Current State of Nutrition Education in Pediatric Critical Care Medicine Fellowship Programs in the United States and Canada

Abstract

Objectives: To assess the current state of nutrition education provided during pediatric critical care medicine fellowship. Design: Cross-sectional survey. Setting: Program directors and fellows from pediatric critical care medicine fellowship programs in America and Canada. Subjects: Seventy current pediatric critical care medicine fellows and twenty-five pediatric critical care medicine fellowship program directors were invited to participate. Interventions: Participants were asked demographic questions related to their fellowship programs, currently utilized teaching methods, perceptions regarding adequacy and effectiveness of current nutrition education, and levels of fellow independence, comfort, confidence, and expectations in caring for the nutritional needs of patients. Measurements and Main Results: Surveys were sent to randomly selected program directors and fellows enrolled in pediatric critical care medicine fellowship programs in America and Canada. Twenty program directors (80%) and 60 fellows (86%) responded. Ninety-five percent of programs (19/20) delivered a formal nutrition curriculum; no curriculum was longer than 5 hours per academic year. Self-reported fellow comfort with nutrition topics did not improve over the course of fellowship (p = 0.03), with the exception of nutritional aspects of special diets. Sixty-five percent of programs did not hold fellows responsible for writing daily parenteral nutrition prescriptions. There was an inverse relationship between total number of fellows in a pediatric critical care medicine program and levels of comfort in ability to provide parenteral nutrition support (p = 0.01). Program directors perceived their nutritional curriculum to be more effective than did their fellows (p ≤ 0.001). Conclusions: Nutrition education was reported as highly underrepresented in pediatric critical care medicine fellowship curricula. The majority of programs rely on allied health care professionals to prescribe parenteral nutrition, which may influence trainee independence in the provision of nutritional therapies. Improving the format of current nutrition curriculums, by relying on more active teaching methods, may improve the delivery and efficacy of nutrition education. The impact of novel training interventions on improving the competency and safety of enteral and parenteral nutrition delivery in the PICU must be further examined.

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

“…In 2017, a survey of 646 cardiologists revealed that while 95% believed discussing nutrition information to be part of their role, only 10% felt adequately prepared. 31 The application to many other specialties including primary care, 32 gastroenterology, 33 endocrinology, 34 and critical care 35 is clear, demonstrating widespread opportunity for GME nutrition innovation.…”

Editor’s Choice Articles for December

“…After reading my fourth Editor’s Choice article (14), by way of an educational review, move onto the 2019 world survey of 920 PICU practitioners in 57 countries that asked about barriers to delivery of enteral nutrition (15). Then read the 2019 survey of North American pediatric critical care fellowship programs, with 20 program directors and 60 fellows, which found that nutrition education was “highly underrepresented” in curricula (16). Next, review the report on postpyloric feeding tube placement under ultrasound guidance (17, 18).…”