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IN U.S
~ _
MEDICAL SCHOOLS
Committee on Nutrition
in MecTical Education
Food and Nutrition Boarc!
Commission on Life Sciences
National Research Council
National Academy Press
Washington, D.C. 1985
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National Academy Press ~ 2101 Constitution Avenue, NW ~ Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils of
the National Academy of Sciences, the National Academy of Engineering, and the
Institute of Medicine. The members of the committee responsible for the report were
chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to
procedures approved by a Report Review Committee consisting of members of the
National Academy of Sciences, the National Academy of Engineering, and the Institute
of Medicine.
The Research Council was established by the National Academy of Sciences in 1916 to
associate the broad community of science and technology with the Academy's purposes
of furthering knowledge and of advising the federal government. The Research Council
operates in accordance with general policies determined by the Academy under the
authority of its congressional charter of 1863, which establishes the Academy as a
private, nonprofit, self-governing membership corporation. The Research Council has
become the principal operating agency of both the National Academy of Sciences and the
National Academy of Engineering in the conduct of their services to the government, the
public, and the scientific and engineering communities. It is administered jointly by both
Academies and the Institute of Medicine. The National Academy of Engineering and the
Institute of Medicine were established in 1964 and 1970, respectively, under the charter of
the National Academy of Sciences.
The work on which this publication is based was supported by the Ruth Mott Fund, the
William H. Donner Foundation, and the National Research Council (NRC) Fund, a pool
of private, discretionary, nonfederal funds that is used to support a program of Academy-
initiated studies of national issues in which science and technology figure significantly.
The NRC Fund consists of contributions from a consortium of private foundations
including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation,
the William and Flora Hewlett Foundation, the John D. and Catherine T. MacArthur
Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the
Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual
contributions from companies that are concerned with the health of U.S. science and
technology and with public policy issues with technological content; and the National
Academy of Sciences and the National Academy of Engineering endowments.
Library of Congress Catalog Card Number 85-61572
International Standard Book Number 0-309-03587-2
Printed in the United States of America
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Committee on Nutrition
in Medical Education
MYRON WINICK (Chairman), Institute of Human Nutrition,
College of Physicians and Surgeons, Columbia University,
New York, New York
STANLEY M. ARONSON, Division of Biology and Medicine,
Brown University, Providence, Rhode Island
RICHARD BEHRMAN, Department of Pediatrics, School of
Medicine, Case Western Reserve University, Cleveland, Ohio
LUCILLE S. HURLEY, Department of Nutrition, University of
California, Davis, California
DOUGLAS S. KERR, Department of Pediatrics and Biochemistry,
Case Western Reserve University, and Division of Pediatric
Endocrinology and Metabolism, Rainbow Babies & Children's
Hospital, Cleveland, Ohio
ALEXANDER LEAF, Department of Preventive Medicine and
Clinical Epidemiology, Harvard Medical School, and the
Cardiovascular Health Center, Massachusetts General
Hospital, Boston, Massachusetts
l. MICHAEL McGTNNIS, Office of Disease Prevention and
Health Promotion, U.S. Department of Health and Human
Services, Washington, D.C.
JACQUELINE ANN REYNOLDS, Physiology Department, Duke
University Medical Center, Durham, North Carolina
Advisors
ATTALLAH KAPPAS, The Rockefeller University, New York,
New York
ROBERT LEVY, Department of Health Sciences, Columbia
University College of Physicians and Surgeons, New York,
New York
Staff
SUSAN E. BERKOW, Staff Officer
FRANCES M. PETER, Editor
MARIANNE LA VElLLE, Research Associate
BARBARA C. MILLER, Secretary
SUSHMA PALMER, Executive Director, Food and Nutrition
Board
· · .
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Food and Nuirition Board
KURT l. ISSELBACHER (Chairman), Harvard Medical School and
Department of Gastroenterology, Massachusetts General
Hospital, Boston, Massachusetts
RICHARD L. HALL (Vice ChairmanJ, Science and Technology,
McCormick and Company, Inc., Hunt Valley, Maryland
HAMISH N. MUNRO (Vice ChairmanJ, U.S. Department of
Agriculture Human Nutrition Research Center on Aging, Tufts
University, Boston, Massachusetts
WILLIAM E. CONNOR, Department of Medicine, Oregon
Health Sciences University, Portland, Oregon
PETER GREENWALD, Division of Cancer Prevention and
Control, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland
JOAN D. GUSSOW, Department of Nutrition Education, Teachers
College, Columbia University, New York, New York
RICHARD l. HAVEL, Cardiovascular Research Institute,
University of California School of Medicine, San Francisco,
California
VICTOR HERBERT, Hematology and Nutrition Laboratory,
Veterans Administration Medical Center, Bronx, New York
NAMES R. KIRK, Research and Development, Campbell Soup
Company, Camden, New Jersey
REYNALDO MARTORELL, Food Research Institute, Stanford
University, Stanford, California
I. MICHAEL McGTNNIS, Office of Disease Prevention and
Health Promotion, U.S. Department of Health and Human
Services, Washington, D.C.
MALDEN C. NESHElM, Division of Nutritional Sciences, Cornell
University, Ithaca, New York
ROBERT H. WASSERMAN, Department/Section of Physiology,
New York State College of Veterinary Medicine, Cornell
University, Ithaca, New York
MYRON WINICK, Institute of Human Nutrition, College of
Physicians and Surgeons, Columbia University, New York,
New York
Staff
SUSHMA PALMER, Executive Director, Food and Nutrition
Board
1V
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Preface
As the American public becomes increasingly aware of the impor-
tance of nutrition in health maintenance and disease prevention
and treatment, physicians are frequently expected to provide their
patients with accurate, up-to-date information and guidance con-
cerning diet, food, and health. This increased public demand for
nutrition information, along with growing recognition of the inte-
gral role of nutrition in health, has contributed to a heightened
awareness within the medical community of the need to provide
physicians with adequate training in this area.
The Food and Nutrition Board (FNB) of the National Research
Council viewed the question of adequate and appropriate nutrition
education in medical schools to be of sufficient national concern to
warrant assessment. Thus, at the request of the Ruth Mott Fund and
the William H. Donner Foundation, the Committee on Nutrition in
Medical Education was established within the FNB and charged
with examining three major issues: (1) How and to what extent is
nutrition incorporated into medical school curricula? (2) What per-
centage of medical schools teaches nutrition? (3) How successfully
is nutrition taught in different categories of medical schools, and
what are the reasons for the success or failure of the programs? The
committee was also asked to make recommendations, based on its
analysis of these questions, concerning the role that nutrition
should play in medical education and the feasibility of and strat-
egies for implementing them. In doing so, it drew upon the wide
range of expertise of its eight members, who have experience in
academic, clinical, and administrative aspects of medical education.
Collectively, the committee represented such disciplines as bio-
chemistry, physiology, nutritional sciences, pediatrics, medicine,
family practice, university administration, and science and health
policy.
v
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The report prepared by the committee begins with an Executive
Summary, Chapter 1, which highlights the major findings and
recommendations resulting from the study. The scientific, social,
and economic forces that have shaped the role of nutrition in the
medical curriculum during this century are discussed in Chapter 2.
Chapter 3 directs the reader's attention to the ever-growing body of
knowledge implicating nutrition as one of the etiological factors
contributing to many forms of chronic and degenerative disease.
The application of nutrition principles to patient care within the
many medical specialties is illustrated. Chapter 4 contains sum-
maries of previous conferences, congressional hearings, and sur-
veys that have examined this subject as well as reviews of other
relevant reports. This chapter also contains the results of an inde-
pendent survey conducted by the committee to determine how and
to what extent nutrition is incorporated into the curricula. The
committee's review of nutrition-related questions on the National
Board examinations and the view of the American Medical Student
Association regarding nutrition education are also presented.
To assist medical schools in incorporating nutrition into their
curricula, the committee developed an outline of core concepts to
identify the basic body of nutrition knowledge that all graduating
medical students should acquire during their medical training.
These concepts, along with examples to illustrate specific kinds of
information, are presented in Chapter 5. Chapter 6 is a summary of
the committee's findings based on all the data that it analyzed. It
also presents the strategies for effectively incorporating nutrition
into the medical school curriculum.
The committee is grateful to all who contributed to the study. It
wishes especially to acknowledge the contribution of the following
consultants, who provided valuable information and expertise: El-
eanor Young, University of Texas, San Antonio; Roland Weinsier,
University of Alabama School of Medicine at Birmingham; Willard
Visek, University of TIlinois; Harold Lubin, American Medical Asso-
ciation; Maurice Shils and Barbara Howell, New York-New Jersey
Regional Medical Center; and William Kassler, President of the
American Medical Student Association.
Special thanks are also due to Edithe Levit, President of the
National Board of Medical Examiners, and Robert lewett, Deputy
Vice President for Evaluation Programs, who were unfailingly help-
fu! and supportive in providing the committee with information
from the National Board examinations.
The following persons also provided valuable information and
V1
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insight that helped make this evaluation possible: lames Schofield,
Association of American Medical Colleges; Merrill S. Read,
National Institutes of Health; and more than 45 deans, associate
deans, and nutrition course coordinators who responded to our
survey and provided support and encouragement.
The committee commends Susan Berkow, the FNB staff officer
for the study, for her superior performance in supporting all aspects
of the committee's work and in taking the initiative, wherever
needed, to propose and apply innovative approaches to accom-
plishing the task. It also wishes to thank Frances Peter and Judy
Grumpstrup-Scott, who provided patient and careful editorial
assistance: Marianne La Veille for providing bibliographical mate-
rial and other research support; and Barbara Miller for dedicated
secretarial services.
The committee is particularly indebted to the officials of the
Commission on Life Sciences and the Food and Nutrition Board:
Frederick C. Robbins, Chairman of the Commission, for his invalu-
able support and assistance to the study, and Sushma Palmer,
Executive Director of FNB, for her untiring dedication and commit-
ment to excellence.
MA
4, - ~
^c:
/ MYRON WINICK
Chairman
Committee on Nutrition
in Medical Education
· e
V11
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Contents
1
2
EXECUTIVE SUMMARY
HISTORICAL PERSPECTIVE
3 RATIONALE FOR INCLUDING NUTRITION
INSTRUCTION IN MEDICAL EDUCATION
9
29
4 CURRENT PROGRL\MS 57
5 CURRICULUM GUIDELINE FOR
INCORPORATING NUTRITION IN
MEDICAL EDUCATION 85
6 CONCLUSIONS AND RECOMMENDATIONS 95
APPENDIXES
A U.S. Medica:! Schools Surveyed by the
Committee and Their Characteristics
B Survey of Medical School Deans and
Associate Deans ...................
C Survey of Medical School Nutrition
Course Coordinators ...............
D Personal Interview Survey of Nutrition
Course Coordinators ..............
E Speakers at Nlarious Committee Meetings
101
103
107
111
119
F Testimony of the American Medical
Student Association: Nutrition Education
in the Undergraduate Medical Curriculum 121
G Nutrition Science Content of National
Board Examinations
INDEX
1X
127
137
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