Dietitians and medical educators Duane Mellor and Elaine Macaninch discuss the role of nutrition in medical education
The unique dietetic nutrition research and education role held by Elaine Macaninch, was developed for Brighton and Sussex Medical School (BSMS), by Dr Kathy Martyn who teaches nutrition at BSMS, the School Of Health Sciences (Nursing and AHP) and on other nutrition courses based at the University of Brighton. Together, Kathy and Elaine recently formed the Education and Research in medical Nutrition Network (ERimNN), linking educators, students, patients, agriculture, producers, public health and the third sector; to share resources and increase the capacity of nutrition education. We are also part of the Nutrition Implementation Coalition, a partnership of four organisations, NNEdPro Global Centre for Nutrition and Health, Culinary Medicine, Nutritank and ERimNN. Its aim is to widen the evidence-based conversation around food and health for the benefit of patients, as explained in this Nutrition Implementation coalition short animation.
One advantage of employing a dietitian is to connect to a wider network of nutrition specialists, such as those who work in areas like kidney care, oncology, neurology, intensive care (ICU), paediatrics and sports etc. This also helps to ensure medical students are grounded in where nutrition is relevant to clinical practice. This allows the students to appreciate the wider roles and responsibilities of the multi-professional team (MDT), as well as the crossover and links between the professions.
Where do you think nutrition fits within medical education?
Nutrition is a key component of basic sciences and clinical practices, relevant to pre and post clinical training. As such the General Medical Council (GMC) recognises nutrition as a key element of patient assessment and care. Our nutrients are key to physiological and biochemical pathways. Also, a poor quality diet is a major risk factor for chronic conditions such as cardiovascular disease, type 2 diabetes, some forms of cancer and strokes.
Dietitians are not a frontline service, we rely on doctors and nurses to identify nutritional problems. Sometimes first-line advice and support are enough. But it is also important to know when you can use social prescribing (a referral on to community programs) and when more specialist help from dietitians is required.
NICE clinical guidelines often include nutrition and lifestyle changes as core elements. But the findings from our paper: Time for nutrition in medical education published last month, found that many UK doctors did not feel confident to talk to their patients about food, or know when to refer a patient on to a dietitian. We want to improve medical students’ understanding and confidence in nutrition, so as doctors they can appreciate the role of good nutrition, alongside medical and pharmacological treatments.
Nutrition is influenced by our psychology, culture, environment and socioeconomic circumstances. Nutrition is not just telling (or nagging) people about what to eat; but it is about how to facilitate, motivate and collaborate with patients to make healthier food choices. We believe this is a great way to practise patient-centred care.
Indeed, research from Australia and the US tells us that patients trust their doctors to be able to advise them on food. GPs in the UK tell us that patients are asking more questions about their diet. So it is imperative that they keep up to date with the latest research and ensure they are applying the most current evidence base while being careful to respect individual differences and medical needs.
Nutrition, therefore, is not a stand-alone subject but should be integrated into medical specialities. In Brighton we teach nutrition within core modules on cardiology, gastroenterology, bone health, public health, renal, paediatrics, general practice and in symposiums on topics such as obesity, among many other areas. We also supervise student research projects and student-selected components (SSCs). We have seen students present their research at national and international conferences and they have published papers, such as: NICE targeted screening to identify gestational diabetes: who are we missing? We have two additional papers on nutrition assessment within dementia care and the potential role of pro and prebiotics in depression treatment coming out soon.
As healthcare professionals, we all need to consider the importance of correct nutrition for patients at risk of or recovering from the coronavirus. But beyond the current pandemic, it is imperative that going forward, we teach medical and healthcare students about nutrition and its role in patient care.
Duane Mellor is an experienced dietitian, researcher and educator having published over 60 papers in the fields of dietetics, nutrition and food science. Having spent the first decade of his career working in diabetes care as a dietitian he moved into research where he investigated the effects of dark chocolate on cardiovascular risk in people with type 2 diabetes. Recently, he has moved into medical education at Aston Medical School, but still is active in diabetes care as part of the Diabetes UK Nutrition Working Group and British Dietetic Association Diabetes Special Interest Group committee.
Elaine Macaninch currently works for Brighton and Sussex Medical School as a Nutrition Medical Educator helping to integrate nutrition into the curriculum. She maintains a clinical role as a Registered Dietitian, specialising in diabetes in pregnancy and is co-founder of the ERimNN (Education and research in Medical Nutrition Network) alongside Dr Kathy Martyn. In addition, she is an executive member of NNedPro Global Centre for Nutrition and is also the nutrition lead and a director for Culinary Medicine UK. She is currently researching gaps in nutrition education from the perspective of medical students and junior doctors.
To qualify as a dietitian requires an undergraduate degree or a postgraduate qualification in nutrition and dietetics and a period of supervised practice in a hospital setting. On completion, you can register as an allied health professional (just like a physiotherapist, radiographer, or speech and language therapist).
A dietitian assesses, diagnoses and treats nutritional problems as part of the prevention or treatment of medical conditions. However, some dietitians work outside of the NHS, in areas such as research, education, within industry or in the media.