Australian and New Zealand Medical Students’ Attitudes and Confidence towards Providing Nutrition Care in Practice
Abstract
:1. Introduction
2. Materials and Methods
Recruitment
3. Results
3.1. Theme 1 – The Role of the Doctor in Providing Nutrition Care
3.1.1. Doctors Have a Role in Providing Nutrition Care
“I definitely think that, especially with the obesity epidemic, that more nutritional advice is warranted, to try and prevent a lot of the diseases.”(P10, UoW)
“Nutrition is a big part of health… It would be silly not to be responsible for the element if you are treating someone.”(P2, FG2, UoA)
3.1.2. Doctors Are Well-Placed to Provide Nutrition Care
“GPs are really well placed to start that [nutrition] conversation with patients and take it as far as they can. And then if patients want a lot of personalised, ongoing information then it might be better off referring to a nutritionist.”(P8, UoW)
“If you are in a situation where a patient asked you for advice, I think we should still be able to give something… We need sufficient knowledge to give some advice… It won’t be at the same level as dietitians or nutritionists.”(P4, FG2, UoA)
3.1.3. GPs Are an Accessible Source of Nutrition Care
“In [the] primary care setting not everyone has access to dietitians, so I think also GP’s would be equipped with that kind of knowledge as well.”(P2, FG3, UoA)
3.2. Theme 2 – Knowledge-Based Nutrition Confidence
3.2.1. Participants Had Variable Nutrition Knowledge
“I suppose a balance between the macro-nutrition and micro-nutrition, so a balance between protein, carbohydrate, fats, as well as well-balanced in terms of the vitamins that are required would be a general answer.”(P10, UoW)
“Most of the diseases that are a problem today are nutrition-related diseases”(P1, FG2, UoA)
3.2.2. Dietary Management Strategies for the Prevention and Treatment of Chronic Disease
“It’s [nutrition] mentioned and then it’s like ‘and this is the drug you put them on’.”(P3, UoW)
“It’s one thing saying “you need to lose weight” but it is another to give them the strategies to do that”(P4, FG2, UoA)
3.3. Theme 3: Skill-Based Nutrition Confidence
3.3.1. Lack of Confidence in the Application of Skill-Based Nutrition Competencies
“Uh, I could grope my way towards it, but I wouldn’t feel very confident in doing it [nutrition care].”(P6, UoW)
“I think we have had enough so far if it were then to be applied…. and shown how it is used in clinical practice later.”(P2, FG2, UoA)
“I think ones for specific(s) like Diabetes Australia does one for diabetes, and… Coeliac Australia does one for coeliac diets and there’s all these ones for FODMAPS as well that are available through those kinds of organisations.”(P4, UoW)
“…There are so many sources of information that it can almost be hard to locate where you got the information from because it just seems like we are constantly surrounded by it….”(P2, FG3, UoA)
3.3.2. A Multidisciplinary Approach to Nutrition Care
“I suppose I’d be happy to give very basic advice, but beyond that I’d probably be inclined to refer onward if I thought that they needed a proper nutritional assessment.”(P10, UoW)
“I think that [Doctors] have to have… a base knowledge, up to date and current and have to be able to describe the basis of a healthy diet and a bad diet. But when it comes down to the… finer details and the specialised diets for different things, then they should give a referral to nutritionists.”(P5, FG5, UoA)
3.4. Theme 4 – Medical Nutrition Education
3.4.1. Poor Translation of Nutrition Science to Clinical Application
“We have been taught functions for these vitamins and this mineral… I would struggle to see how it would translate to patients.”(P3, FG2, UoA)
“In terms of the curriculum, I don’t think we are given enough information about the practical aspects of nutrition.”(P13, UoW)
3.4.2. Poor Integration of Nutrition into Medical Education
“It (nutrition education) needs to be more integrated into other modules”(P3, FG5, UoA)
“It seemed to me that our framework was that it [nutrition education] all happened in the same fortnight… So, the foundation was put there to really build on it, but we never got the chance.”(P3, UoW)
“I think… there are a lot of things that I wouldn’t be able to do a management plan for. We are not expected to know how to completely intervene for certain things at this stage.”(P2, FG3, UoA)
“I understand that in our first year and a half the amount of curriculum is so much that adding to that may not be welcome or feasible, and even necessary at this stage of training.”(P12, UoW)
3.4.3. Poor Engagement with Nutrition Professionals
“Small group activities are quite a good place to discuss nutrition.”(P5, FG2, UoA)
“I feel like there either needs to be more from those sorts of clinicians that come in or at least (some) emphasise to know where your limitations are and refer onwards and even say ‘look, do A, B and C, but once it goes beyond there refer to a dietitian’.”(P10, UoW)
3.5. Theme 5 – Personal Beliefs Shaping Students’ Attitudes Towards Nutrition
Personal Experience of Specific Dietary Advice
“Another good thing that I’ve read is not buying anything with ingredients that a third grader couldn’t read”(P7, UoW)
“I guess the information is out there, and when we get guidelines on what a ketosis diet is, and what a plant-based diet is, then we’ll [students] be better off”(P1, UoW)
3.6. Theme 6 – Nutrition for Population Health
3.6.1. Environmental Determinants as Limitations to Dietary Adherence
“I think also the elderly, they can’t take care of themselves yep, they are more prone to problems.”(P3, FG3, UoA)
“In New Zealand especially, there is a lot higher prevalence of … fast food and … low nutritional but cheap restaurants related to low socioeconomic gradients.”(P3, FG4, UoA)
3.6.2. Time Is a Limitation to the Provision of Nutrition Care
“Nutrition is more of an attitude rather than a set of guidelines and sharing that attitude is what shares… healthy beliefs… sharing attitude I feel is much more complex… how do we share that with a patient when you might only have like 10–15 min?”(P3, FG2, UoA)
3.6.3. The Role of Policy and Media in Health
“I don’t believe that having better educated doctors is going to be enough. It needs to be a public health message and I feel like nutrition and dietitians should be publicly funded.”(P1, FG5, UoA)
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Knowledge-based Nutrition Competencies |
K1 – Sciences: Demonstrate understanding of the basic sciences in relation to nutrition |
K2 – Prevention: Demonstrate knowledge of the interactive role of nutrition in health and the prevention of disease |
K3 – Treatment: Demonstrate knowledge of the evidence-based dietary strategies for prevention and treatment of disease |
K4 – Food: Demonstrate awareness of food, sources of nutrients, food habits and the cultural and social importance of food |
Skill-based Nutrition Competencies |
S1 – Risk: Demonstrate skills in the identification of nutritional risk, nutritional deficits and excesses |
S2 – Critical: Demonstrate ability to interpret nutrition evidence in a critical and a scientific manner and apply appropriately in clinical practice |
S3 – Application: Demonstrate ability to apply basic dietary strategies for prevention and treatment of medical conditions, disease and trauma, with recognition that many nutritional issues require specialist management by a dietitian |
S4 – Ethics: Demonstrate the ability to apply principles of ethics related to nutritional management |
S5 – Team: Demonstrate ability to work effectively in a team with other health professionals to deliver optimal nutrition care |
Interview Questions | Inquiry Logic |
---|---|
Do you think doctors have a role in providing nutrition information to patients? | Explore students’ perceptions of their role in providing nutrition care. |
On a scale of 1–5 (1 being poor and 5 being excellent), please rate the nutrition training you have received so far in your medical education. (Probe)
| Identify students’ perceptions of their nutrition training and ways it can be improved. |
Can you identify what constitutes a healthy diet? | Identify students’ perceptions of a healthy diet. |
Do you think nutrition is important in preventing lifestyle diseases? (Probe)
| Identify students’ perceptions of the link between nutrition and the development of lifestyle-related disease. |
Can you tell me about diseases and medical conditions that affect nutrition requirements? (Probe)
| Identify students’ perceptions of knowledge of medical conditions that affect nutrition requirements. |
Can you tell me about treatments/ medications that may alter a patient’s nutrition intake and/or requirements? | Identify students’ knowledge of medical treatments/medications that affect nutritional status. |
Can you tell me about the psychological and societal causes of malnutrition? (Probe)
| Explore students’ perceptions of the psychological and societal causes of malnutrition. |
Do you think that healthy food is accessible in New Zealand/Australia? (Probe)
| Explore students’ perceptions of the accessibility of healthy food in New Zealand/Australia. |
Can you list a situation where nutrition may be a priority over other lines of therapy (e.g., pharmaceutical)? | Identify students’ ability to prioritise nutrition therapy in certain situations. |
Where do you locate information about healthy eating? (probe)
| Identify students’ ability to locate reputable sources of information for healthy eating and for specific conditions which require nutrition care. |
Do you have any other comments that you would like to add? | Explore students’ perceptions related to medical nutrition education. |
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Share and Cite
Lepre, B.; Crowley, J.; Mpe, D.; Bhoopatkar, H.; Mansfield, K.J.; Wall, C.; Beck, E.J. Australian and New Zealand Medical Students’ Attitudes and Confidence towards Providing Nutrition Care in Practice. Nutrients 2020, 12, 598. https://doi.org/10.3390/nu12030598
Lepre B, Crowley J, Mpe D, Bhoopatkar H, Mansfield KJ, Wall C, Beck EJ. Australian and New Zealand Medical Students’ Attitudes and Confidence towards Providing Nutrition Care in Practice. Nutrients. 2020; 12(3):598. https://doi.org/10.3390/nu12030598
Chicago/Turabian StyleLepre, Breanna, Jennifer Crowley, Dineo Mpe, Harsh Bhoopatkar, Kylie J. Mansfield, Clare Wall, and Eleanor J. Beck. 2020. "Australian and New Zealand Medical Students’ Attitudes and Confidence towards Providing Nutrition Care in Practice" Nutrients 12, no. 3: 598. https://doi.org/10.3390/nu12030598