Consumers and patients are unsure of whom to trust for nutritional advice. Although medical doctors are seen as experts in nutrition and their advice is regularly followed, data are lacking on the amount of nutrition education in European medical school curricula. In line with US research, we distributed a survey on required and/or optional nutrition contact hours to medical education directors of all accredited medical schools (N=217) in Western European Union countries (N=14). In total, respondents from 32 medical schools (14.7%) from 10 countries indicated that nutrition education, in some form, was required in 68.8% of schools where, on average, 23.68 h of required nutrition education was provided. The results from this small-scale survey are comparable to a 2010 US study; conversely, European educators were satisfied with the amount of nutrition education. We substantiate the increasing concern over the inadequate amounts of nutrition education provided to medical students in Europe.
Circulatory diseases including hypertension, hypercholesterolemia, diabetes and ischemic heart disease—all of which are strongly diet related—are among the leading causes of death in the European Union, second only to cancer.1 Although diet is clearly a major determinant of health, consumers and academics are unsure of whom to trust for nutritional advice and nutritional advice from doctors is regularly taken.2
In light of this, medical practitioners bear an important social responsibility in advising patients on their diet and nutritional intake. Studies in the United States (US)3,4 have investigated the status of nutrition education in medical curricula and academics have thoroughly discussed the implications of the limited and inadequate amount of nutrition education in US medical curricula.5,6 Several standalone studies7,8 have highlighted the lack of confidence in and inadequacy of nutritional knowledge in European doctors and yet, to date, no studies have been conducted on the level of nutrition education in European medical curricula.
This study on the current status of nutrition education in medical curricula from Western countries of the European Union intends to provide a scientifically grounded perspective on this discussion. Our survey aimed to quantify the hours of required nutrition education provided in Western European medical curricula. Owing to the increasing trend toward integrated or problem-based curricula and the broad, multifaceted discipline of nutrition, we defined nutrition education as ‘nutritional and dietetic coursework about the relation of food and nutrients to health and disease, and/or coursework on promoting healthier food choices and habits in patients'. We defined this education as required when it was a ‘core part of the assessable curriculum’.
Materials and methods
The contact details of accredited Western European medical schools were obtained through the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER).9 In May 2013, all medical schools (n=217) from the selected countries (cf. Table 1) were contacted by telephone and/or e-mail and a link to our survey was subsequently e-mailed to them. The survey was translated into Spanish and Italian, owing to low English proficiency in these countries. At least two follow-up calls per medical school and e-mails continued through July 2013.
The 18-question online survey was adapted from a previous US survey.4 Respondents were asked to provide the number of contact hours of required nutrition education in their medical schools, the ratio of nutrition teaching in preclinical versus clinical years, and to indicate in what type of course nutrition was taught (Table 2). Respondents were also asked to state whether they considered the nutrition teaching in their medical school curriculum to be sufficient.
From the 217 schools, representatives from 32 schools responded, resulting in a 14.7% response rate. Self-reported basic demographic data of the medical schools are displayed in Table 1. According to the respondents, nutrition education was, in some form, required only in 22 schools (68.8%). The other respondents indicated that nutrition education was ‘optional only’ (n=6; 18.8%), ‘not offered’ (n=3; 9.4%), or ‘don’t know’ (n=1; 3.1%). The mean hours of required nutrition education for the entire curriculum required to obtain a medical degree are also listed in Table 1.
The schools requiring nutrition education provided an average of 23.68 (±17.6) contact hours in the complete curriculum. Contact hours took place equally during the preclinical phase (14.0±12.4) and clinical phase of the medical training (9.4±10.7). The average hours of required nutrition education are comparable to the US medical curricula as assessed in surveys from 2006 (23.9 h) and 2010 (19.6 h).3,4 Unlike their US counterparts, the European respondents expressed that they did not feel that this amount was insufficient.
In our small-scale survey, we found that, on average, 23.68 h of nutrition education was required in European medical schools and we question whether this amount is adequate. Unfortunately, there is no benchmark for ‘adequate amount of nutrition education’ in Europe; in the United States, however, ‘adequate nutrition education’ was determined in 1985 to be 25 h by the National Academy of Sciences.3,4 Later, the American Society for Clinical Nutrition conducted a survey where administrators and nutrition educators recommended 37–44 h of nutrition education.10 The European average therefore falls short of both these US recommendations.
It should be noted that there are several limitations of the study. First, a low response rate (14.7%) was obtained. Despite measures taken to accommodate countries with low English knowledge, the extensive language barriers within the EU are believed to have been the main hindrance to a higher response rate. Second, sampling bias may have had a role in the response to the survey. In this respect, the universities with a relatively high amount of required nutrition education might have been more inclined to participate in this survey; for fear of scrutiny, those with low or even no required nutrition education were perhaps consequently less likely to respond. Finally, it can be questioned as to whether the amount of required nutrition education is a good marker against which solid nutrition knowledge is measured. In this light, registered dieticians who have a substantially higher amount of required nutrition education (for example, years vs hours) may also have inadequate knowledge of human nutrition and food science.
Future research should focus on diminishing these limitations. Moreover, research is needed on European nutrition education in medical specialist education (for example, training of general practitioners) as this may contribute to a better understanding of total nutrition education and to a comparison of the nutrition knowledge of medical doctors with other health professionals (such as dieticians).
From our data we conclude that, although the scientific principles related to nutrition are taught in some medical schools, the amount of nutrition education provided to medical students is of concern. Thus, an officially recommended curriculum for nutrition education in medical schools to provide a solid basis for nutritional advice is warranted. With this, a benchmark of ‘adequate amount of nutrition education’ in the EU is needed to determine whether medical schools meet recommendations.
We express our gratitude to Kelly Adams, MPH, RD, Assistant Project Director and Research Associate, Department of Nutrition, University of North Carolina at Chapel Hill for the original survey. In addition, we thank Dr Bridget Maher, Lecturer Clinical Science and Practice, School of Medicine, University College Cork for her invaluable input. We further thank Laura Borile and Gabriella Ortiz, research assistants at the Department of Human Biology, Maastricht University for translating the survey and helping with data collection in Italy and Spain.
FJPHB and VJvB designed the research. MC, VJvB and NN conducted the research. All authors analyzed the data and VJvB performed statistical analysis. MC, VJvB, EW and NN wrote the base paper. MC was primarily responsible for final editing and FB and VJvB were primarily responsible for final content. All authors read and analyzed the cited literature; all authors read and approved the final manuscript.