nutrition education for pediatric residents: a survey of canadian

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:
Duration of Nutrition
Instruction
13%
4.7/10
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%
• Program structure
Teacher profession
25%
• Who does the teaching?
75%
MDs and RDs
RDs Only
Nutrition instruction per year
• 5.6 hours during AHD
10
9
• Range 2-12
8
• 1.9 hours outside AHD
• Range 0-10
Hours
7
6
5
4
3
2
1
0
Setting
AHD
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
Health implications of diet
Parenteral/enteral nutrition
Managing parenteral/enteral
nutrition
Failure to thrive
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
Help us improve.
Aidons-nous à nous améliorer.
Your input matters.
Votre opinion compte.
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