NUTRITION EDUCATION FOR PEDIATRIC RESIDENTS: A SURVEY OF CANADIAN TRAINING PROGRAMS Jason Silverman, MD FRCPC University of Calgary September 27, 2013
I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Jason Silverman MD FRCPC September 27, 2013
Nutrition in medical practice Nutrition central to health and disease Nutrition key to optimal health and growth of children Patients and parents seek physician advice on nutrition
Nutrition in undergraduate medicine Very limited! Nutrition education in US medical schools NAS recommends 25 hours of nutrition instruction during curriculum 40% 60% 25 hours < 25 hours Adams et al The American journal of clinical nutrition. May 2006;83(4):941S-944S.
Nutrition in undergraduate medicine 933 Canadian medical students surveyed Satisfaction rating: 4.7/10 Duration of Nutrition Instruction 13% 87% More needed Sufficient Gramlich LM, et al. Appl Physiol Nutr Metab 2010;35(3):336 43.
Nutrition in postgraduate medicine 61 internal medicine residents surveyed 77% agreed nutrition assessment should be part of routine visits 94% agreed they should discuss nutrition with patients 14% felt physicians adequately trained to to counsel patients Vetter ML, et al. J Am Coll Nutr 2008;27(2):287 98.
Goal To assess formal nutrition instruction in Canadian pediatric residency training programs
Methods Online survey All Canadian pediatric residency program directors Able to be completed in less than 15 minutes
Survey content Nutrition instruction Who, when and for how long? RC objectives in nutrition Which ones, and how? Changes in program Why, and why not?
Results Response rate 71% Survey response 29% 71% Responded Did not respond
Results Response rate 71% Program Structure Program structure 50% 50% Two-year cycle Three-year cycle
Results Response rate 71% Teacher profession Program structure 25% Who does the teaching? 75% MDs and RDs RDs Only
Hours Nutrition instruction per year 5.6 hours during AHD Range 2-12 1.9 hours outside AHD Range 0-10 10 9 8 7 6 5 4 3 2 1 0 AHD Setting Outside AHD
Coverage of RC nutrition objectives Most programs felt all objectives covered during training 2 programs identified objectives not addressed at all AHD content varied significantly between programs
Coverage of RC nutrition objectives Covered in AHD Covered through clinical exposure Recommended nutrient requirements Nutritional assessment Breastfeeding/infant feeding Parenteral/enteral nutrition Failure to thrive Health implications of diet Managing parenteral/enteral nutrition Counselling for healthy active living Obesity
Changes in nutrition coverage 58% had increased hours of nutrition instruction in past 5 years Barriers Insufficient time in AHD curriculum Lower priority/competing demands Lack of interested faculty
Conclusions Formal nutrition instruction for pediatric residents is limited 7.5 hours per year Despite increases in 58% of programs RC objectives covered in most programs Limited time in AHD biggest barrier to more nutrition coverage
Next steps Online learning may help overcome barriers to increasing nutrition education Thesis project will compare in-person to online learning in nutrition for pediatric residents Stay tuned
Acknowledgements Thesis Committee Dr. Maitreyi Raman Dr. Sylvain Coderre Dr. Decker Butzner Dr. Dana Boctor Dr. Kevin McLaughlin Help and support: Dr. Kathy Tobler Research arm of CPPG
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