Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination.

Nutrition plays an important role in health promotion and disease prevention and treatment across the lifespan. Physicians and other healthcare professionals are expected to counsel patients about nutrition, but recent surveys report minimal to no improvements in medical nutrition education in US medical schools. A workshop sponsored by the National Heart, Lung, and Blood Institute addressed this gap in knowledge by convening experts in clinical and academic health professional schools. Representatives from the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, the Liaison Committee on Medical Education, and the American Society for Nutrition provided relevant presentations. Reported is an overview of lessons learned from nutrition education efforts in medical schools and health professional schools including interprofessional domains and competency-based nutrition education. Proposed is a framework for coordinating activities of various entities using a public-private partnership platform. Recommendations for nutrition research and accreditation are provided.

Update on Nutrition, Metabolism, and Lifestyle Curricula for Medical Education, Research, and Practice: USA.

Although physicians are expected to counsel their patients about nutrition-related health conditions, surveys report minimal to no medical nutrition education improvements in the United States medical schools. From 1998 to 2005, the National Institutes of Health (NIH) introduced and funded the Nutrition Academic Award program among 21 medical schools to incorporate nutrition into their curricula. Since then, nutrition champions have developed several education models and continue to advocate for inclusion of nutrition content in the U.S. Medical Licensing Examination and for recognition of nutrition as a national subspecialty in medicine. As a result, the American Society for Nutrition (ASN) and NIH published recommendations for remodeling nutrition education, training, and research. As medical education has shifted to a competency-based system, an inter-professional and competency-based approach to curricular changes was recommended. As a result, ASN aims to launch a coordinating center using a public-private partnership platform to achieve those goals. This collaborative will further allow for inclusion of all healthcare professionals engaged in improving patients' nutrition-related outcomes. This article describes the educational context and steps needed to advance the field of medical nutrition, metabolism, and lifestyles in the United States.

Peripheral arterial disease: lack of awareness in Canada.

BACKGROUND: Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with a high risk of stroke, myocardial infarction and cardiovascular death. PAD also fosters major morbidity by causing claudication, functional impairment, disability and amputation. PAD is largely unrecognized and under-treated compared with other cardiovascular diseases. The public health impact of PAD, as a contributor to Canadian national rates of heart attack, stroke, amputation, death and disability, will be challenging to address if the public is unaware of this common cardiovascular disease. OBJECTIVE: To assess public knowledge of PAD in Canada. METHODS: A cross-sectional, population-based telephone survey of 501 adults 50 years of age and older (mean age 64.4 years) was conducted using random digit dialing. The survey assessed demographics and risk factors of the study population and knowledge of PAD causes and consequences. RESULTS: Survey respondents reported a high prevalence of atherosclerotic risk factors including high blood pressure (43%), high blood cholesterol (37%), diabetes (12%) and smoking history (18% current and 49% former smokers). Only 36% of respondents reported familiarity with PAD, which was significantly lower than other cardiovascular diseases or risk factors. Knowledge of perceived consequences of PAD was low and knowledge gaps were more pronounced in older, less educated and lower income respondents. CONCLUSIONS: The Canadian public is largely unaware of PAD as a prevalent systemic manifestation of atherosclerosis and its associated morbidity and mortality. National PAD awareness programs should be instituted to increase PAD knowledge to levels comparable with other cardiovascular diseases and risk factors.

Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey.

BACKGROUND: Lower-extremity peripheral arterial disease (PAD) is associated with decreased functional status, diminished quality of life, amputation, myocardial infarction, stroke, and death. Nevertheless, public knowledge of PAD as a morbid and mortal disease has not been previously assessed. METHODS AND RESULTS: We performed a cross-sectional, population-based telephone survey of a nationally representative sample of 2501 adults > or = 50 years of age, with oversampling of blacks and Hispanics. The survey instrument measured the demographic, risk factor, and cardiovascular disease characteristics of the study population; prevalent leg symptoms; PAD awareness relative to atherosclerosis risk factors and other cardiovascular and noncardiovascular diseases; perceived causes of PAD; and perceived systemic and limb consequences of PAD. Respondents were 67.2+/-12.6 years of age with a high prevalence of risk factors but only a modest burden of known coronary or cerebrovascular disease. Twenty-six percent of respondents expressed familiarity with PAD, a rate significantly lower than that for any other cardiovascular disease or atherosclerosis risk factor. Within the "PAD-aware" cohort, knowledge was poor. Half of these individuals were not aware that diabetes and smoking increase the risk for PAD; 1 in 4 knew that PAD is associated with increased risk of heart attack and stroke; and only 14% were aware that PAD could lead to amputation. All knowledge domains were lower in individuals with lower income and education levels. CONCLUSIONS: The public is poorly informed about PAD, with major knowledge gaps regarding the definition of PAD, risk factors that lead to PAD, and associated limb symptoms and amputation risk. The public is not aware that PAD imposes a high short-term risk of heart attack, stroke, and death. For the national cardiovascular disease burden to be reduced, public PAD knowledge could be improved by national PAD public education programs designed to reduce critical knowledge gaps.

Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes.

OBJECTIVES: Studies were conducted to: 1) assess physicians' attitudes and practices in managing cardiovascular disease (CVD) risks in diabetes; and 2) determine the awareness of CVD risks among diabetic patients. BACKGROUND: Cardiovascular disease is the leading cause of premature death among diabetic patients. As diabetes is often seen as a "glucose-centric" disease, it is unclear whether diabetic patients are talking with their doctors about CVD and other key clinical parameters of diabetes care such as blood pressure and cholesterol. METHODS: An online survey was completed by a nationally representative sample of 900 physicians. The 95% confidence interval is approximately +/-2.5%. Before this study, a telephone survey of 2,008 people with diabetes was conducted using random, direct-dial screenings of U.S. households. RESULTS: Ninety-one percent of physicians believe that their patients with diabetes are "very" or "extremely" likely to have a cardiovascular event. Although physicians report discussing CVD risk factors with 88% of their diabetic patients, they perceive their diabetic patients as being only moderately knowledgeable about their increased CVD risks. Sixty-eight percent of the people with diabetes do not consider CVD to be a serious complication of diabetes; they are more likely to be aware of complications such as blindness (65%) or amputation (36%) rather than heart disease (17%), heart attack (14%), or stroke (5%). Physicians perceive "poor compliance" with behavioral modifications and medication regimens as the greatest barriers to the management of CVD risks in diabetic patients. CONCLUSION: Materials should be made available to help facilitate communication about CVD risks, and strategies for improving compliance with life-style modifications and multiple drug therapies should be explored. Efforts should continue to promote a comprehensive approach to the management of diabetes to include aggressive control of blood glucose and other CVD risk factors.