Assessing the Impact of Nutrition Training Among Medical Students

Poor dietary choices are one of the strongest risk factors for death and disability in the United States, leading to conditions such as obesity, type 2 diabetes, and cardiovascular disease.¹ These chronic illnesses are preventable, but many adults lack the knowledge to make dietary changes.^2,3 The public consistently identifies primary care doctors as the preferred source of nutrition information and counseling.⁴ However, physicians cite a lack of knowledge as a major barrier to counseling patients on nutrition/disease prevention.⁵ Additionally, physicians’ personal habits predict how much they will counsel their patients on these topics.⁶

Nutrition education in American medical schools is inadequate and decreasing.^7–9  Furthermore, there is a paucity of literature evaluating the impact of nutrition education among medical students.^10,11 Therefore, increasing medical students’ nutrition education may be important to help change this paradigm.

This project was developed to expand the existing Keck School of Medicine of the University of Southern California (KSOM) nutrition curriculum. We created a 1-hour nutrition lecture that was delivered to first-year medical students. The students were surveyed before and after the lecture. This study aimed to assess change in medical students' knowledge and attitudes after receiving an additional nutrition curriculum.

A 1-hour nutrition lecture was delivered, both live and via webcast, to 186 first-year KSOM medical students. Attendance was optional. The lecture overviewed clinically important vitamins and minerals, emphasizing micronutrient deficiencies throughout the life cycle.

Using pre-, post-, and 3-month postsurveys, we assessed the students on the following parameters: (1) change in their knowledge; (2) confidence in counseling patients; (3) change in their own behaviors; and (4) satisfaction with the curriculum. We assessed change in knowledge using multiple choice factual recall questions, and we assessed confidence, behavior, and satisfaction using 10-point Likert scale survey questions. The postsurvey also included two free-response questions. The same survey was given pre, post, and 3 months after the curricular intervention. The survey is available in the STFM Resource Library.¹²

We used a paired samples t test to compare student responses. We analyzed the free-response questions for common themes using an inductive approach.¹³ This project was deemed exempt by the University of Southern California’s Institutional Review Board. 

One hundred forty-two of 186 students (76%) attended the live lecture. Of the 142 students in attendance, 105 (73.9%) completed both pre/postsurveys, and 65 (45.8%) completed the 3-month follow-up survey. Students improved their knowledge of the material, from an average score of 37% to 82% (P<.001). These scores dropped to 65% at the 3-month mark (P<.001; Figure 1). Student comfort in assessing and counseling patients improved across the three intervals surveyed, from 3.53 to 5.90 to 8.00 on a 10-point Likert scale (P<.001). Students' motivations to change their personal behaviors were high overall, starting at 8.04 (pre) and improving to 8.36 (post) and 8.25 (3-month post) surveys, respectively (P<.05). Moreover, students were satisfied with the lecture (8.58/10). Students also largely agreed that medical schools should include more nutrition curricula (8.58/10; Figure 2).

The free-response questions yielded a few common themes, which are represented in Table 1.

This study assessed the impact of additional nutrition curricula among first-year medical students. Our findings support continued and increased preclinical nutrition training as it increases student nutrition knowledge and perceived competence. The most dramatic increase was seen in nutrition knowledge, highlighting these medical students' knowledge gap before the lecture. However, knowledge retention decreased at the 3-month mark, reflecting the need for a longitudinal curriculum that provides repeated exposure to these concepts.

Generally, medical students show a high level of interest in nutrition education and believe more nutrition content should be included in medical school curricula.^14,15 Our study supports this fact given the overall high level of satisfaction (8.58/10), agreeing that medical schools should include more nutrition curriculum (8.58/10), and high response rates of 73.9% (initial response rate) and 45.8% (3-months posttraining).

Our study also found a high level of student motivation to change their dietary behaviors. This may predict an increased likelihood of providing nutrition care, as previous studies have shown that doctors or medical students who follow healthy dietary habits are more likely to provide similar recommendations to their patients.^16,17 Therefore, the ability of an intervention to improve the habits of students will not only improve their personal well-being but may also be passed on to their patients.¹⁸

This study has several limitations. Both the brevity of the survey and the short 3-month study time span may limit the validity of assessing long-term student knowledge retention. Moreover, the survey items reflect self-reported attitudes, which are susceptible to recall and social-desirability biases. A nonresponse bias may also be present, particularly with the decline in response rate for the 3-month survey, in which the students who responded may already be interested in the topic. This may impact generalizability.  Further, we have no data to evaluate the actual practices of the students when counseling patients, which may be better measured in residency and postresidency doctors who are further involved in patient care. In addition, our intervention was limited to a single 1-hour lecture with a narrow focus on vitamins and minerals. Future studies should aim to include a more extensive, longitudinal curriculum that allows more concepts to be covered and repeated over time.¹⁹ Lastly, medical schools may choose to implement more hands-on programs that allow students to directly engage with the food. This has proven to be an effective tool for increasing nutrition competency.^20,21

With a clearly demonstrated deficit in medical student nutrition education, it is important to continue implementing more content into the curricula. While nutrition education should be longitudinal with multiple training sessions, this pilot study evaluates the impact of a single nutrition session and shows promise for a larger-scale curricular nutrition integration.