Biden Administration Works to Improve Nutrition and Health Education in Medical School Curriculums

Despite the prevalence of obesity and related diseases, including type 2 diabetes, hypertension, heart disease, cancer, and stroke in the US, there is little training on nutrition in American medical schools. 

Dr. Stephen Devries, a cardiologist and co-lead of the Nutrition Education Working Group at the Harvard School of Public Health, spoke about this gap in the medical curriculum on a recent AMA podcast. “Nutrition just hasn't been recognized as a priority in medical education, despite the fact that dietary changes are well recognized to be the leading risk factor for premature death and disability in the United States. On average, medical students spend about 19 hours over the course of four years in medical school on nutrition. But much of that is related to biochemistry and topics that are important but not directly clinically relevant for patients. So in the absence of meaningful nutrition education, what are medical students to think when they graduate, other than the fact that nutrition must not be very important in their training because they only learned about drugs and procedures?” he said. 

Due to the public health concern and the costs related to poor nutrition, government representatives are starting to speak up. From the House of Representatives to the White House, there are calls for action to improve education and outreach on nutrition and diet-related disease from medical schools to elementary schools. Earlier this year, following a congressional briefing with the Nutrition Education Working Group at the Harvard School of Public Health, Congressman McGovern (D, MA) and Congressman Burgess (R, TX) passed a bipartisan resolution in the House calling for “medical schools, residency, and fellowship programs to provide nutrition education that demonstrates the connection between diet and disease.” The resolution will encourage federal agencies to prioritize funding for medical “programs that incorporate substantive training in nutrition and diet sufficient for physicians and health professionals to meaningfully incorporate nutrition interventions and dietary referrals into medical practice.” 

In late September, the White House hosted its first Conference on Hunger, Nutrition, and Health in over 50 years where they unveiled a formal strategy to promote better nutrition and improve food security. The administration announced $8 billion in commitments, underneath five pillars, involving stakeholders from non-profits to universities to tech start-ups. The second pillar, “Integrate Nutrition and Health,” is most heavily geared towards medical students and physicians. Some of the named actions include:

• A commitment by the American College of Lifestyle Medicine (ACLM) to make an in-kind donation of $24.1 million to improve nutrition training for medical professionals

• A first-ever Medical Education Summit on Nutrition in Practice organized by the AAMC and ACGME to convene 150 medical education leaders

• A signed pledge by many leading health organizations (including the National Medical Association and National Hispanic Medical Association) to take action on strengthening health professionals’ nutrition education

• A commitment by The University of South Carolina School of Medicine Greenville to make a $4.8 million in-kind donation to assist in the implementation of its Lifestyle Medicine curriculum for interested medical schools and to provide content guidance to the National Board of Medical Examiners

Student Bloggers Urge Medical Schools to Incorporate Gun Safety Training

Can medical schools play a role in preventing gun violence? David Velasquez, a fourth-year student at Harvard Medical School, and Jesper Ke, a third-year student at the University of Michigan School of Medicine think so. Their blog, published in StatNews, urges medical schools to take on gun violence by educating their students on the risks and empowering them to proactively speak with patients about gun safety and violence prevention. Just 15 percent of medical schools currently have gun-related material as a component in the curriculum.

The authors suggest the following curriculum updates:

• Teach the basics of responsible gun ownership and safety in class. The article notes that first-year medical students at the University of California, San Francisco used a small group discussion-based curriculum, which included a patient counseling role-play exercise.  

• Invite patients impacted by gun violence to tell their stories and discuss how guns have impacted them physically, mentally, and emotionally (similar to how patients battling disease are invited to share their clinical journey). 

• Incorporate relevant gun-related content into clinical rotations. The authors note that the Warren Alpert Medical School of Brown University updated their curriculum to embed firearm safety throughout the four-year program, and incorporate skills exercises into clinical rotations.

Medical Community Lauds Addition of Public Health Priorities to Methodology of U.S. News’ Medical Rankings

In response to criticism from the medical community, the U.S. News & World Report updated the methodology behind their 2022 Best Medical Schools in Primary Care ranking. A recent JAMA Viewpoint article entitled, “Increasing Transparency for Medical School Primary Care Rankings—Moving From a Beauty Contest to a Talent Show“ by Robert L. Phillips Jr, MD, MSPH, Andrew W. Bazemore, MD, MPH, and John M. Westfall, MD, MPH described the updates: “The rankings were modified in 2021 such that 30% of the score is now based on graduates practicing primary care after their residency training, rather than those entering primary care training. Initial residency comprises 10% of the score, which still overestimates primary care, but this measure has been reduced from its previous weighting of 30%. The remaining score (60%) is still largely based on reputation, which is assessed by (1) surveys of medical school deans, internal medicine chairs, or admissions directors (15%); (2) survey of primary care residency directors (15%); (3) student selectivity (median Medical College Admission Test score, 9.75%; median undergraduate grade point average, 4.5%; acceptance rate, 0.75%); and (4) faculty to student ratio (15%).” The authors call the updates to the methodology “a step in the right direction,” although they continue to express that the reputation portion of the score is subjective and self-perpetuating. 

More important than the methodology update, the authors say, is U.S. News's addition of four new data-based rankings. The newly added rankings include: 1) graduates practicing primary care; 2) most diverse medical schools; 3) graduates practicing in medically underserved areas; and 4) graduates practicing patient care in rural areas. These rankings were created with the Robert Graham Center, a division of the American Academy of Family Physicians, and were defined to measure medical schools’ performance on key health care issues. The graduate-based rankings use data collected five-to-seven years after a physician’s training, making them more reflective of student outcomes and better able to showcase the public health contributions of schools that are hidden within the broader rankings. For example, the authors point to the disparity seen in the Harvard Medical School rankings; the medical school, ranked 8th for Best Primary Care, ranks 141st for graduates practicing in primary care fields. Conversely, the Pacific Northwest University of Health Sciences, which is unranked in the primary care ranking, ranks second for graduates practicing in primary care fields, second for graduates working in medically underserved communities, and seventeenth for graduates working in rural areas.  

One of the article’s authors, Dr. Phillips, speaking with the AMA, notes that students should understand the large role that reputation plays in the mainstream rankings and should proceed with caution when using the rankings to inform their medical school options. “Students should be careful in using medical school rankings to inform their choices as many rankings are opinion-driven.” Rather, he recommended that students consider the more objective, data-driven rankings based on where and what graduates end up practicing. “We also hope that the new ranking heralds continued improvement of the information that help students make career decisions. 

On a wider-scale, the authors call out the importance of the four new rankings in providing transparency into how schools contribute to key social outcomes, for policy decisions by both states and medical schools themselves. “These outcome measures should help medical schools to assess fidelity to their missions and alter admissions, curriculum, and training settings if different outcomes are desired.”