How can nutrition organisations support the teaching of nutrition to student doctors?

We’d like doctors to learn more about nutrition – here’s how we can help.

The importance of nutrition for health is widely recognised, and poor nutrition is associated with an increased risk of ill health[1],[2]. Public Health England acknowledged the need to develop training in diet and health for non-nutritionists[3] and the NHS long-term plan commits to ensuring that “nutrition has a greater place in professional education training.”[4]  Yet nutrition has not been well covered in medical training, with reports suggesting there is only between 2 and 19 hours of teaching devoted to nutrition over a 5-year medical degree programme[5] [6]. The Academy of Nutrition Sciences and its member organisations, the Association for Nutrition (AfN), British Dietetic Association, British Nutrition Foundation and The Nutrition Society, are committed to championing nutrition science, enhancing its impact on policy and health for public benefit.  Improving the coverage of nutrition within the medical curriculum is, therefore, a key concern.

Understanding the reasons for this lack of nutrition coverage in the medical curriculum is important.  When the AfN, surveyed medical schools they found that one reported reason is the time pressure on an already crowded curriculum. Another is the need for nutrition expertise within teaching staff.  Medical schools wanted to see how nutrition teaching would map against the General Medical Council  (GMC) Outcomes for Graduates and the Medical Licensing Assessment (MLA), and asked for evidence-based resources.  Examples that demonstrate how to integrate nutrition into the curriculum have also been identified as useful. An important factor is that medical schools have a great deal of freedom in what they teach.  Although the GMC articulates “graduate fundamentals” and sets the Medical Licensing Assessment, medical schools determine the detail of their syllabus – it is in this detail where nutrition should sit. 

AfN became the custodians of the nutrition curriculum for undergraduate medical training in 2018, building on the work of the Academy of Medical Royal Colleges[7] who published their nutrition curriculum guidance in 2013.  The challenge was not just to create a modern, competency-based curriculum, but also to understand these barriers and to encourage greater inclusion of nutrition in the syllabus.  The task was to design a curriculum which would provide the basic nutrition knowledge which doctors need on “day 1”, which would provide a foundation for later learning within specialities and which would help newly qualified doctors to understand when specialist nutrition support would benefit their patients.  But it was also about providing a curriculum which makes sense to medical schools, which can be integrated into their existing syllabus in a coherent way, and which can be assessed as part of the existing assessment structures.

In 2021, AfN published the updated Undergraduate Curriculum in Nutrition for Medical Doctors[8], the work of an Interprofessional Group which included representatives from a range of nutrition, dietetic and medical organisations. This was a multidisciplinary piece of work which demonstrated what is possible when professional associations, learned societies, practitioners, academics and policy makers work together.  It will take the joint efforts of these organisations to promote, encourage and enable uptake of the curriculum by medical schools.

It is this joint working model which the Academy is well placed to promote.  All of the Academy founding members are members of the Interprofessional Group and all have a role to play in supporting implementation.  One of the benefits of the Academy is that it provides a forum where nutrition organisations can co-ordinate their activities on issues which matter to all of us, and bring together their strengths to work for public benefit.  

The curriculum has been designed to provide doctors with an understanding of key principles in nutrition.  The intention is not to make doctors nutrition professionals, but rather to give them the knowledge they need to support their medical practice, to provide basic nutrition advice and to understand how and when to refer patients for specialist nutrition support.  The curriculum was mapped against the GMC Outcomes for Graduates and the Medical Licensing Assessment, so that medical schools can see where nutrition teaching can be usefully added to their existing teaching and, indeed, where it may already be covered without being explicitly identified as nutrition.  Assessment drives learning, so the Interprofessional Group is also developing questions to contribute to the MLA question bank.

The Interprofessional Group identified three areas of activity to support implementation of the curriculum – communications, resource development and quality assurance.  These areas require the support of all member organisations of the IPG and, indeed, the nutrition and dietetic community more widely, to maximise the impact of the curriculum on initial medical training.  A scoping exercise has been conducted to identify the current capabilities and resources of the IPG members, which could support implementation of the curriculum. 

We believe that medical schools should be supported to easily identify resources that will support them in delivering the nutrition curriculum, so a quality assurance scheme has been established that endorses the resources developed by the nutrition and dietetic community against the curriculum, identifying the teaching points that are supported.  AfN has launched a web page to provide a “one stop” point of access to the resources and CPD opportunities available, ready for promotion to medical schools as they are encouraged to implement the nutrition curriculum.  Work is ongoing to publish academic papers about the curriculum, and other promotional activity has been undertaken including a social media campaign and direct communications with medical schools.  

Ultimately, the success of the nutrition curriculum depends on the ability of medical schools to integrate its teaching points into the detail of their syllabus.  Doing so will require support and expertise, which the Academy of Nutrition Sciences, and its member organisations, are well placed to provide through the development of resources to support teaching points, CPD opportunities for medical educators and the promotion of examples of good practice which already exist.  

Helen Clark

Chief Executive, Association for Nutrition
Academy of Nutrition Sciences Operational Support Group Member

[1] Public Health England, “Calorie reduction: The scope and ambition for action,” March 2018. [Online]. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/800675/Calories_Evidence_Document.pdf.

[2] Development Initiatives, “2020 Global Nutrition Report: Action on equity to end malnutrition,” July 2020. [Online]. Available: https://globalnutritionreport.org/documents/566/2020_Global_Nutrition_Report_2hrssKo.pdf.

[3] Public Health England, “Sugar Reduction: The evidence for action,” October 2015. [Online]. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/470179/Sugar_reduction_The_evidence_for_action.pdf.

[4] NHS Digital, “The NHS Long Term Plan,” 7 January 2019. [Online]. Available: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/. [Accessed September 2020].

[5] Macaninch E, Buckner L, Amin P, Broadley I, Crocombe D, Herath D, et al. Time for nutrition in medical education York Teaching Hospital NHS Foundation Trust. 2020 [cited 2022 Mar 10];0. Available from: http://dx.doi.org/10.1136/bmjnph-2019-000049

[6] Broad J, Wallace M. Nutrition and public health in medical education in the UK: reflections and next steps. Public health nutrition [Internet]. 2018 Sep 1 [cited 2022 Mar 11];21(13):2523–5. Available from: https://pubmed.ncbi.nlm.nih.gov/29708088/

[7] https://www.aomrc.org.uk/reports-guidance/uk-undergraduate-curriculum-nutrition/

[8] https://www.associationfornutrition.org/careers-nutrition/wider-workforce/nutrition-training-for-medical-doctors