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      Setting priorities for research in medical nutrition education: an international approach

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          Abstract

          Objectives

          To identify the research priorities for medical nutrition education worldwide.

          Design

          A 5-step stakeholder engagement process based on methodological guidelines for identifying research priorities in health.

          Participants

          277 individuals were identified as representatives for 30 different stakeholder organisations across 86 countries. The stakeholder organisations represented the views of medical educators, medical students, doctors, patients and researchers in medical education.

          Interventions

          Each stakeholder representative was asked to provide up to three research questions that should be deemed as a priority for medical nutrition education.

          Main outcome measures

          Research questions were critically appraised for answerability, sustainability, effectiveness, potential for translation and potential to impact on disease burden. A blinded scoring system was used to rank the appraised questions, with higher scores indicating higher priority (range of scores possible 36–108).

          Results

          37 submissions were received, of which 25 were unique research questions. Submitted questions received a range of scores from 62 to 106 points. The highest scoring questions focused on (1) increasing the confidence of medical students and doctors in providing nutrition care to patients, (2) clarifying the essential nutrition skills doctors should acquire, (3) understanding the effectiveness of doctors at influencing dietary behaviours and (4) improving medical students' attitudes towards the importance of nutrition.

          Conclusions

          These research questions can be used to ensure future projects in medical nutrition education directly align with the needs and preferences of research stakeholders. Funders should consider these priorities in their commissioning of research.

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          Most cited references14

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          Setting priorities in global child health research investments: guidelines for implementation of CHNRI method.

          Igor Rudan, Jennifer L Gibson, Shanthi Ameratunga … (2008)
          This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global.
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            Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners.

            R Kushner (1995)
            Previous surveys have shown that there is a disparity between physicians' beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of nutrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the delivery of nutrition counseling by primary care physicians. A random-sample-mailed questionnaire was sent to 2,250 primary care physicians selected from the AMA masterfile from general practice, internal medicine, and pediatrics, representing self-employed, group, hospital, and HMO practices. Participants were stratified by age, gender, geographical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patients receiving dietary counseling and to identify barriers to the delivery of nutrition counseling. A 49% response rate (n = 1,103) was obtained. Results are presented for the 1,030 physicians (70% private practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer min discussing dietary changes. Despite this pattern, nearly three-quarters of respondents feel that dietary counseling is important and is the responsibility of the physician. Ranking of perceived barriers to delivery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling, training, lack of knowledge, inadequate reimbursement, and low physician confidence. This survey suggests that multiple barriers exist that prevent the primary care practitioner from providing dietary counseling. A multifaceted approach will be needed to change physician counseling behavior.
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              Nutrition education in U.S. medical schools: latest update of a national survey.

              Kelly Adams, Martin Kohlmeier, Steven H. Zeisel (2010)
              To quantify the number of required hours of nutrition education at U.S. medical schools and the types of courses in which the instruction was offered, and to compare these results with results from previous surveys. The authors distributed to all 127 accredited U.S. medical schools (that were matriculating students at the time of this study) a two-page online survey devised by the Nutrition in Medicine Project at the University of North Carolina at Chapel Hill. From August 2008 through July 2009, the authors asked their contacts, most of whom were nutrition educators, to report the nutrition contact hours that were required for their medical students and whether those actual hours of nutrition education occurred in a designated nutrition course, within another course, or during clinical rotations. Respondents from 109 (86%) of the targeted medical schools completed some part of the survey. Most schools (103/109) required some form of nutrition education. Of the 105 schools answering questions about courses and contact hours, only 26 (25%) required a dedicated nutrition course; in 2004, 32 (30%) of 106 schools did. Overall, medical students received 19.6 contact hours of nutrition instruction during their medical school careers (range: 0-70 hours); the average in 2004 was 22.3 hours. Only 28 (27%) of the 105 schools met the minimum 25 required hours set by the National Academy of Sciences; in 2004, 40 (38%) of 104 schools did so. The amount of nutrition education that medical students receive continues to be inadequate.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2016
                Publication date (Electronic): 14 December 2016
                Volume: 6
                Issue: 12
                Electronic Location Identifier: e013241
                Affiliations
                [1 ]Menzies Health Institute Queensland, Griffith University , Gold Coast, Queensland, Australia
                [2 ]The Need for Nutrition Education/Innovation Programme, C/O MRC Elsie Widdowson Laboratory, The University of Cambridge , Cambridge, UK
                [3 ]Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo , Waterloo, Ontario, Canada
                [4 ]Faculty of Medical and Health Sciences, University of Auckland , Auckland, New Zealand
                Author notes
                [Correspondence to ] Dr Lauren Ball; l.ball@ 123456griffith.edu.au
                Article
                Publisher ID: bmjopen-2016-013241
                DOI: 10.1136/bmjopen-2016-013241
                PMC ID: 5168600
                PubMed ID: 27974369
                SO-VID: 30566842-5922-4f23-8f87-d5ea4d3e71f1
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 28 June 2016
                Date revision received : 2 September 2016
                Date accepted : 21 October 2016
                Categories
                Subject: Medical Education and Training
                Subject: Research
                Subject: 1506
                Subject: 1709
                Subject: 1714

                ScienceOpen disciplines: Medicine
                Keywords: nutrition & dietetics,medical education & training,statistics & research methods
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: nutrition & dietetics, medical education & training, statistics & research methods

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