Five of the ten leading causes of death in the United States are directly related to nutrition. Although most individuals cite their physicians as a major source of nutrition information, physicians receive little if any formal nutrition training. This study evaluated the effectiveness of a 9-month, 11-session, nutrition education lecture series on the nutrition knowledge and related professional behaviors of a group of family practice residents. The subjects were the 15 residents at the Family Practice Center, Terre Haute, Indiana, U.S.A. Residents worked with registered dietitians in an active learning/team teaching model for each session. A patient questionnaire was used to determine the patients’ perception of the amount, type, and effectiveness of the nutrition information presented during office visits with their family practice resident. A 55-question, multiple-choice, nutrition knowledge test was used to evaluate the residents’ knowledge of nutrition in each of the 11 topic areas. Results indicated significant differences between the pre- and post-test scores and improvement in several nutrition-related professional education behaviors of the residents after the 11-session nutrition education program. Significant increases were noted for the discussions of nutrition related to health maintenance, for overall nutrition recommendations, and for recommendations to see a dietitian.

• Acknowledgments

• Chapter 1. Introduction

• Purpose of the study
• Statement of the problem
  
• Delimitations
  
• Assumptions
  
• Hypotheses

• Chapter 2. Review of Literature

• Nutrition knowledge and related behavior of physicians
  
• Nutrition in formal medical education
  
• Nutrition education intervention programs
  

• Chapter 3. Methodology

• Subjects
  
• Subject preparation
  
• Topic survey
  
• Patient questionnaire
  
• Nutrition test
  
• Education sessions
  
• Experimental design
  

• Chapter 4. Results and Discussion

• Nutrition knowledge of family practice residents
  
• Descriptions of medical concerns of patients surveyed
  
• Nutrition-related professional behaviors of residents
  
• Nutrition education behaviors used by residents for health maintenance patients
  (well child, prenatal, physical/check-up)
  
• Patient requests for nutrition information and evaluation of residents’ responses
  

• Chapter 5. Summary and Conclusions

• Discussion
  
• Research recommendations
  

• Bibliography

• Appendices:

• A.    Curriculum Survey

• B.    Patient Questionnaire

• C.    Nutrition Test

• D.    T-Test Statistics*

• E.    Selected Statistically Significant Contingency Tables*

• F.    Pre-Test vs. Post-Test: Additional Contingency Tables*

For their contributions to the completion of this thesis, I would like to acknowledge the following:

• The Family Practice Center in Terre Haute, Indiana, under the direction of Randall Stevens, M.D., James Buechler, M.D., Paul Daluga, M.D., Margret Pappas, M.D., and Steve Phillipson, M.D., for allowing us to use their medical center, their patients for the study, for their help in compiling the data, and for financially supporting the catered gourmet vegetarian lunches.

• The residents of the Family Practice Center, classes of 1996, 1997, and 1998, who not only allowed us to use them as subjects, but also contributed their time to help implement the program and present the lectures.

• The office and administrative staff of the Family Practice Center, for their help in organizing the program and the distribution and collection of the patient surveys. I hope they enjoyed the fresh-baked cookies.

• The registered dietitians and pharmacists of Union Hospital, Terre Haute, Indiana, for contributing their time and expertise to the development and implementation of the curriculum.

• The community dietitians of Terre Haute, Indiana, for contributing their time and expertise to the development and implementation of the curriculum. A special thanks to Lana Taylor, R.D. and Marie Campbell, R.D. for all their help in preparing the lunches.

• Thomas E. (Tom) Billings, of Berkeley, California for his help with the analysis, interpretation, and understanding of the statistical data.

• Lisa Hark, Ph.D., R.D., University of Pennsylvania Medical Center, for her support and direction in getting this whole project started, implemented and completed.

• The nutrition faculty of the Department of Family and Consumer Sciences, Indiana State University, including Drs. Rao Ivaturi, Frederica Kramer, Judith Byrne, and Carol Reed for contributing their time and expertise to the implementation of the curriculum.

• Dr. Sarah Hawkins, Nutrition Professor, Indiana State University, who continually contributed her time, knowledge, expertise, and guidance, both day and night, to seeing this project through.

• Kathleen Steinstra, M.D., Associate Director, Family Practice Center, Terre Haute, Indiana, for believing in me and for sharing my vision of teaching nutrition to medical residents, for opening her center to allow us access to the residents and patients, and for sticking with me through it all.

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