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Title: Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: a science advisory from the American Heart Association

Author
item ASPRY, KAREN - American Heart Association
item VAN HORN, LINDA - Northwestern University
item CARSON, JO ANN - University Of Texas
item WYLIE-ROSETT, JUDITH - Albert Einstein College Of Medicine
item KUSHNER, ROBERT - American Heart Association
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item DEVRIES, STEPHEN - Northwestern University
item FREEMAN, ANDREW - American Heart Association
item CRAWFORD, ALLISON - American Heart Association
item KRIS-ETHERTON, PENNY - Pennsylvania State University

Submitted to: Circulation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/1/2018
Publication Date: 6/5/2018
Citation: Aspry, K.E., Van Horn, L., Carson, J.S., Wylie-Rosett, J., Kushner, R.F., Lichtenstein, A.H., Devries, S.M., Freeman, A.M., Crawford, A., Kris-Etherton, P.M. 2018. Medical nutrition education, training, and competencies to advance guideline-based diet counseling by physicians: a science advisory from the American Heart Association. Circulation. 137(23):e821-e841. https://doi.org/10.1161/CIR.0000000000000563.
DOI: https://doi.org/10.1161/CIR.0000000000000563

Interpretive Summary: Physician-initiated diet counseling in patients with heart disease or at risk can significantly advance cardiovascular health in individuals and the population-at-large, thereby reducing the large public health and economic burdens from the disease. This scientific statement presents timely opportunities for and real-world examples of enhanced medical education in nutrition and outlines the competencies and entrustable behaviors that are the expected outcomes of these educational efforts. Educational programs will benefit from evaluating their nutrition education activities against these competencies and, when not met, can improve their curricula, the experiences of other nutrition educators, and innovation. Since nutrition is a dynamic science with a rapidly evolving evidence base requiring continual updating and renewed translational efforts, the nutrition competencies framework outlined provides both foundational elements and flexible options for incorporating evolving nutrition knowledge, technology, and skills, including those that may arise from innovations in education. Emphasized is increased need for collaboration with qualified professionals to enhance and sustain physician-initiated diet education efforts, a model facilitated by the growing emphasis on inter-professional education and teamwork. Like other collaborative care models, team-based nutrition care delivered systematically within health systems, coupled with equally robust public health and population-based efforts to improve adherence to evidence-based dietary guidelines and patterns, could improve diet quality and reduce the public health and economic and burdens from heart to a degree not previously actualized in this country.

Technical Abstract: Growing scientific evidence of the benefits of heart-healthy dietary patterns and of the massive public health and economic burdens attributed to obesity and poor diet quality have triggered national calls to increase diet counseling in outpatients with atherosclerotic cardiovascular disease or risk factors. However, despite evidence that physicians are willing to undertake this task and are viewed as credible sources of diet information, they engage patients in diet counseling at less than desirable rates and cite insufficient knowledge and training as barriers. These data align with evidence of large and persistent gaps in medical nutrition education and training in the United States. Now, major reforms in undergraduate and graduate medical education designed to incorporate advances in the science of learning and to better prepare physicians for 21st century healthcare delivery are providing a new impetus and novel ways to expand medical nutrition education and training. This science advisory reviews gaps in undergraduate and graduate medical education in nutrition in the United States, summarizes reforms that support and facilitate more robust nutrition education and training, and outlines new opportunities for accomplishing this goal via multidimensional curricula, pedagogies, technologies, and competency-based assessments. Real-world examples of efforts to improve undergraduate and graduate medical education in nutrition by integrating formal learning with practical, experiential, inquiry-driven, interprofessional, and population health management activities are provided. The authors conclude that enhancing physician education and training in nutrition, as well as increasing collaborative nutrition care delivery by 21st century health systems, will reduce the health and economic burdens from atherosclerotic cardiovascular disease to a degree not previously realized.