|Chapter 1. INTRODUCTION|
Diet a common factor in disease.Many scientific studies have documented the important role that nutrition plays in the promotion and maintenance of health, and in the prevention of disease. The Surgeon Generals Report on Nutrition and Health (U.S. Department of Health and Human Services, 1988) showed that 8 of the 10 leading causes of death and disease in the United States in 1987 were directly linked to what we eat and drink. These 10 leading causes of death account for an estimated 2.125 million deaths (in the U.S.) in 1987, and the situation has changed little since then. Five of the 10 are directly related to the food we eat, and are caused by dietary imbalances and excesses. These 5 (heart disease, cancer, stroke, atherosclerosis, and diabetes) account for 68%, or 1.45 million of the 2.125 million annual deaths. Diet was also identified as a contributing factor to the development of other conditions, such as hypertension, osteoporosis, obesity, dental caries, and gastrointestinal diseases. As a result of this report, the U.S. dietary guidelines (Nutrition and Your Health: Dietary Guidelines for Americans, 4th ed., U.S. Department of Health and Human Services, 1995) were redesigned in 1995 to urge consumers to change and improve their eating patterns .
Physicians need improved nutrition education.To meet the dietary changes recommended in The Surgeon Generals Report on Nutrition and Health and the dietary guidelines, the Nutrition Policy Board (U.S. Department of Health and Human Services, the editors of The Surgeon Generals Report on Nutrition and Health) suggested that physicians should receive improved nutrition training in the role of diet in health promotion and disease prevention, and in the therapeutic aspects of dietary intervention (U.S. Department of Health and Human Services, 1988). Another outgrowth of The Surgeon Generals Report on Nutrition and Health was the development of the publication, Promoting Health/Preventing Disease: Year 2000 Objectives for the Nation (U.S. Department of Health and Human Services, 1999), a national strategy for improving the health of the nation. This document includes goal statements advocating that the proportion of primary-care providers who supply nutrition counseling and/or referral to qualified nutrition specialists increase to over 50%.
Doctors, however, have traditionally received little if any nutrition training during their medical education, residency training, or time in actual practice (Committee on Nutrition in Medical Education, 1985). Without proper nutrition education, it is unlikely that physicians will be able to be effective in helping reduce the high incidence of nutrition-related death and disease in this country. Ongoing research continues to establish both the cost-effectiveness and care-effectiveness of proper nutrition in the prevention and treatment of disease (Coats, Morgan, Bartolucci, and Weinsier, 1993; Health Care Reform Legislative Platform, 1993). As a result, an increasing number of people will look to their physicians to provide them with accurate nutrition information. Hence, the problem of lack of nutrition education and knowledge among physicians becomes an even greater concern.
Purpose of the Study
As the need for accurate nutrition knowledge and information among physicians increases, it is important to find a way to incorporate this information into the educational experience of physicians. Nutrition education programs need to be developed, implemented, and studied for their effectiveness in improving the nutrition knowledge of physicians. In addition to increasing the physicians nutrition knowledge, it will be important to identify areas and study ways for physicians to effectively impart this knowledge to their patients.
Statement of the Problem
The purpose of this study is to evaluate the effectiveness of a nine-month nutrition lecture series on the related knowledge and professional behaviors of a group of first, second, and third-year family practice residents.
This study was delimited as follows:
Eleven nutrition education sessions were conducted during noontime lunch conferences.
The sessions occurred one to two times monthly.
Session time was 45 minutes.
The study subjects consisted of 15 family practice residents, including five first-year, five second-year, and five third-year residents;
Conference attendance averaged about 75% due to scheduling demands of the residents.
The study was restricted to family practice residents and faculty.
Instructional methods for the education sessions included the use of an active learning/team teaching model that incorporated the subjects as instructors.
The nutrition department of the hospital provided coordinated lunches reflecting the session topic.
The following assumptions were made in this study:
Residents receive no other nutrition education. The study subjects (residents) would receive no other formal didactic nutrition training at the Family Practice Center during the study period.
Increased nutrition education would result in an increase in nutrition knowledge as measured by scores on a standardized comprehensive nutrition test.
Increased nutrition knowledge of the residents would result in an increase in the frequency and number of nutrition handouts, discussions of nutrition, and nutrition recommendations to the patients.
Increased nutrition knowledge would result in an increase in the adequacy of the residents responses to patient requests for nutrition information; and
The residents would complete their family practice training at the Union Hospital Family Practice Residency Center.
The following null hypotheses were tested at the 0.05 significance level:
H0(1): program does not change resident nutrition knowledge. That is, no differences exist between the residents scores on a standardized nutrition test before and after the 11-session nutrition education program.
H0(2): program does not change resident nutrition behaviors. No differences exist between the frequency of the residents distribution of nutrition handouts, discussions of nutrition, and nutrition-related patient recommendations, during patient visits before and after the 11-session nutrition education program.
H0(3): program does not change resident responses to patients. No differences exist in the adequacy of the residents responses to patient requests for nutrition information before and after the 11-session nutrition education program.