In this survey study of first and second-year medical students, we found that respondents not only perceived nutrition counselling as an important component of health, but also view physicians as an important player in providing nutrition counselling. Students at the end of their first-year reported significantly higher knowledge of basic nutrition concepts and the role of nutrition in the treatment of disease, compared to students finishing second-year. Furthermore, students with previous nutrition experience had higher agreement with most knowledge-related questions compared to students without previous nutrition education. Students’ overall satisfaction with the nutrition education they receive in medical school is low. Interestingly, first-year respondents reported higher agreement with all satisfaction-related questions compared to second-year students.
Comparison to previous findings
The present study observed that first and second year medical students believe nutrition is an important topic in medicine while feeling low satisfaction with their nutrition education, findings that are in line with previous research. Previous research in the U.S. demonstrated that insufficient time spent on nutrition education (18) as well as other barriers, including lack of time and compensation, as contributing factors in physicians’ reporting of a lack of preparedness to help their patients adapt healthier eating habits (4,5). Canadian research has demonstrated similar results (11). Among the 933 medical students from all years of study who completed their survey, Gramlich et al. demonstrated that knowledge of basic nutrition concepts was higher than perceived preparedness to provide nutrition counselling. Hanninen and Rashid (12) found that upwards of 95% of students agreed on the importance of nutrition in disease prevention and treatment, as well as the role of physicians as role models for positive nutrition behaviours; however, satisfaction with their nutrition education was low with 30.3% of respondents dissatisfied or strongly dissatisfied with the nutrition curriculum and 78.6% in agreement that more nutrition education should be provided.
Potential explanations for findings
In today’s society where there are varying opinions about which diet is optimal for health (19), students may not know how to appraise this information while simultaneously participating in a demanding medical curriculum. A need for increasing multidisciplinary care may also contribute to current issues surrounding the integration of nutrition into patient care (20). Cambridge University identified a collaborative approach among doctors, dietitians, nutritionists and nurses as a key factor in the success of their nutrition education initiative (21).
Our finding of differences in knowledge and satisfaction based on year of study may be a result of the structure of the Dalhousie University medical school curriculum. At Dalhousie, the majority of structured nutrition education is delivered during students’ first-year, which may have influenced our survey as a result of the proximity between when the first-year students learned the nutrition content of the curriculum and the time of survey distribution. Alternatively, perhaps the higher perception of nutrition knowledge in first-year versus second-year students is an expression of Albert Einstein’s adage ‘the more I learn, the more I realize how much I don't know.’ Previous research found that students earlier on have more positive perceptions of nutrition counselling by physicians (11,22,23).This may be related to a cognitive bias known as the Dunning-Kreuger effect, in which those who are less skilled in a given area often rate their knowledge as greater than those who are more experienced in the same discipline (24–26).
Strengths and limitations
This study is based on self-report and does not include objective measurements of nutrition knowledge; however, previous research has reported that perceived quality of nutrition training in medical school is positively correlated with proficiency scores, providing evidence that self-perceived knowledge may serve as a reliable proxy for clinical proficiency (27). The findings of the current research were strengthened by a response rate of 57%, which is higher than similar previous studies (11,12,28).
Implications and future directions
The current study indicates that the first couple of years of medical school could be an appropriate time to incorporate additional nutrition education to increase physician competency in nutrition counseling. The NPAEQ may be used in future research to explore similar questions among different cohorts, such as family medicine residents who are at the front-line of primary care, an area where nutrition counselling can be used as a form of preventative medicine to reduce the prevalence of lifestyle-associated diseases.
This research adds to the growing body of evidence supporting improved nutrition in medical education (10,11,29). A number of American medical schools have implemented culinary medicine electives, in which students receive cooking instruction and review principles of dietary counselling (30,31). The University of Toronto recently began teaching undergraduate medical students how to prepare affordable, healthy food, and ways to help support patients to do the same (32). Future research could evaluate education changes like these on the improvement of physician comfort and competence in providing dietary advice to patients.