A Nutrition Counseling Curriculum to Address Cardiovascular Risk Reduction for Internal Medicine Residents

Abstract

Introduction Primary care providers play a critical role in reducing patients' risk for cardiovascular disease, including providing dietary counseling. However, few physicians feel adequately trained to provide this counseling, and most internal medicine (IM) residencies do not offer nutrition education. Methods We created an interactive, case-based activity for IM residents to improve the delivery of nutrition counseling to patients with hypertension, hyperlipidemia, overweight, and obesity. The curriculum was given over two in-person small-group sessions facilitated by physician preceptors. It reviewed evidence for relevant dietary patterns, provided resources for dietary referrals, and allowed residents to practice counseling based on a patient's stage of behavioral change. Results Residents completed electronic surveys prior to curriculum implementation, immediately after, and 2 months after completion of the curriculum. Aggregate percent correct scores of knowledge questions improved significantly in the immediate postsurvey ( n = 24 paired responses, p = .004). We also reviewed electronic health records of patients with body mass index ≥ 25, hypertension, or hyperlipidemia who were seen in our resident clinics 2 months prior ( n = 503) and 2 months after ( n = 473) curriculum delivery. Residents' documented nutrition counseling increased from 35% to 41% (odds ratio, 1.27; 95% CI, 0.97–1.67; p = .085). Discussion We demonstrated improved knowledge of nutrition interventions to reduce cardiovascular risk and reported improvement of resident-provided nutrition counseling for appropriate patients. This activity offers IM residents effective initial nutrition training for patients at risk for cardiovascular disease and is practical to implement as part of an ambulatory curriculum.

Increasing Trainee Comfort with Nutrition

“…Opportunities to practice a specific skill usually are limited in residency curricula secondary to time constraints and lack of resources such as standardized patients, as evidenced by the lack of inclusion of a standardized patient encounter in other published nutrition curricula. 7,8 The focus on this specific skill after dedicated didactic learning likely increased resident comfort levels in addition to their appreciation for the importance of this skill. For this reason, we suspect that participation in all three of these activities drove the attitudinal changes for the residents.…”

“…As part of the design of this three-part curriculum, residents were given the opportunity to practice conducting a nutritional assessment with standardized patients for a common clinical scenario in addition to more traditional didactic and case-based learning modalities. Opportunities to practice a specific skill usually are limited in residency curricula secondary to time constraints and lack of resources such as standardized patients, as evidenced by the lack of inclusion of a standardized patient encounter in other published nutrition curricula 7,8 . The focus on this specific skill after dedicated didactic learning likely increased resident comfort levels in addition to their appreciation for the importance of this skill.…”

“…Although this is beginning to change at the undergraduate medical education level with the development of nutrition in medicine modules, culinary medicine programs, and self-directed learning modules, there is a lack of published nutrition curricula at the graduate medical education level 5,6 . The few that exist within Internal Medicine (IM) residency programs focus on culinary medicine or cardiovascular-related nutrition counseling but lack a focus on the basics of how to conduct a nutritional assessment 7,8 …”

The Time is Ripe: The Case for Nutrition in Graduate Medical Education in the United States

“…Many educators have already developed innovative curricula to teach nutrition in a variety of formats ranging from workshops to community settings to teaching kitchens and culinary medicine models that promote nutrition education alongside practical skills and personal well-being. 41 - 44 Table 1 provides an overview of notable examples. These existing tools and curricula merit further study for both replicability and overlap with competency measures.…”