Focus Group Meeting

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Focus Group Meeting: March 8, 2001
Topic: Nutrition preparedness of MSIV
Participants: Six MSIV students

Questions and responses:

Do you feel like you were adequately prepared to address the nutrition-related problems of the patients you have seen during your clinical year?

  • No

Did you receive any instruction or training in the area of nutrition? If so, where did you receive this training?

  • Minimal
  • We were introduced to nutrition in Biochemistry. Some students had taken the noon hour Nutrition Elective.
  • Would like to have had nutrition integrated into Physiology and Pharmacology so that it be clear to us how it relates to the pathophysiology of the disease, the diagnosis, and to patient care.
  • General Surgery rotation provided a talk on nutrition (parenteral nutrition) but it did not apply to primary care patients.
  • One student had interacted with the clinical nutritionist during patient rounds and found this very helpful.
  • In the hospital, we are taught to call for a nutrition consult but this does not help us in caring for patients in the clinic.

Would you change anything in the curriculum or do you feel like it is sufficient to have what you have and be able to contact a nutritionist to help you out with your patient care?

  • PBL would be a good place in the curriculum to teach nutrition
  • Emphasis should be put on the transition from nutrition as a basic science to the care of patients.
  • Include instruction on a healthy diet so that we can counsel patients in the clinic
  • Would include lectures on clinical applications of nutrition such as nutrition and pregnancy, and then test the students at the end of these lectures
  • Include an 8- or 9-week block during second year where there is one nutrition lecture each week and then give a test on nutrition at the end of the block

Do you feel like you have adequate resources for nutrition to use when you are seeing patients in the clinic or in the hospital?

  • The nutritionists are a good resource and are usually very willing to help.
  • Nutrition consults can be requested

What kind of resources would be helpful?

  • A website with calculations that we need to know in the hospital
  • Palm pilot software for medical calculations such as BMR, body weight, calorie levels
  • Opportunities to observe in a clinic with a nutritionist or nurse educator
  • What do you consider essential for a medical student to learn?
  • Vitamins - deficiency, toxicity, and different forms available
  • Parenteral nutrition - total, partial, different formulas, complications (sepsis, bowel integrity)

Where would you put the specific things that you have mentioned in the curriculum?

  • Surgery rotation
  • At the beginning of the Medicine rotation and in Pediatrics - spend one day on nutrition before beginning clerkship
  • During the Clinical Skills session
  • A session on preventive medicine: the healthy heart diet, diabetic diet, etc.
  • In the Family Medicine rotation with the information that you need to know about diabetes, obesity, hypertension, etc. to counsel patients in the Family Medicine clinic

Do you feel that you are adequately prepared to discuss physical activities with patients who need to lose weight or improve their cardiovascular fitness?

  • Some of it is common sense but we really do not have the specifics about the type of exercise to recommend or the amount of time the patient needs to spend doing it.
  • We know that we should recommend exercise for patients with high blood pressure or who are obese, for example, but we do not know how to counsel them about the specifics.
  • Do you feel comfortable in discussing the potential health risks and treatment options with a patient who is overweight or obese?
  • This is a very difficult area to address
  • Would talk about exercise
  • Explain the health consequences of being overweight and try to motivate the patient
  • Yes, but would refer to someone in this field

Are you familiar with the "Stages of Change" (Prochaska and DiClemente) to determine whether your patient is ready to make positive lifestyle changes that will improve their health?

  • Yes. We learned this in Family Practice.

Do you feel that as a physician, your attitude towards diet, physical activity and other healthy lifestyle factors will influence your patients' compliance and motivation to change their life?

  • Yes.
  • Yes, but we do not always have time to do these things (eat healthy, exercise, get adequate sleep)
  • This is the ideal
  • Do you use evidence-based medicine for determining appropriate nutritional therapy for your patients?
  • Evidence-based medicine is valuable but we usually do not have time to do this.
  • Evidence-based medicine might be more practical during residency

Are you aware that Clinical Nutrition fellowships are available at several medical schools? Is that something that you are knowledgeable about?

  • One student remembered getting an e-mail message about a clinical nutrition internship during medical school.
  • No awareness

Do any of you have any interest in pursuing post-graduate training in nutrition or becoming board-certified in nutrition?

  • No

Do you intend to include nutritional care in your clinical practice?

  • Yes, in primary care
  • Yes, in Ob-Gyn
  • Yes, if I work with the elderly
  • It will be specialty dependent

Do you see patients in the clinics who are using alternative medicine? Would instruction in this area be helpful?

  • Yes. We see a lot of patients who use supplements and other alternative therapies.
  • Yes. It would be helpful to have a speaker on this topic possibly in the nutrition elective.
  • One student commented that it would not be useful to learn this and that it should be left to the specialists in alternative medicine; evidence-based medicine could be used when we need to know about a specific supplement.
  • An elective in alternative medicine would be helpful.
  • Resources for alternative therapies would be useful.

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