Health CommitteeWritten evidence from the Intercollegiate Group on Nutrition (ETWP 32)

Summary

Nutrition is a key determinant of the health of people and of populations, and a critical component of care of the sick.

It is therefore critical that doctors and other healthcare professionals receive an adequate undergraduate education in nutrition, and subsequent training to assure their safety and competence to practise.

The current education and training of doctors and other healthcare professionals cannot assure that they are safe and competent to practise in respect of nutrition.

The Intercollegiate Group on Nutrition, a group of the Academy of Medical Royal Colleges, is the only national professional body that has nutrition as its primary concern. Under its auspices an undergraduate curriculum in nutrition for medical students has been developed.

We urge that this curriculum should be delivered to all medical students as an integral part of their undergraduate training.

We further urge that all other healthcare professions include an appropriate element of nutrition in their undergraduate curricula, and that this training should be accredited by the Association for Nutrition.

1.1 The Intercollegiate Group on Nutrition (ICGN) was founded in 1996, following a report of the Royal College of Pathologists which recommended an initiative in post-graduate training in nutrition be established for doctors across the range of medical specialties. It was established as a collaborative venture between several Medical Royal Colleges, in collaboration with the British Dietetic Association, and with observers from the Chief Nursing Officer and the British Pharmaceutical Nutrition Group, and has since inception been hosted by the Royal College of Pathologists. Current membership is from the Royal Colleges of Anaesthetists, General Practitioners, Obstetricians and Gynaecologists, Pathologists, Paediatrics and Child Health, Physicians (London, Edinburgh), Physicians and Surgeons (Glasgow), Psychiatrists, Radiologists, Surgeons (England and Edinburgh), the Faculty of Public Health, the Intensive Care Society and the British Dental Association.

1.2 The ICGN was set up in recognition of the importance of nutrition in medical practice for patient care and public health. The need for systematic education and training in nutrition was therefore considered a prerequisite to demonstrate safety and competence to practise. In contrast training in nutrition throughout the undergraduate and postgraduate medical curricula was absent or fragmented. The only national resource until recently has been the 1994 Department of Health document Core Curriculum for Health Professionals, which outlined 18 bullet points covering nutritional science, nutrition support and public health nutrition. More recently there has been a wider recognition of the need to incorporate nutrition in medical training both by the GMC at undergraduate level (Tomorrow’s Doctors), and the Royal College of Physicians at postgraduate level (Nutrition and Patients: a doctor’s responsibility).

1.3 Nutrition is an important determinant of the health of people and of populations, and of people’s response to illness. Thus, improving nutrition offers great scope for improving health, and reducing the impact of disease. In contrast, although nutritional issues are common in clinical and public health practice, they are all too often not recognised or adequately managed.

1.4 As a discipline, nutrition has its roots in the basic sciences, but its practical application in relation to human health presumes the delivery of a service. However, at the present time these services are not well characterised, nor adequately developed. There is considerable evidence that better nutrition before or during illness improves outcome and reduces hospital stay, but the application of this evidence in practice is not adequate. The services for the delivery of health, including public health, are provided by a variety of health professions who may have only modest, if any, nutritional education and training. Further, those who are currently engaged in delivering services in nutrition are not always trained to explicitly recognised standards, other than in the case of Registered Dieticians, and Nutritionists and Public Health Nutritionists registered with the Association for Nutrition.

1.5 Doctors in particular are critical to delivery of adequate nutritional care, but their education and training in nutrition are haphazard at best, and many doctors regard themselves as inadequately trained to give nutritional advice. This contrasts with the high regard that doctor’s advice (however poorly informed) enjoys: and with their impact on the rest of the health team as leaders and role models.

1.6 These two factors—inadequately defined standards across the health professions, and a range of greatly varying competences for those who need to access nutrition in their professional practice—limit the great potential offered by nutrition for health improvement and for economic savings. There is therefore a need to set standards for education and training for all health professionals so that they are trained to a level where they are safe and competent to practise. The current failure to achieve this leads to the widespread lack of recognition of nutritional problems (either of over or under nutrition) within the community and in hospital care, and in poor standards of nutritional management leading to adverse patient outcomes.

1.7 We believe that all health professionals should be able to demonstrate safety and competence to practise, including in nutrition at an appropriate level for their practice. We consider that medical curricula from undergraduate through the foundation years should include an explicit nutritional component. In the absence of this, the ICGN has set up the Intercollegiate Course in Human Nutrition as an opportunity for qualified doctors to reach the basic standard of nutrition education that should be expected from undergraduate experience. The course is designed to deliver agreed learning outcomes from each representative Royal College. A prototype course was held in 1997 and since then 22 courses have been held in Southampton, Nottingham, Durham and Scotland, with plans to continue two or three courses each year. Each Course comprises 20–30 delegates from a variety of specialities, and at different levels of seniority. Although some Royal Colleges now include elements of nutrition in their examinations this is not yet comprehensive.

1.8 The Intercollegiate Group has also considered the appropriate level of training that they would expect from newly qualified doctors to embark on postgraduate training in their specialities. They therefore developed an undergraduate core curriculum in nutrition for medical students, with the involvement of all medical schools in the UK, and this curriculum has been supported by the Heads of Medical Schools and the GMC. In addition this curriculum provides an explicit foundation to progress to achieving the learning outcomes of the Foundation years curriculum in nutrition, also developed with the Intercollegiate Group.

1.9 We regard the achievement of the core undergraduate nutrition curriculum and the nutritional elements of the Foundation Years curriculum as essential. Although some elements are covered in some places, this is not the norm and we urge that it should become so.

Conclusion

1.10 There is a need for an adequately trained workforce that includes doctors but encompasses all other health professionals, even if their main focus is not nutrition. In addition it should encompass those with specific expertise in nutrition ie registered nutritionists and dieticians. The current review is an opportunity. It would add substantial value to doctor’s efforts, and save expensive time, if there were sufficient numbers of adequately trained nutritionists.

1.11 It is important to recognise that the needs for adequate provision of nutritional services within the NHS and public health systems, and within community services, require a comprehensive approach; and that education and training are but one necessary though not sufficient consideration.

1.12 We urge that the available resources detailed above are incorporated into the training of all medical students and doctors in training, to assure their safety and competence in professional practice in relation to nutrition. We also urge that other non-medical parts of the health workforce receive training in nutrition, accredited by the Association for Nutrition in respect of their nutritional components; and that resources are allocated to maintaining an adequately staffed and trained workforce to deliver a comprehensive national nutrition service.

December 2011

Prepared 22nd May 2012