As obesity is becoming an epidemic and people are more conscious about the role of food in heart disease and other conditions, nutrition as a scientific discipline has gained more prominence. To help the next generation of physicians incorporate nutrition into their future practices, P&S has begun to more closely link nutrition science to medical education throughout the four-year curriculum. The latest development in the curriculum allows students to track the nutritional content of their course work on a new web site that features course notes, slides, and online nutrition assessment tools. > Two years ago, P&S was one of 21 American medical schools to receive a five-year, $1 million National Heart Lung and Blood Institute grant to emphasize nutrition knowledge and skills in training physicians and to further apply nutrition science to the clinical practice of medicine. Dr. Christine L. Williams, professor of clinical pediatrics (in the Institute of Human Nutrition) and principal investigator of the NHLBI grant, spoke with In Vivo writer Matthew Dougherty about the initiative's progress and goals.

What are the grant's goals?

The main goal of the NHLBI program, known as the National Academic Award (NAA), is to develop or enhance curricula so students, residents, and practicing physicians learn more about nutrition and to practice applying that knowledge to prevent cardiovascular diseases, obesity, diabetes, and other chronic diseases. The initial focus at P&S is on medical students but we will also include residents and faculty as we go along. The consortium of grant recipients is developing a nutrition curricular guide for training physicians and creating methods that test if the coursework is successful. Its other goals are to develop standards so practicing doctors can appropriately inform patients about how food and nutrition affects disease.

We are building on the 1997 re-design of the P&S curriculum, which created four-year course themes in basic, population, social, behavioral, and clinical sciences. Nutrition, as one of these four-year threads, is interspersed throughout the curriculum rather than contained in a specific nutrition course. The curriculum takes a case-based learning and applied nutrition approach.

What has been done so far?

In conjunction with the Center for Education Research and Evaluation and the Center for New Media Teaching and Learning, we recently launched a web site (www.columbia.edu/itc/hs/medical/nutrition/index.html) that allows students to see how nutrition fits in the P&S curriculum. The site contains downloadable notes and slides from course lectures. It also has links to online tools for diet assessment, body mass index calculations, and other resources, such as the NAA site, Columbia's Institute of Human Nutrition, and the American Heart Association. We try to attract students to the site with a monthly nutrition question that offers prizes for the correct answer.

Do you plan to change the nutrition curriculum?

As part of the NAA project, Dr. Hilary Schmidt, assistant professor of clinical psychology (in psychiatry) and assistant vice president and dean for education research and evaluation, and Dr. Vicki LeBlanc, project leader for education research and measurement, are leading an evaluation of the new curriculum. The evaluation will measure changes in students' knowledge, skills, and attitudes about nutrition as we implement the curriculum. At baseline, in 1999, a majority of fourth-year students felt there was not much nutrition education. But by 2005, we hope students will feel they received the necessary amount of nutrition education, be able to demonstrate knowledge of basic clinical nutrition, and recognize the role of the physician in patient nutritional evaluation and education. We're meeting with course directors to get their opinions on the new web site and what else should be included. Over the next two or three years we'll be analyzing and comparing the courses to national nutrition curriculum guidelines, which we are helping to draft as part of the NAA consortium.

How will the increased attention to nutrition help doctors and patients?

The nutrition training will teach a medical student to assess what someone is eating, whether it is a good diet, and how to counsel patients to change their diet, exercise more, and lower their lipids. A lot of doctors don't know how to modify a diet and that's something we would like to change, especially as the number of overweight and obese people in America continues to rise. We don't expect doctors to do all the nutrition counseling but they need to know the basics and have an opportunity to practice these clinical skills.