Year One:

During the first year of the Nutrition Academic Award (NAA) Program, it was determined that a Curriculum Committee should be established, with the goal to develop curriculum objectives for dissemination to other medical schools. Dr. Charles B. Eaton (Brown University) and Dr. Lisa Hark (University of Pennsylvania) were named as co-chairs and education experts from each NAA institution were appointed by the Principal Investigators. The document was entitled Nutrition Curriculum Guide for Training Physicians and consists of nutrition-related knowledge, practice behavior skills and attitudinal objectives covering the field of nutrition. The entire process was completed over a five year period from 1998 to 2003.

Initial discussions identified the topics that would be included in the Guide. Several key research studies and consensus reports of medical educators served as the foundation for these decisions. These included the 1995 American Medical Student Association (AMSA) national consensus report which identified 92 content areas as "Essential for Nutrition Education in Medical Schools" (1) as well as the American Society for Clinical Nutrition (ASCN) Committee on Medical/Dental School and Residency Nutrition Education which prioritized 40 nutrition content areas within medical school curriculum (2). Finally, the landmark 1985 "Nutrition Education of US Medical Schools: "Curriculum Guidelines for Incorporating Nutrition in Medical Education" published by the Food and Nutrition Board, Council on Life Sciences, National Research Council was also an important resource (3).

The 40 and 92 content areas in the AMSA and ASCN documents were cross-referenced and organized into 23 topics or chapters, as listed in the table of contents. Additional content areas felt to be important in each of the major topics were added as needed. A team of multidisciplinary content specialists from each of the 21 NAA schools contributed nutrition-related knowledge, practice behavior skills and attitudinal objectives for each content area within a specific topic area. The majority of the initial contributors and reviewers were members of the NAA Curriculum Committee (Appendix). Ongoing drafts underwent multiple rounds of review and revision by other NAA members as well.

Year Two:

During year two, Dr. Brian Tobin and Dr. Michael Smith at Mercer University School of Medicine were appointed the task of editing all of the objectives in order to produce a single, consistent format with behavioral objectives that were educationally sound and measurable in keeping with Mager (4). The goal has been to produce a set of learning objectives that aimed to promote higher levels of thinking by writing objectives that included an appropriate mix at both lower levels of Bloom's Taxonomy (knowledge and comprehension) and objectives at higher levels (e.g., synthesis and evaluation) (5). Less than one quarter of the current set of objectives are at the knowledge level, and approximately one third are at Bloom's synthesis or evaluation level. In addition to cognitive, knowledge-centered objectives, the Guide also includes learning objectives for student attitudes and practice behavior skills. Thus, each section includes four components: a brief list of content areas consistent with previous national curriculum recommendations for nutrition, knowledge objectives, practice behavior skill objectives, and attitudinal objectives.

Year Three:

During year three, the revised objectives were resubmitted to the NAA contributors for a final review and it was determined that the objectives spanned medical students, residents, as well as advanced level practitioners or specialists. Therefore, the NAA Curriculum Committee determined that it was critical for each objective to be ranked according to the level of the learner (medical student, resident or specialist), in order to prioritize the extensive list of objectives. To accomplish this task, a modified Delphi technique was successfully implemented under the direction of Dr. Craig Scott, at the University of Washington School of Medicine, who established a Web-based process to accomplish this arborous task. A team from each NAA school was responsible for categorized each objective as either a) core or essential for medical students , b) recommended for medical students who want more training in nutrition, c) appropriate for residents, or d) appropriate for specialists in post-GME programs. In addition, within each of these categories, reviewers were asked to rate each objective according to its importance in clinical medicine. Objectives that more than 50 percent of the reviewers rated as clinically important are bolded in order to be distinguished among the list.

Year Four:

During year four, the NAA Curriculum Committee agreed on the best possible way to list the objectives as well as dissemination strategies. It was decided that all objectives would be included in the first distribution of the document, since the nutrition content at medical schools may be at different levels and the nutrition faculty may be also responsible for graduate medical education as well. The medical student, resident and specialists objectives were also grouped together within each topic in order to help educators incorporate these objectives into their curriculum.

Year Five:

A Web-based version was the top priority for the Nutrition Curriculum Guide for Training Physicians, as we agreed that this method would be the most accessible and utilization could also be easily tracked. The entire document can be downloaded or a single topic area of interest using the links established from the table of contents versions in either PDF and HTML format to meet individual user's needs. The Web-based version of the Guide can be used not only by US medical and health professional schools, but also by all medical schools worldwide. In addition, The Guide will be disseminated by a variety of professional publications and presentations (6,7) such as the Annual Meetings of the Association of American Medical Schools, American Society of Clinical Nutrition, Society of Teachers of Family Medicine and the American Dietetic Association.

Lisa A. Hark, PhD, RD, Charles B. Eaton, MD and the Curriculum Committee