Preface/User's Guide

The purpose of this preface is to serve as both a brief introduction to this document and a User's Guide to assist readers in finding the information most useful to them.

Background and Introduction: In recognition of the need to develop and enhance undergraduate and graduate medical nutrition education, the National Heart Lung and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) established the Nutrition Academic Award (NAA) Program in 1997 (www.nhlbi.nih.gov/funding/training/naa). The NAA Program provided 21 U.S. medical schools with five-year grants to support nutrition education programs for medical students, medical residents, and clinical faculty (Appendix). This Nutrition Curriculum Guide for Training Physicians represents the efforts of medical nutrition educators at these schools. The section topics were selected after reviewing the existing literature and curricula. Members of the NAA Curriculum Committee were then assigned the task of creating or reviewing first drafts of a given section.

Each section was written with four components: a brief list of content areas, consistent with previous curriculum recommendations for nutrition, and learning objectives written for knowledge, practice behavior skills, and attitudes. After each section was reviewed, the entire document was revised by Drs. Brian Tobin and Michael Smith at Mercer School of Medicine to ensure that the learning objectives used language consistent with Bloom's taxonomy and included objectives that represented each area of development of expertise (cognitive and problem-solving). At this point the objectives were submitted to a consensus-generating "Delphi" process with the assistance of Dr. Craig Scott, at the University of Washington School of Medicine.

Nutrition education spans the continuum for medical students, residents, and specialists and we have attempted to address this issue by listing objectives as appropriate for each of these levels. Learners at each level would be expected to have some degree of competency in those objectives listed for learners below their level. The Delphi process allowed us to prioritize objectives and we have done this by placing in BOLD type the items ranked in the top 1/3 of all objectives at each learner level. Objectives that follow are not in order of priority. Clearly, an individual programs' ability to accomplish these objectives depends upon many factors (educational priorities, resources, etc.).

This curriculum is designed to be used by medical educators and evaluators, curriculum committees, Deans offices, etc. to assist in creating, evaluating, modifying, and updating nutrition curricula at individual programs (medical schools, residency and fellowship training programs). We have organized the Chapters in a way that allows individual course leaders to rapidly identify those areas relevant to their course. Curriculum committees will be most interested in the global behavior and attitude objectives listed first in this manual. These objectives were common themes across many of the individual sections.

The goal of any curriculum is to elucidate for teachers and learners the knowledge, practice behavior skills, and attitudes that are expected for competence and mastery. It also allows for specific evaluation strategies to be created. These objectives are already in use at many of the NAA schools to help define and refine teaching efforts. They have begun to appear in syllabi, chapter headings, lecture introductions, course summary guides, etc. Evaluation strategies have been (and will continue to be) developed to assist educators in assessing student's progress in meeting these objectives.

The National Board of Medical Examiners (NBME) who administers the USMLE Step 1, 2 and 3 exams has developed a nutrition sub-score for the Step 1 exam. The NBME has approved members of the NAA Program to review the Step 1, 2 and 3 exams in 2002 in order to assess the quantity and quality of the nutrition-related items. This process will also determine if it is appropriate to recommend a nutrition-subscore for the Step 2 and Step 3 exams. As schools modify their nutrition curriculum, they will be able to assess student progress through this mechanism.

Conclusion and Use of the Guide: On behalf of the entire NAA Curriculum Committee and Principal Investigators, we hope that the objectives in the Nutrition Curriculum Guide for Training Physicians will be as valuable a resource for our readers as we have found them to be in our teaching efforts. These objectives can be used by medical educators and evaluators involved in planning, implementing and evaluating nutrition curriculum across the continuum of medical education.

This effort represents a continuation of prior work in this field and is not intended to be the final work on this subject. This document will be revised as users provide feedback on it and as new medical information accumulates. A process for revising it has been created by the authors.

For a complete description of how the Nutrition Curriculum Guide for Training Physicians was developed, see Appendix 3.

Please visit the NAA Web site for additional nutrition education resources (www.nhlbi.nih.gov/funding/training/naa).

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