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.
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
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.
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.
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.
a complete description of how the Nutrition Curriculum Guide for Training
Physicians was developed, see Appendix 3.
visit the NAA Web site for additional nutrition education resources (www.nhlbi.nih.gov/research/training/naa).
A. Hark, PhD, RD and Charles B. Eaton, MD
and Members of the Curriculum Committee
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