Survey correlations: proficiency and adequacy of nutrition training of medical students.

OBJECTIVE: The majority of graduating US medical students reported inadequate nutrition training over the past decade. This trend could in part be due to the lack of valid measures to assess the relationship between adequacy of nutrition training and proficiency on nutrition topics deemed essential. The study's objective was to test the hypothesis that self-reported nutrition proficiency is positively correlated with the perceived adequacy (quality, quantity, coverage and importance) of nutrition training of University of Washington medical students. METHOD: Cross-sectional e-mail survey of 1st to 4th year medical students (n = 708), including a survey prompt and three e-mail follow-up measures. To reduce and interpret the survey data, principal components analysis was employed, followed by Varimax rotation with Kaiser normalization. To assess internal consistency reliability, alpha (alpha) of nutrition proficiency items and factors was determined. RESULTS: A 44.5% response rate was achieved (n = 315 respondents). The 31-item questionnaire was reduced to 6 factors, explaining 60.2% of the total variance (alpha = 0.947). Self reported nutrition proficiency was positively correlated with the perceived quality, quantity and coverage of nutrition training in all 6 essential nutrition factors or topics determined after factor analysis (P < 0.01). CONCLUSION: Quality and coverage may be effective gauges of adequacy of nutrition training and related nutrition proficiency in medical education. Current national medical education evaluation measures focus on the quantity of nutrition instruction. The lowest reported proficiency topics; nutrition and disease management, micronutrients and complementary and alternative medicine are recommended for particular curricular emphasis.

Regional solutions to the physician workforce shortage: the WWAMI experience.

With major medical organizations predicting a national shortage of physicians in coming years, a number of institutional models are being considered to increase the numbers of medical students. At a time when the cost of building new medical schools is extremely expensive, many medical schools are considering alternative methods for expansion. One method is regional expansion. The University of Washington School of Medicine (UWSOM) has used regional expansion to extend medical education across five states without the need to build new medical schools or campuses. The WWAMI program (the acronym for Washington, Wyoming, Alaska, Montana, Idaho), which was developed in the early 1970s, uses existing state universities in five states for first-year education, the Seattle campus for second-year education, and clinical sites across all five states for clinical education. Advantages of regional expansion include increasing enrollment in a cost-effective fashion, increasing clinical training opportunities, responding to health care needs of surrounding regions and underserved populations, and providing new opportunities for community-based physicians to enhance their practice satisfaction. Challenges include finding basic-science faculty at regional sites with backgrounds appropriate to medical students, achieving educational equivalence across sites, and initiating new research programs. UWSOM's successful long-term regional development, recent expansion to Wyoming in 1997, and current consideration of adding a first-year site in Spokane, Washington, indicate that regional expansion is a viable option for expanding medical education.

Physician informational needs in providing nutritional guidance to patients.

OBJECTIVES: This study's objective was to assess patient nutrition inquiries and related physician resources to identify the nutrition topics about which physicians most need information for patients and practice. METHODS: A survey was mailed to a 50% random sample of Washington Academy of Family Physicians (WAFP) members (n=778) to identify the top 10 patient nutrition inquiries that the physician would like to be better equipped to answer. The responding physicians' use of nutrition resources (journals, pamphlets, Web resources, toll-free numbers, and referrals to registered dietitians) was also recorded. RESULTS: A total of 306 (39.3%) physicians responded. The majority wanted more information on weight management (66.5%), followed by information on herbals, botanicals, and other complementary and alternative medicines (CAM) (36.4%) and vitamin and mineral supplements (24.4%). Other common nutrition inquiries for which respondents wanted more information included diet for prevention of disease, high protein-low carbohydrate diets, and childhood nutrition. A minority of respondents used nutrition Web resources and toll-free numbers. Nearly all respondents reported referring patients to registered dietitians. CONCLUSIONS: Physicians in our survey expressed a need for information on topics such as obesity, CAM, and life cycle and disease-specific diets. Medical nutrition educators should consider the educational needs of the practicing physician.

Nutrition care of older adults with chronic disease: attitudes and practices of physicians and patients.

OBJECTIVES: Eighty percent of older adults have at least one chronic disease. Most conditions could be improved with nutritional intervention. This scientific study assessed physician and patient knowledge of, and behaviors about nutrition, resulting in tools to guide physicians in nutrition management of chronic diseases. METHODS: Surveys were conducted of 300 practicing physicians and 600 older adults to identify current attitudes and practices regarding the role of nutrition in chronic disease management. RESULTS: Ninety percent of physicians surveyed recognize the relationship between nutrition and chronic disease. Yet nutrition care occurs only sporadically in primary care settings. CONCLUSIONS: Most physicians are aware of nutrition in managing chronic disease, but a significant percentage do not routinely include nutrition in their practice. This research led to the development of tools to assist in identifying and managing the nutritional aspects of chronic disease.

Self-reported nutrition proficiency is positively correlated with the perceived quality of nutrition training of family physicians in Washington State.

BACKGROUND: Despite concerted scientific, educational, and congressional calls to increase nutrition coverage in medicine for more than half a century, most graduating medical students report an inadequate quality and quantity of nutrition training. Furthermore, practicing physicians report a lack of confidence and related proficiency in nutrition counseling skills because of inadequate training. Assessment of nutrition proficiency and related training of practicing physicians may support the prioritization of nutrition topics to be included in medical education. OBJECTIVE: We tested the hypothesis that the perceived adequacy of nutrition training (quality and quantity) of family physicians in Washington State is positively correlated with self-reported nutrition proficiency in 5 nutrition factors determined after confirmatory factor analysis. DESIGN: A randomized mail survey method (n = 778 possible respondents), which involved one mass-mailing follow-up, was used. RESULTS: A 39.3% response rate was achieved (n = 306 respondents). The 31-item questionnaire was reduced to 5 factors, explaining 48.5% of the total variance (alpha = 0.916). Perceived quality (poor to excellent) of nutrition training was positively correlated with self-reported nutrition proficiency scores for all 5 factors (P < 0.01). No significant differences were noted between zip code or sex and mean nutrition proficiency scores for all 5 factors. CONCLUSION: The examination of correlations between perceived quality of education and self-reported proficiency may be a useful gauge of effectiveness of nutrition training in medicine. Prioritization of nutrition information based on proficiency levels, including information on complementary and alternative medicines and nutritional management of disease, merits further investigation.