American Medical Association (AMA)

HOD Action- Council on Medical Education Report 1-I-99; Adopted and report filed

To increase the legitimacy of clinical nutrition in medicine, leading professional organizations have shifted their primary emphasis on course content requirements and amount of curricular time devoted to the teaching of clinical nutrition. To bring about needed change, they are now convinced of the primordial and critical importance of physician role models: physician nutrition specialists, able to fully demonstrate and convince medical students and physicians of the relevance of this field to the practice of medicine. Their efforts in the past few years have been to identify these role models, recognize them, and help them more clearly define their responsibilities in medical education and practice. In view of these new developments the Council on Medical Education recommends that: 1. The AMA offer to assist the American Society for Clinical Nutrition in meeting its commitment to ensure that medical schools have appropriate faculty role models to teach clinical nutrition. 2. The AMA identify and disseminate to medical schools new instructional initiatives that heighten the relevance of clinical nutrition content to medical practice.

REPORT OF THE COUNCIL ON MEDICAL EDUCATION
CME Report 1-I-99

Recommendation 3 in Council on Medical Education Report 3 (I-97), which was adopted by the House of Delegates, asked our AMA to continue monitoring the effectiveness of nutrition training and the development of new measurement criteria.

STATUS OF NUTRITION EDUCATION IN 1997

Over the past four decades, nutrition and dietetics have received increased weight from national, professional, and educational institutions accountable for the education of physicians. Although 98% of US medical schools offered educational experiences in nutrition in 1996-97, either as a separate required course or as part of another required course, the extent to which nutrition topics were included in medical school curricula was still uncertain.

The reasons for this state of affairs came partly from the measures used to assess and report the importance given to nutrition in medical school curricula: required versus elective courses, separate versus covered as part of another course. The data indicated that the number of medical schools with a separate required nutrition course ranged from 22% to 37% over a 15-year period (1981-1996), and the number of medical schools with nutrition covered as part of another required course ranged from 57% and 86% over the same period.

In 1996, the LCME added other measures to assess nutrition education. It asked about the number of hours of instruction in biochemical basis of nutrition, nutritional assessment, and clinical dietetics. The data revealed that medical schools spent an average of 27 hours over the 4-year curriculum teaching these three topics and a greater amount of time on the biochemical basis of nutrition. These measures, however, did not tell much about the integration, quality, and effectiveness of nutrition education.

Defining clear educational objectives was another crucial task for a field as multidisciplinary and diverse as nutrition. The incoming president of the American Society for Nutritional Sciences, Janet King, put it this way: "The nutritional sciences are a collection of complex integrations that need the perspective of all related disciplines. If one or more disciplines are missing, those remaining suffer." This condition can be a strength and a weakness when objectives need to be defined. However, clearer educational objectives will allow clinical nutrition to gain the academic legitimacy it needs. CME Report 3 (I-97) presented objectives developed by the American Society for Clinical Nutrition and the American Medical Student Association for nutrition education. These have been disseminated by the AMA and main professional stakeholder organizations.

The report also alluded to an increase in nutrition-related items of Part I and Part II of the United States Medical Licensing Examination (USMLE). However, the content and appropriateness of these items were not evaluated. Moreover the National Board of Medical Examiners (NBME) does not make available nutrition sub-scores.

What has happened since this 1997 CME Report?

PRESENT STATE OF NUTRITION AND DIETETIC EDUCATION IN US MEDICAL SCHOOLS

Since 1997, the state of nutrition and dietetic education in US medical schools does not appear to have changed. In 1998-99, medical schools covered nutrition and dietetic education either in separate required courses (26%) and/or as part of a required course (85%). Ninety-eight percent of US medical schools always offered separate elective nutrition courses or nutrition courses covered as part of an elective course in conjunction with required nutrition courses or nutrition modules part of another required course. Nine percent offered an elective nutrition course in addition to a required separate course. Thirty-seven percent offered an elective nutrition course in addition to a nutrition module part of another required course (but not a separate required course).

Over the past 6 years, the Association of American Medical Colleges (AAMC) Medical School Graduation Questionnaire data continue to show that almost two out of three fourth-year medical students believe the time devoted to nutrition in medical school has been inadequate. (Table 1)

To address recommendation 3 (CME Report 3-I-97), the AMA added new questions to the 1997-98 LCME Annual Medical School Questionnaire Part II. The questions elicited information on the incorporation of content related to clinical nutrition/dietetics in required clerkships, teaching formats used to deliver this content, and medical schools offering a clinical nutrition elective.

Clinical nutrition/dietetics content was incorporated in 78% of pediatrics clerkships, 66% of surgery clerkships, 61% of internal medicine clerkships, 58% of family medicine clerkships, and 43% of obstetrics-gynecology clerkships. Table 2 shows that lectures were predominantly used to deliver clinical nutrition/dietetics content. Paper cases were used in about one out of four clerkships teaching clinical nutrition. And fewer than one out of ten clerkships used computer cases.

About two out of three medical schools (64%) offered a clinical nutrition elective.

More recent and noteworthy initiatives have been reported in the literature, i.e. a two-day multidisciplinary interclerkship on Hunger and Malnutrition at the University of Massachusetts Medical School¹, and the longitudinal and multidisciplinary UCLA School of Medicine doctoring curriculum².

The interclerkship successfully involved basic scientists, clinical nutritionists, social scientists, community organizations, and primary care and pediatric specialist physicians. Beside lectures, it used multiple teaching methods, such as small-group case discussions, panel discussions, standardized patient interviews, and counseling sessions to study childhood hunger and malnutrition and demonstrate the importance of nutritional health in preventive medicine.

The UCLA doctoring curriculum operates alongside the traditional one with efforts to integrate learning experiences within and between years. It gives more emphasis to nutrition among other topics usually not covered in the medical school curriculum.

Also Web-based nutrition education is expanding and could be yet another method of incorporating nutrition in the medical school curriculum. The Tufts University Nutrition Navigator was developed as the first online rating and review guide designed to help sort out nutrition information on the Internet. Its Advisory Board is a panel of recognized US and Canadian nutrition specialists with expertise in research, policy, nutrition education, and communications³.

NEW NUTRITION AND DIETETIC AGENDA FOR MEDICAL EDUCATION

Weinsier⁴ has collected limited but convincing evidence that some factors are more critical than others in developing a successful medical-nutrition education program. Factors critical to its success are 1) relevance of course material (applicability to the practice of medicine and methods of presentation used) and 2) positive role modeling. Factors important but not critical to its success are 1) required compared with elective courses, 2) course content (which should be based on students' needs rather than on instructors' research interests), and 3) length of course. Less important factors are 1) separate compared with integrated course work and 2) time when course is taught in the curriculum.

More recent publications in the American Journal of Clinical Nutrition⁵ show that these factors have found their way into a new professional agenda aimed at legitimizing clinical nutrition as a subject in curricular programs across the medical education continuum:

1. Focus on multidisciplinary nutritional sciences research
2. Identification of physician nutrition specialist role models for every medical center
3. Clear definition of physician nutrition specialists' educational and practice responsibilities
4. Development of residency clinical nutrition training and postgraduate fellowship programs
5. Active participation of each physician nutrition specialist in regional continuing physician professional development programs
6. Partnership development with health maintenance organizations to collect reliable data on the cost-effectiveness of nutrition counseling and to ensure appropriate reimbursement of physicians and other health care professionals who apply clinical nutrition to medical practice.

Nutrition science is a major part of the NIH research agenda related to prevention. In 1998, NIH was urged by Congressional committees to reaffirm its commitment to nutrition science as a major cross cutting research priority, which enables understanding of the relationship of diet to cancer, diabetes, child development, heart disease, and hypertension. A particular concern has been expressed for the integration of basic science, such as molecular genetics, and clinical science. The belief is that clinical nutrition research units, obesity centers, and similar program project grants are an important method of advancing nutrition science through the integration of basic and clinical science and through training programs that permit nutritional scholars to develop training in molecular genetics and clinical science⁶.

In 1997, the American Society for Clinical Nutrition (ASCN) Council and the National Institutes of Health convened a panel of US nutrition experts known as the Intersociety Professional Nutrition Education Consortium. This group includes members of the ASCN, the American College on Nutrition, the American Dietetic Association, and other organizations. They are committed to making sure that every medical center has at least one effective role model in clinical nutrition⁷ . They are also responsible for establishing educational standards for fellowship training and a unified mechanism for certification of physician nutrition specialists.

To reinforce these objectives, the ASCN in 1997-98 and 1998-99 selected Nancy F. Krebs, MD, of the University of Colorado, Department of Pediatrics, School of Medicine, as the recipient of its Physician Nutrition Specialist award. This award provides $25,000 for partial salary support for an academic physician who is specializing or subspecializing in nutrition and filling a leadership role in developing and sustaining education programs for medical students, interns, and practicing physicians at the awardee's institution. It is believed that this award will heighten the visibility of clinical nutrition, provide role models for students, and institutionalize the expertise necessary to influence medical education programs. The ASCN views the continuation and expansion of this award as a major priority and voted to support two Physician Nutrition Specialist awards for 1999-2000.

Summary

To increase the legitimacy of clinical nutrition in medicine, leading professional organizations have shifted their primary emphasis on course content requirements and amount of curricular time devoted to the teaching of clinical nutrition. To bring about needed change, they are now convinced of the primordial and critical importance of physician role models: physician nutrition specialists, able to fully demonstrate and convince medical students and physicians of the relevance of this field to the practice of medicine. Their efforts in the past few years have been to identify these role models, recognize them, and help them more clearly define their responsibilities in medical education and practice.

Recommendations

In view of these new developments the Council on Medical Education recommends that

1. The AMA offer to assist the American Society for Clinical Nutrition in meeting its commitment to ensure that medical schools have appropriate faculty role models to teach clinical nutrition.
2. The AMA identify and disseminate to medical schools new instructional initiatives that heighten the relevance of clinical nutrition content to medical practice.
3. The remainder of the report be filed.

Complete references for this report are available from the Medical Education Group.

Fiscal Note: No significant

OTHER AMA ACTIONS

H-150.968 Transfer of Function for National Nutrition Education
The AMA urges the Bush Administration to establish an entity comprised of relevant Cabinet level departments to develop and implement dietary guidelines for the nation, with the Department of Health and Human Services serving as the coordinating agency. The AMA supports providing appropriate input to assist in the formation of these dietary guidelines that should be established on the basis of sound scientific principles. (Sub. Res. 45, A-91)

H-150.993 Medical Education in Nutrition
The AMA recommends that instruction on nutrition be included in the curriculum of medical schools in the United States. (Sub. Res. 82, I-80; Reaffirmed: CLRPD Rep. B, I-90; Reaffirmed: CME Rep. 3, I-97)

H-150.995 Basic Courses in Nutrition
The AMA encourages effective education in nutrition at the undergraduate, graduate, and postgraduate levels. (Sub. Res. 116, A-78; Reaffirmed: CLRPD Rep. C, A-89)

H-150.996 Nutrition Courses in Medicine
The AMA recommends the teaching of adequate nutrition courses in elementary and high schools and that the LCME work toward enhancement of the teaching of nutrition in medical schools. (Sub. Res. 66, I-77; Reaffirmed: CLRPD Rep. C, A-89)

American Medical Association - Medical Student Section

REPORT OF THE COUNCIL ON MEDICAL EDUCATION CME Report 1-A-00
Subject: Annual Report on Medical Education in the United States: 1999-2000

Reports and Activities Related to the Medical Education Curriculum
Nutrition and Dietetic Education: "Nutritional and Dietetic Education for Medical Students" (CME Report 1, I-99) led the AMA to identify and disseminate to medical schools new instructional initiatives that heighten the relevance of clinical nutrition content to medical practice and to offer to assist the American Society for Clinical Nutrition (ASCN) in meeting its commitment to ensure that medical schools have appropriate faculty role models to teach clinical nutrition. As a result, representatives from the ASCN will meet with the Council during this meeting. The Council continues to monitor progress in curriculum development and will share the results with medical schools.

Topics deemed essential for developing physician competencies in nutrition.
(Adapted from: Report of the American Medical Student Association's Nutrition Curriculum Report Essentials of nutrition education in medical schools: a national consensus. Am J. Clin Nutr, 65:1559-1561, 1997)

Biochemistry, Physiology, Pathophysiology Deficiency of vitamis and minerals Sources of: antioxidants, B12, calcium, complex carbohydrates, fats, fiber, iron, potassium, protein, sodium. Energy balance Gastrointestinal tract: overview of function Deficiency of: calories, A, C, D, K, B complex vitamins, Zn, Fe, protein Criteria of an adeeuate diet Hormonal control of nutrient metabolism Lipids and cholesterol Nutrition and Immunity Physiology of hunger and satiety Water and electrolytes Trace minerals Nutrition Assessment Body composition Waist:hip ratio Diet history taking Nutrition physical examination Biochemical evaluation Anthropometrics Assesments of: vitamin intake and balance, mineral intake and balance, electrolyte intake and balance, antioxidant intake and balance, protein intake, carbohydrate intake, fat intake, energy balance, fiber intake Plotting growth Diet and Prevention Pregnancy Lactation Growth and development Geriatrics Cardiovascular disease Cancer Osteoporosis Obesity Hypertension Criteria for an adequate diet National nutritional programs and goals Nutritional supplments Low-sodium diet Vegetarianism

Nutrition and Disease Bulimia Anorexia Depression Schizophrenia Failure to thrive Nutritional anemias Diabetes Cancer Hypertension Osteoporosis Hyperlipidemia and atherosclerosis Coronary artery and CVD Reflux disease Liver disease Peptic ulcer disease Water, electrolytes, acid-base balance Hospital malnutrition Surgery, trauma, and infection Food born ilnesses Drug-nutrient interactions Primary malnutrition Diet and wound healting Allergies Cystic fibrosis Rheumatoid disease Oral cavity Inborn errors in metabolism Acquired immunodeficiency syndrome Tests of digestive function Nutrional Therapy Digestive enzyme therapy The "MD-RD" tean Nutritional supplements Alcohal abuse Enteral nutrition support Writing nutritional prescriptions Writing nutritional referrals Cultural issues

Medical Specialty Societies

National Medical Specialty Societies and Boards (all listed)

American Academy of Family Physicians (AAFP)

The Society of Teachers of Family Medicine (STFM)

Contacted 9/2/99
8/7/00 No change in position; textbook revision: see below

Nutrition Education
Goals for the Group on Nutrition Education include integrating nutrition education within other STFM groups and maintaining resources for family medicine educators to use in enhancing nutrition education. Currently a project to update the Recommended Core Education Guidelines for Family Practice Residents, Nutrition (AAFP Reprint No. 275) and to also update the STFM Physician's Curriculum on Clinical Nutrition are in progress. Members work in all areas of family medicine education: predoctoral, residency and CME.

AAFP textbook, Physician Curriculum in Clinical Nutrition, was published in 1990. This textbook is under revision by committee and will be reissued in the winter of 2000.

The transcripts of recent Virtual Seminars are posted at
http://www.preventivenutrition.com

Education Chair:
Marian R. Stuart, PhD
UMDNJ - RWJ Medical School
Department of Family Medicine
One Robert Wood Johnson Place, CN-19
New Brunswick, NJ 08901-0019
732-235-7670
Fax: 732-246-8084
stuart@umdnj.edu

AAFP Administration
Mary Ruhl
800-274-2237 X5404
admstaff@stfm.org

 

American Academy of Pediatrics (AAP)

Contacted 8/31/99
Reply 9/7/99

"The AAP does not have a position statement specifically supporting education in nutrition in medical school. You may want to refer to the document/recommendations developed by the pediatric organizations/community (Future of Pediatrics Task Force) entitled, "Future of Pediatric Education II". This can be found on the AAP Web site, www.aap.org under "Professional Education". This project is meant to assess the health care needs of children in the future and the workforce necessary to meet those needs. This will also be published in the AAP Pediatrics journal in late 1999 or early 2000."

Contacted 8/7/00
Reply 8/8/00
"Pediatrician's Responsibility for Infant Nutrition and Residency Training and Continuing Medical Education in School Health.  They can be obtained from the AAP Web site, professional education Web page, then click on AAP Policy Statements.  Other than those two statements, there is no specific policy statement on nutrition education by the AAP."

Pamela T. Kanda, MPH
Manager
American Academy of Pediatrics
Division of Technical and Medical Services
800/433-9016 ext 4927
pkanda@aap.org

American Board of Internal Medicine (ABIM)
PASSWORD REQUIRED

Contacted 8/31/99
Replied 9/1/99
"In answer to your question, no, the ABIM does not have a position statement on Nutrition Education."

Contacted 8/7/00
"ABIM does not have a position statement on nutrition in the curriculum and in education. The ABIM is responsible for administering the certification and recertification examinations; however, the ACGME oversees curriculum."

Karen Mullian
ABIM Communications
KMULLIAN@ABIM.ORG

American Gastroenterological Association (AGA)

Contacted 8/31/99
Replied 9/2/99:
"The AGA does not yet have an official statement but may be developing one in the next year."

Contacted 8/3/00
"Over the past two years, AGA has undertaken an effort to formalize specific practice areas and focus on these more closely for the benefit of our members. Nutrition is one of those areas. To this end, our members can now sign up and join the AGA section on "Growth, Development and Nutrition." Further, AGA continues to develop guidelines in the areas of enteral and parenteral nutrition and will offer specific symposium during Digestive Disease Week 2001. As for an official statement, there is none."

Wendy Cohen, MPH
Vice President, Clinical Practice and Economics
American Gastroenterological Association
7910 Woodmont Avenue, 7th Floor
Bethesda, MD 20814

P(301)941-2611
F(301)652-3891
wcohen@gastro.org

American College of Cardiology (ACC)
PASSWORD REQUIRED

Contacted 9/1/99
Replied 9/1/99
"We do not have a position statement in support of nutrition education in medical schools."

Contacted 8/3/00
"There has been no change in our position on the inclusion of nutrition education for medical students and residents as it relates to heart disease. We refer all parties to the American Heart Association."

Helene Goldstein, Director
Online and Library Services
American College of Cardiology
9111 Old Georgetown Road
Bethesda, MD 20814
301-897-2682
301-897-9745 (fax)
hgoldste@acc.org

American College of Obstetricians and Gynecologists (ACOG)

Contacted 9/1/99
Partial response 9/2/99, Reply 9/23/99
"The OCOG does not set guidelines for the education of medical students or residents in obstetrics and gynecology."

Contact: ACOG Reference Desk at (202) 863-2518

Contacted on 8/3/00
"It is not the responsibility of ACOG to set guidelines for either medical student or resident education. Notify APGO for medical student related questions and CREOG for resident related questions." SEE BELOW

Association of Professors of Gynecology and Obstetrics (APGO)
Undergraduate Medical Education Committee
Essential learning objectives in womens's health.
"Nutrition: Students will be able to counsel patients in good nutrition habits, including
recommended intake of calories, fiber, fat, and essential vitamins and elements. Students will be able to recognize nutritional deficiencies, in particular, iron deficiency. They will be albe to describe an evaluation of anemia and recognize its impact on pregnant and nonpregnant women's health."

Association of Professors of Gynecology and Obstetrics (APGO)
409 12th Street, SW
Washington, DC 20024
(202) 863-2507

Council for Resident Education in Obstetrics and Gynecology (CREOG)
Publish: Educational Objectives for residency training
While there is no distinct section on nutrition in the outlined learning objectives, nutrition learning objectives are included in multiple sections including pregnancy.

Council for Resident Education in Obstetrics and Gynecology (CREOG)
409 12th Street, SW
Washington, DC 20024
(202) 863-2558
Deanne Nehra

 

American College of Physicians - American Society of Internal Medicine (ACP-ASIM)

Contacted 9/1/99
Contacted 8/3/00

No Response To Date.

American College of Surgeons (ACS)

Contacted 9/1/99
Contacted 8/3/00

No Response To Date.

Ann Singleton
633 North Saint Clair Street
Chicago, IL 60611-3211
(312) 202-5000

Medical Education

Association of American Medical Colleges (AAMC)

AAMC Medical Schools of the US and Canada

AAMC Curriculum Management & Information Tool (CurrMIT) PASSWORD PROTECTED
http://www.aamc.org/currmit

http://143.220.1.32/meded/curric/start.htm

(Adapted from Website text: http://uxsys08.aamc.org:8000/)

Culminating from work over the past several years, staff of the AAMC Division of Medical Education (DME) and Office of Information Resources (OIR), working with a consultant, have developed a curriculum database to enhance understanding and management of the medical student education program.

Purpose
The overall project will allow each medical school to manage its own curriculum locally on a database containing common, defined data elements in use nationally. The database will support medical school curriculum managers in administering their programs; will allow for comparisons of curricula between schools; and, over time, can be used to analyze trends in medical education in the U.S. and Canada.

More specifically, the database will identify information on course directors, to foster networking about courses; track what teaching methods and materials are in use; specify sites used for teaching and learning, contact hours devoted to specific topics, and assessment techniques used to determine whether predefined objectives are being met. It will support the efficient use of successful curriculum reform strategies by documenting and making available detailed information about ongoing reform and innovation.

The CurrMIT Support Desk:
All questions about CurrMIT's use are sent through the CurrMIT Support Desk
helpcurrmit@aamc.org
voice 202-862-6262

For further information:
Albert A. Salas, Project Director
Staff Associate, Division of Medical Education
aasalas@aamc.org

M. Brownell Anderson
Associate Vice President, Division of Medical Education
mbanderson@aamc.org

AAMC Curriculum Management & Information Tool (CurrMIT)

CurrMIT Database on Nutrition Courses in Medical Schools
(Adapted from Website: http://uxsys08.aamc.org:8000/)

Crs/Block/Clerkship Name	Academic  Period	Institution Name
Basic Clinical Nutrition	2	UC Davis School of Medicine
Biochemical Basis of Nutrition	1	UMDNJ-R W Johnson Medical Schl
Biological Chemistry and Nutrition Lab	1	UCLA School of Medicine
Block 3 (6 weeks): Gastrointestinal; Liver Diseases/Nutrition	2	Washington U Schl of Medicine
Cell Structure, Metabolism, and Nutrition	1	U of Pittsburgh School of Med
Clerkship in Pediatric Gastroenterology and Nutrition	3or4	Vanderbilt U Schl of Medicine
Clinical Gastroenterology and Nutrition-UH & VAMC (Oklahoma City)	3or4	U of Oklahoma Coll of Medicine
Clinical Nutrition	1	Wayne State U Schl of Medicine
Clinical Nutrition	4	Baylor College of Medicine
Clinical Nutrition	1	Georgetown U. School of Med
Clinical Preventive Medicine and Nutrition	2	UMDNJ-New Jersey Medical School
Digestion and Nutrition (GI)	2	U of Pittsburgh School of Med
Endocrinology, Metabolism, and Nutrition	1	McGill University
G.I. & Nutrition Organ System	2	U of Utah Schl of Medicine
Gastroenterology and Nutrition	2	University of Alberta
Gastroenterology and Nutrition	4	Finch UHS-Chicago Med School
Gastro-Intestinal/Nutrition	2	U of Tx-Galveston Medical Schl
GI and Nutrition	2	U of Pennsylvania Schl of Med
Health of the Public, Law and Medicine, Nutrition	2	Jefferson Medical College
Human Biochemistry and Nutrition Laboratory	1	UCLA School of Medicine
Introduction to Clinical Nutrition	2	Vanderbilt U Schl of Medicine
Junior Nutrition Core	3	Medical U of South Carolina
Metabolism and Nutrition	1	University of Toronto
Nutrition	1	U of Alabama
Nutrition	1	SUNY Stony Brook School of Med
Nutrition	1	U of Nevada School of Medicine
Nutrition	1	E Tenn-J H Quillen Col of Med
Nutrition	2	Morehouse School of Medicine
Nutrition	2	Mount Sinai School of Medicine
Nutrition	1	University of Saskatchewan
Nutrition	2	U of Tennessee College of Med
Nutrition	1	U of Illinois College of Med- Chicago
Nutrition	1	SUNY Upstate Medical University
Nutrition	2	Dartmouth Medical School
Nutrition	1	U of Minnesota Medical School
Nutrition	1	USC Keck School of Medicine
Nutrition	1	Meharry Medical College
Nutrition	2	U of Wisconsin Medical School
Nutrition	1	MCP Hahnemann School of Medicine
Nutrition	3	Mayo Medical School
Nutrition	1	University of Saskatchewan
Nutrition	1	University of Saskatchewan
Nutrition	1	U of Mass Medical School
Nutrition (30 weeks)	1	Albany Medical College
Nutrition and Medicine	1	Tufts University School of Medicine
Nutrition and Metabolism	Other	Universite de Montreal
Nutrition for Physicians	2	U of Washington Schl of Med
Nutrition II (30 weeks)	2	Albany Medical College
Nutrition III (16 hours)	3	Albany Medical College
Nutrition in Medicine	2	UNC-CH School of Medicine
Nutrition in Medicine	1	U of Chicago-Pritzker Schl of Med
Nutrition Seminar	1	UNC-CH School of Medicine
Pathophysiology 2 (Block 6): Cardiovascular, respiratory, blood disorders, nutritional diseases	2	U of Mo-Columbia School of Med
Pathophysiology: Nutrition	2	Brown University School of Medicine
PBL-Energy and Nutrition	1	S Illinois U Schl of Medicine
Pediatric Gastroenterology & Nutrition (Tulsa)	4	U of Oklahoma Coll of Medicine
Pediatric Gastroenterology/Nutrition/ Hepatology/Cystic Fibrosis	4	Finch UHS-Chicago Med School
Phase 1: GI/Metabolism/Nutrition	1	U of New Mexico Schl of Med
Preventive Medicine & Nutrition (2 hrs/wk)	2	Harvard Medical School
Principles of Nutrition	1	U of Colorado Schl of Medicine
Scientific Basis of Medicine/Nutrition	2	Northwestern U. Medical School
Nutrition II (30 weeks)	2	Albany Medical College
Nutrition III (16 hours)	3	Albany Medical College

To view the complete Course Report, Please download this Excel Docuement.

Liaison Committee on Medical Education (LCME)

LCME Accreditation Standards
Content (Adapted from Website. http://www.lcme.org/ )
Updated 08/07/00

The medical faculty is responsible for devising a curriculum that permits students to learn the fundamental principles of medicine, to acquire skills of critical judgment based on evidence and experience, and to develop an ability to use principles and skills wisely in solving problems of health and disease. In addition, the curriculum must be designed so that students acquire an understanding of the scientific concepts underlying medicine. In designing the curriculum, the faculty must introduce current advances in the basic and clinical sciences, including therapy and technology, changes in the understanding of disease, and the effect of social needs and demands on medical care.

The curriculum cannot be all-encompassing. However, it must include the sciences basic to medicine, a variety of clinical disciplines, and ethical, behavioral, and socioeconomic subjects pertinent to medicine. There should be presentation of material on medical ethics and human values. The faculty should foster in students the ability to learn through self-directed, independent study throughout their professional lives.

The curriculum must include the contemporary content of those expanded disciplines that have been traditionally titled anatomy, biochemistry, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine. Instruction within these basic sciences should include laboratory or other practical exercises which facilitate the ability to make accurate quantitative observations of biomedical phenomena and critical analyses of data. When graduate students and postdoctoral fellows in the biomedical sciences serve as teachers or teaching assistants, they must be familiar with the educational objectives of the course and be prepared for their roles in teaching and evaluation.

All schools must provide broad-based clinical education programs that equip students with the knowledge, skills, attitudes, and behaviors necessary for further training in the practice of medicine. Instruction and experience in patient care must be provided in both ambulatory and hospital settings. All schools must offer a core curriculum in primary care, utilizing the disciplines or multidisciplinary approaches involved in the delivery of such care.

Clinical education programs involving patients should include disciplines such as family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery. Schools that do not require clinical experience in one or another of these disciplines must ensure that their students possess the knowledge and clinical abilities to enter any field of graduate medical education. Clinical instruction should cover all organ systems, and must include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care.

The faculty must participate in a process that defines the objectives of clinical education and establishes quantified criteria for the types of patients (real or simulated), the level of student responsibility, and the appropriate clinical settings necessary to accomplish these purposes. A system for monitoring the achievement of clinical educational goals must be developed, based on these criteria, and students must be evaluated in this framework. If the level or diversity of student interactions with patients does not meet the school-based criteria, specific mechanisms must be in place to adjust the criteria or to alter the educational program. Either may be done only within appropriate, documented means that ensure continued educational quality.

The curriculum must provide grounding in the body of knowledge represented in the disciplines that support the fundamental clinical subjects, for example, diagnostic imaging and clinical pathology. Students must have opportunities to gain knowledge in those content areas that incorporate several disciplines in providing medical care, for example, emergency medicine and the care of the elderly and disabled. In addition, students should have the opportunity to participate in research and other scholarly activities of the faculty.

The committee responsible for curriculum must require close faculty supervision of the learning experience of each student at the appropriate level of graded clinical responsibility. Supervision must be provided throughout required clerkships by members of the school s faculty. The required clerkships should be conducted in a teaching hospital or ambulatory care facility where residents in accredited programs of graduate medical education, under faculty guidance, may participate in teaching the students. Residents must be fully informed about the educational objectives of the clerkships and be prepared for their roles as teachers and evaluators of medical students. In an ambulatory care setting, if faculty supervision is present, resident participation may not be required.

The faculty committee responsible for curriculum should develop, and the chief academic officer should enforce, the same rigorous standards for the content of each year of the program leading to the M.D. degree. The final year should complement and supplement the curriculum so that each student will acquire appropriate competence in general medical care regardless of subsequent career specialty. The curriculum should include elective courses designed to supplement the required courses and to provide opportunities for students to pursue individual academic interests. Faculty advisors must guide students in the choice of elective courses. If students are permitted to take electives at other institutions, there should be a system centralized in the dean s office to screen the students proposed extramural programs prior to approval and to ensure the return of a performance appraisal by the host program. Another system, devised and implemented by the dean, should verify the credentials of students from other schools wishing to take courses or clerkships at the school, approve assignments, maintain a complete roster of visiting students, and provide evaluations to the parent schools.

All instruction should stress the need for students to be concerned with the total medical needs of their patients and the effect on their health of social and cultural circumstances. The curriculum should prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting and treatment of violence and abuse. A medical school must assure that its students learn and exhibit scrupulous ethical principles in caring for patients, and in relating to patients' families and to others involved in the care of patients.

The faculty and students must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Medical students should learn to recognize and appropriately address gender and cultural biases in health care delivery, while considering first the health of the patient.

In view of the increasing pace of discovery of new knowledge and technology in medicine, the LCME encourages experimentation that will increase the efficiency and effectiveness of medical education. Experiments should have carefully defined goals and plans for implementation, including methods of evaluating the results.  Planning for educational innovation should consider the incremental resources that will be required, including demands on library facilities and operation, information management needs and computer hardware and software.

The LCME must be notified of plans for major modification of the curriculum, so that the term of accreditation of the program can be reconsidered if judged necessary.

|  Section 1  |  Section 3  |  Section 4  |  Section 5  |
|  Preface  |  The White Paper  |  Committee Members  |
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