collaboration pilot was longer than the NEWTayDoc intervention (only half a day), the
evaluation method of a questionnaire and focus group were equivalent [11]. Both
interventions reported similar shifts to knowledge scores suggesting that brief
interventions may be at least as effective as longer ones.
As the NEWTayDoc pilot was a small scale project, it was able to obtain detailed opinions
from the participants. In addition the rapport built with participants was helpful for
honest feedback on the material and the workshop as a whole and useful discussions
continued with some tutors for several months after the project. Several participants
initiated contact when they were looking for nutrition training or had nutrition related
questions. Participant and tutor suggestions from the focus groups and from continued
communication all formed the basis for a larger scale educational intervention.
Limitations
This pilot was conducted on a limited number of self-selected participants which may
affect the representativeness and generalizability of the results. Post-training evaluation
indicated that some participants did not improve their nutrition knowledge from baseline
(30% of questions were answered incorrectly pre and post training). This suggested that
some of the material needed to be adapted and/or changes made to the teaching and/or
evaluation methods. As the sample size was limited, some results, including changes
Planning Nutrition Education Interventions for the Medical Workforce
8 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
from baseline, may have been affected by random error rather than as a direct effect of
the intervention.
Improvements to the reliability of the evaluation could have been made by using a
questionnaire that was more reflective of the teaching material. Use of a pre-validated
questionnaire from the Nightingale study not created by the tutors may have indicated
that some questions may not have been addressed precisely by the training [5].
As the post-training evaluation was conducted immediately after the training, results
may be due to recall bias as opposed to knowledge acquisition. Other studies have also
indicated it would be beneficial to have long term follow-up and evaluation [7-9].
Confounding factors may have also affected the results due to varying baseline levels of
nutrition knowledge among participants who were at different stages in their medical
curricula.
CONCLUSION
Based on the overall outcome of this pilot project, and taking into account the
strengths, limitations and participant feedback of the NEWTayDoc education innovation
pilot a larger, more robust, programme called the Need for Nutrition Education
Programme (NNEdPro) was established [12]. Some suggestions incorporated from the
pilot in NEWTayDoc, included: teaching nutrition earlier in the curriculum (NNEdPro
focused on medical students, not junior doctors); creating an evaluation questionnaire
based on the teaching material which assess knowledge, attitudes and practice (KAP);
conducting post-training evaluations at one and three month intervals to eliminate recall
bias; and developing rapport with participants to gain insight into the training from the
participant perspective.
NNEdPro was successfully conducted in 2009, and results indicated that it increased
nutrition KAP in a population of fourth year medical students [12]. The NEWTayDoc pilot
intervention provided the key to establishing the NNEdPro group, which lays the
foundations of nutritional knowledge to clinical practice in tomorrow’s doctors [12].
Planning Nutrition Education Interventions for the Medical Workforce
9 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
What is already known on the subject:
One in three hospital patients is affected by malnutrition.
Increased awareness of the problem, particularly in the medical workforce, could
help prevent hospital malnutrition and associated problems.
There is a gap in nutrition teaching across a number of medical school curricula.
This gap may be filled through an innovative approach to nutrition education.
What this study adds:
This study demonstrates the key elements required to conduct a successful pilot
nutrition education intervention for junior doctors (NEWTayDoc).
This intervention adds to the evidence supporting nutrition education of later-
stage medical students and/or junior doctors.
Tutors determined that this intervention could be converted into a wider reaching
national programme, Need for Nutrition Education Programme (NNEdPro).
ACKNOWLEDGEMENTS AND DECLARATIONS
Funding: Supported by an educational grant from the NHS Tayside Endowment Fund.
Competing interests: None
Contributors: The NEWTayDoc Teaching Team Dr Sumantra Ray, Dr Minha Rajput-
Ray, Debbie Baldie, Caroline Hubbard, Dr Poonam Rana, Joyce Thompson, Anne Hobbs
and Anne Woodcock. The NEWTayDoc Analysis Team - Dr Sumantra Ray, Celia Laur, Dr
Minha Rajput-Ray, Dr Susie Schofield and Dr Joan Gandy.
Ethics Approval: The project was evaluated by Tayside NHS Research Ethics
Committee and exempted from the need for formal ethical approval.
Provenance and Peer Review: Not commissioned. Externally peer reviewed.
Data sharing statement: Data may be shared as long as anonymity and confidentiality
are preserved.
Planning Nutrition Education Interventions for the Medical Workforce
10 | Ray S, Laur C, Rajput Ray M, Gandy J, and Schofield S P a g e
MedEdWorld Publish www.mededworld.org
REFERENCES
[1] McWhirter JP, Pennington CRCP. Incidence and recognition of malnutrition in
hospital. BMJ. 1994;308:945-8.
[2] Edington J, Boorman J, Durrant ER, Perkins A, Giffin CV, James R, et al.
Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition
Prevalence Group. Clin Nutr. 2000;19:191-5.
[3] Russell CA, Elia M. Nutrition Screening Survey in the UK and Republic of Ireland
in 2010. British Association for Parenteral and Enteral Nutrition (BAPEN). 2010.
[4] Elia M, Bistrian B. The Economic, Medical/Scientific and Regulatory Aspects of
Clinical Nutrition Practice: What Impacts What? 2009.
[5] Nightingale JMD, Reeves J. Knowledge about the assessment and management of
undernutrition: a pilot questionnaire in a UK teaching hospital. Clinical Nutrition.
1999;18(1):23-7.
[6] Nutrition Summit stakeholder group working in partnership with the Department
of Health. Improving Nutritional Care: A joint Action Plan from the Department of Health
and Nutrition Summit stakeholders. 2007.
[7] Roberts DH, Kane EM, Jones DB, Almeida JM, Bell SK, Weinstein AR, et al.
Teaching medical students about obesity: a pilot program to address an unmet need
through longitudinal relationships with bariatric surgery patients. Surgical Innovation.
2011;18(2):176-83.
[8] Wylie A, Furmedge DS, Appleton A, Toop H, Coats T. Medical curricula and
preventing childhood obesity: pooling the resources of medical students and primary
care to inform curricula. Education for Primary Care. 2009;20(2):87-92.
[9] Swift JA, Sheard C, Rutherford M. Trainee health care professionals' knowledge of
the health risks associated with obesity. Journal of Human Nutrition & Dietetics.
2007;20(6):599-604.
[10] Health Improvement Scotland. Clinical Standards.
[11] Markey K. Supporting Interprofessional Learning in Practice an Evaluation of a
Pilot Project University of Derby's Online Journal. 2009(4).
[12] Ray S, Udumyan R, Rajput-Ray M, Thompson B, Lodge K-M, Douglas P, et al.
Evaluation of a novel nutrition education intervention for medical students from across
England. BMJ Open. 2012 January 1, 2012;2(1).
... In early 2011, the University of Cambridge, School of Clinical Medicine, Department of Public Health and Primary Care, in collaboration with the NERG, piloted a nutrition education session in the first clinical year of the undergraduate medical degree. This teaching was shaped by the early work of the NNEdPro group 22,23 and was incorporated into undergraduate and graduate medical curricula following favorable evaluations. ...
Article
Full-text available
Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of Clinical Medicine, including 1) the approach to medical nutrition education, 2) evaluation of the medical nutrition education initiative, and 3) areas identified for future improvement. The initiative utilizes a vertical, spiral approach during the clinically focused years of the Cambridge undergraduate and graduate medical degrees. It is facilitated by the Nutrition Education Review Group, a group associated with the UK Need for Nutrition Education/Innovation Programme, and informed by the experiences of their previous nutrition education interventions. Three factors were identified as contributing to the success of the nutrition education initiative including the leadership and advocacy skills of the nutrition academic team, the variety of teaching modes, and the multidisciplinary approach to teaching. Opportunities for continuing improvement to the medical nutrition education initiative included a review of evaluation tools, inclusion of nutrition in assessment items, and further alignment of the Cambridge curriculum with the recommended UK medical nutrition education curriculum. This paper is intended to inform other institutions in ongoing efforts in medical nutrition education.
... The Nutrition Education and Leadership for Improved Clinical Outcomes (NELICO) project stemmed from earlier work completed by the NNEdPro Group. The original work of the group looked into the effectiveness and value of providing a short training in clinical nutrition to medical students [6][7][8][9]. NELICO aimed to assess whether an intensive training intervention could equip junior doctors to run a hospital Nutrition Awareness Week (NAW) and thus contribute to improvement in clinical nutrition and patient outcomes in UK hospitals. ...
Article
Full-text available
Background: One in four adults are estimated to be at medium to high risk of malnutrition when screened using the 'Malnutrition Universal Screening Tool' upon admission to hospital in the United Kingdom. The Need for Nutrition Education/Education Programme (NNEdPro) Group was developed to address this issue and the Nutrition Education and Leadership for Improved Clinical Outcomes (NELICO) is a project within this group.The objective of NELICO was to assess whether an intensive training intervention combining clinical and public health nutrition, organisational management and leadership strategies, could equip junior doctors to contribute to improvement in nutrition awareness among healthcare professionals in the National Health Service in England. Methods: Three junior doctors were self-selected from the NNEdPro Group original training. Each junior doctor recruited three additional team members to attend an intensive training weekend incorporating nutrition, change management and leadership. This equipped them to run nutrition awareness weeks in their respective hospitals. Knowledge, attitudes and practices were evaluated at baseline as well as one and four months post-training as a quality assurance measure. The number and type of educational events held, pre-awareness week Online Hospital Survey results, attendance and qualitative feedback from training sessions, effectiveness of dissemination methods such as awareness stalls, Hospital Nutrition Attitude Survey results and overall feedback were also used to determine impact. Results: When the weighted average score for knowledge, attitudes and practices at baseline was compared with four months post-intervention scores, there was a significant increase in the overall score (p = 0.03). All three hospital teams conducted an effective nutrition awareness week, as determined by qualitative data collected from interviews and feedback from educational sessions. Conclusion: The NELICO project and its resulting nutrition awareness weeks were considered innovative in terms of concept and content. It was considered useful, both for the junior doctors who showed improvement in their nutrition knowledge and reported enthusiasm and for the hospital setting, increasing awareness of clinical and public health nutrition among healthcare professionals. The NELICO project is one innovative method to promote nutrition awareness in tomorrow's doctors and shows they have the enthusiasm and drive to be nutrition champions.
Article
Full-text available
Problems such as hospital malnutrition (∼40% prevalence in the UK) may be managed better by improving the nutrition education of 'tomorrow's doctors'. The Need for Nutrition Education Programme aimed to measure the effectiveness and acceptability of an educational intervention on nutrition for medical students in the clinical phase of their training. An educational needs analysis was followed by a consultative process to gain consensus on a suitable educational intervention. This was followed by two identical 2-day educational interventions with before and after analyses of Knowledge, Attitudes and Practices (KAP). The 2-day training incorporated six key learning outcomes. Two constituent colleges of Cambridge University used to deliver the above educational interventions. An intervention group of 100 clinical medical students from 15 medical schools across England were recruited to attend one of two identical intensive weekend workshops. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure consisted of change in KAP scores following intervention using a clinical nutrition questionnaire. Secondary outcome measures included change in KAP scores 3 months after the intervention as well as a student-led semiqualitative evaluation of the educational intervention. Statistically significant changes in KAP scores were seen immediately after the intervention, and this was sustained for 3 months. Mean differences and 95% CIs after intervention were Knowledge 0.86 (0.43 to 1.28); Attitude 1.68 (1.47 to 1.89); Practice 1.76 (1.11 to 2.40); KAP 4.28 (3.49 to 5.06). Ninety-seven per cent of the participants rated the overall intervention and its delivery as 'very good to excellent', reporting that they would recommend this educational intervention to colleagues. Need for Nutrition Education Programme has highlighted the need for curricular innovation in the area of clinical health nutrition in medical schools. This project also demonstrates the effectiveness and acceptability of such a curriculum intervention for 'tomorrow's doctors'. Doctors, dietitians and nutritionists worked well in an effective interdisciplinary partnership when teaching medical students, providing a good model for further work in a healthcare setting.
Article
Full-text available
Despite obesity's relevance and impact, curricula addressing obesity are underrepresented in clinical medical education. A novel pilot program to begin teaching medical students about care of the obese patient was developed and student attitudes toward obesity and bariatric surgery were assessed. The authors paired third-year students with obese patients undergoing bariatric surgery. Students established a longitudinal patient relationship, received faculty mentorship, and kept a reflections journal. An attitude assessment survey was administered before and after third year. Reflections were analyzed for common themes. Baseline student responses differed from those previously reported for practicing physicians on many survey statements, including more strongly agreeing with the relationship between obesity and serious medical conditions (P < .001), the need to educate patients about obesity risks (P < .001), and willingness to recommend bariatric surgery evaluation (P = .004). These differences were maintained after clinical clerkships. Reflection themes included recognition of obesity stereotypes, improved estimation of body mass index, and awareness of physicians' attitudes about obesity. Development and assessment of a novel pilot program to teach third-year medical students about obesity and bariatric surgery suggests a potential impact on student attitudes and understanding of obesity and obesity surgery. Students today may have different attitudes toward obesity than those reflected in prior data for physicians in practice, and programs such as this may help maintain positive attitudes.
Article
Full-text available
The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.
Article
Full-text available
To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. Prospective study of consecutive admissions. Acute teaching hospital. 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.
Article
his paper reports on the effectiveness of the learning and teaching approaches incorporated into a small scale interprofessional education pilot project, as evaluated by the participating students. The pilot brought together second-year nursing students and third-year medical students, for a period of four weeks of clinical practice, taught classroom sessions, self-directed study and facilitated reflective sessions. The findings suggest that interprofessional learning in practice for undergraduate students on health care programmes is a highly valued experience, however, it requires extensive facilitation and structuring. Students involved in this pilot reported that they better understood the roles and remit of other healthcare professionals, including strengths and challenges that are present. The variety of learning and teaching approaches were evaluated positively although these elicited different views from student respondents. Students highlighted the importance of structuring, focusing and facilitating such experiences to maximise the true interprofessional learning opportunities. Recommendations are made around the need for focussed and facilitated interprofessional learning opportunities in practice and the need for the incorporation of a variety of learning and teaching approaches. Although it is not within the scope of this article, these recommendations highlight the need for good interprofessional facilitation skills.
Book
Malnutrition has been known in hospital and outpatient care for more than 30 years. It is estimated that an average of 30% of patients are affected, and in the majority of cases the problem remains unrecognized and untreated. Moreover, this disease-related malnutrition increases health costs by 30-70% as recent studies have shown, exceeding even the costs of obesity. Nutrition interventions, generating in comparison only a small cost, may therefore result in substantial absolute savings. This publication gives an overview of the current state of affairs in Europe and the US, also examining the economics of malnutrition. Also discussed are reimbursement models for enteral nutrition as well as regulatory aspects and their impact on practice. The book closes with a discussion of future challenges and opportunities. Considering the extent of the problem, this publication will be of interest not only to doctors directly involved in the care of patients, but also to policy makers and administrative personnel.
Article
Objectives: To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units. Design: Prospective study of consecutive admissions. Setting: Acute teaching hospital. Subjects: 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly. Main outcome measures: Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status. Results: On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented. Conclusion: Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.
Article
The detection, prevention and treatment of undernutrition in hospitals is often poor. This study assesses the knowledge about undernutrition of staff in a UK teaching hospital. Twenty nine doctors, 65 final year medical students, 45 nurses, 11 dietitians, and 11 pharmacists anonymously completed a questionnaire of 20 multiple choice questions. One of five possible answers was considered correct. Twelve questions were about adult nutritional assessment and requirements, five about oral/enteral nutrition and three about parenteral nutrition. Dietitians scored significantly more (median 16) than the other groups (doctors: seven, medical students: eight, nurses: seven and pharmacists: nine) (P < 0.0001). Medical students scored more than doctors (P < 0.001). Examples of areas in which knowledge could be improved are: 67% respondents thought the prevalence of hospital undernutrition to be less than 30%. While 91% of respondents correctly chose a well 70 kg man to need about 2000 kcal/day, only 23% knew that approximately the same amount was needed for a febrile post-operative patient. Sixteen percent knew antibiotic treatment to be the most common reason for enteral feeding-related diarrhoea. Knowledge about the assessment and management of undernutrition among doctors, medical students, nurses and pharmacists was poor. This questionnaire provides a framework for teaching and auditing the effectiveness of an educational program.
Article
The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity. We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lost > or = 10% of their body weight, had a Body Mass Index <20, or had a Body Mass Index <20 with one anthropometric measurement <15th centile were considered malnourished. Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished. One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.
Article
Trainee nurses, doctors and dietitians will direct the future of obesity treatment and prevention. To do so effectively, they must have sufficient knowledge regarding the health risks associated with obesity and feel that part of their professional role is to counsel obese patients regarding these risks. An online survey collected data on professional roles, training needs and the Obesity Risk Knowledge-10 (ORK-10) scale from 38 dietetic, 88 nursing (Diploma), 74 nursing (Masters) and 389 medical students. Final-year dietetic students demonstrated higher ORK-10 scale scores than final-year nursing (Dip), nursing (MSc) and medical students (P < 0.001). The majority of students agreed that part of their profession's role was to counsel obese patients about the health risks associated with obesity. Dietetic students were more satisfied with the teaching they had received than each of the other student groups (P < 0.05). Future health care professionals recognize their responsibility to communicate health risk information to obese patients. Dietetic students have a sound knowledge base to support them in this. Educators of trainee nurses and doctors may like to respond to their students' lower levels of knowledge and desire for more training.