There is overwhelming evidence that diet strongly influences risk of cardiovascular diseases, hypertension, diabetes, obesity and some cancers. National dietary guidelines have been established to help reduce the incidence of these diseases, but the majority of the population does not adhere to them. More specifically, the National Cholesterol Education Program (NCEP) advocates diet as the cornerstone of treatment of cardiovascular disease, but few physicians feel prepared to provide dietary advice. Nutrition impacts the health status of every patient, young or old, inpatient or outpatient, whatever the diagnosis but tat present only 22% of US medical schools offer a required course in nutrition. In part, this is a reflection of the minimal attention paid tot nutrition on the National Board Exams. In 1993, only 12% of the board questions related to nutrition. Since most medical schools have few, if any, medical faculty with credentials, training, and interest in nutrition there is little or no support for this subject in curriculum development. Existing faculty with nutrition expertise are often preoccupies with clinical practice or research leaving little or incentive for teaching. Physicians who indicate they feel prepared to provide or facilitate dietary counseling also indicate that their medical school training included it. The purpose of this proposal is to develop, teach and test a comprehensive medical nutrition education model that improves nutrition knowledge, attitude and related clinical behavior of medical students and raises the visibility and support for nutrition in prevention and treatment of disease. Essential to effective application of these objectives is a supportive environment where standardized nutritional assessment and effective dietary intervention is commonly practiced and modeled by residents and attending physicians. To achieve these outcomes, faculty tutors for Problem Based Learning Courses will be provided with nutrition related guidelines. Also, a variety of continuing education opportunities, concluding a Visiting Nutrition Scholar program, are planned for residents, fellows, faculty and other health professionals on campus. Registered dietitians will be trained to play a supporting role in these efforts both academically and in clinical practice. The ultimate goal of this combined strategy is to improve patients' dietary behavior in efforts to prevent and treat disease. The generalizability of this model with potentially collaborative research opportunities with other medical schools in testing some of these strategies are further addressed.
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