We learn nothing about nutrition, claim medical students
By Sheila Dillon
bbc.co.uk/news/health-43504125
Presenter, Radio 4's Food Programme
25 March 2018
Medical students say they currently learn almost nothing about the way diet and lifestyle affect health - and they should be taught more.
They say what they are taught is not practical or relevant to most of the medical problems they see in GP surgeries, clinics and hospitals.
A leading GP estimated that up to 80% of his patients had conditions linked to lifestyle and diet.
These included obesity, type 2 diabetes and depression.
Why does this lack of training matter?
This year the NHS will spend more than £11bn on diabetes alone - social care costs, time off work etc, will almost double that bill.
Type 2 diabetes - the most common kind - is linked to obesity. And right now Britain is the fat man of Europe.
Training too traditional
But doctors are not being trained to deal with what medics call non-communicable diseases - and it's those kind of illnesses that are threatening to bankrupt our health system, so a new kind of training is crucial.
Speaking to BBC Radio 4's The Food Programme, Dr Rangan Chatterjee, author and podcast host, told me: "The health landscape of the UK has dramatically changed over the last 30 or 40 years and I think the bulk of what I see as a GP now - almost 80% - is in some way driven by our collective lifestyles."
Dr Michael Mosley, presenter of BBC One's Trust Me I'm A Doctor, said, "Unfortunately it's not part of the traditional training. At medical school I learnt almost nothing about nutrition. And I have a son at medical school and it's again not part of his key curriculum.
"So I don't get the sense that there are lots of doctors out there who feel empowered to tell patients much about nutrition."
A hotbed of the new revolution is Bristol University where, in 2017, third year medical students Ally Jaffee and Iain Broadley founded Nutritank.
It's an online organisation created for and by medical students to share nutrition science research and organises events and lectures on campus.
This summer, it will welcome GP, author and podcast host Dr Rupy Aujla to Bristol to lead the first UK course in culinary medicine for medical students.
From one society in Bristol, Nutritank has now spread to 15 other student-led groups at universities across the country.
'It's time'
Ally Jaffee said: "There's just about a society at medical school in everything from sexual health to orthopaedics to dermatology. But there just wasn't a nutrition and lifestyle or a preventative medicine society.
"We're taught about 10 to 24 hours over five to six years in medical school on nutrition."
This month, the British Medical Journal announced it will launch a journal on the science and politics of nutrition in June 2018.
Dr Fiona Godlee, editor-in-chief of the BMJ, told me, "It's time we recognised that food and nutrition are core to health. There is a growing body of research out there that needs to be published - and we want to contribute to that effort."
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Image caption
What people eat has a bearing on their general health, doctors say
She said the same levels of quality and scrutiny should be applied to food science that are applied to other areas of health research.
The BMJ's announcement follows an opinion piece it published in October 2017 written by two University of Cambridge graduate medical students, Kate Womersley and Katherine Ripullone.
Kate said: "I was in an obesity clinic as part of my medical shadowing.
"A patient came in and said very frankly to the doctor, the consultant in charge, 'Why am I so fat?'.
"The patient was asking a very straightforward question and I think was expecting a straightforward answer. But often that's a question where doctors seem to clam up a bit.
"We were interested to write this piece for the BMJ, because we didn't feel prepared to be receiving that question."
Medical schools in the UK are responsible for setting their own curriculum with guidance and standards published by the General Medical Council.
The GMC is now reviewing that guidance but so far it's been very general. It told us that it recognises the significance of the impact of diet and nutrition on health and wellbeing and has sought to express this more explicitly in its revised "outcomes" that will be released this summer.
Things are also beginning to change at medical schools. University of Cambridge told us it plans to double the amount of core course content on nutrition and has asked Kate and Katherine to help.
Similarly, Bristol medical school has sought input from students to redesign its curriculum.
Meanwhile, Prof Sumantra Ray of NNedPro Global Centre for Nutrition and Health told us his organisation is involved in rolling out training in diet and nutrition for student doctors by 2020.
Kate said: "Students need to see nutrition as something at the cutting edge of scientific discovery.
"I think there needs to be an image change of how doctors perceive nutrition, but also how it's presented to students."
You can hear more about this story on The Food Programme on Radio 4 at 12:32 BST on Sunday or on iPlayer afterwards.
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Doctors Could UK Med Students Trigger Tipping Point
28 March 2018
anhinternational.org/2018/0...
There are times when a need for change is so great, and so desired, that a perfect confluence of events occurs that creates the necessary tipping point to make that change inevitable. It would seem that we have reached that time with regard to the provision of healthcare in the UK. All it needs is a bit more of a concerted push to topple us over the edge and let the changes cascade like dominoes. Could nutrition-minded UK medical students be important facilitators of this tipping point?
Creating a tipping point
The dismal projections on the future of the NHS, which is buckling under the weight of chronic disease, are not new, but they are reaching a new low. GPs, exasperated or overwhelmed by the stress of impossibly short consultation times, mounting patient demand and a lack of training in handling many of the conditions facing them, are leaving the profession in droves.
Last week we revealed that our revolutionary blueprint for a sustainable health system is on the brink of being released for consultation. After 16 years of experience-gathering and 2 years in creation, the blueprint has Solution tattooed across its core.
This week BBC Radio 4’s programme, Doctor’s Orders: Getting tomorrows medics cooking, revealed the monstrous lack of training in nutrition that our medical students are receiving. The programme also highlighted an initiative led by medical students at Bristol Medical School, Iain Broadley and Ally Jaffee, called Nutritank. Recognising the importance of nutrition and lifestyle in healthcare, medical students are being forced to take matters into their own hands and search out their own education. Nutritank was launched in October 2017 and already has society branches in over 15 medical schools across the UK with another 5 on the way. Its rapid progress is clear testimony that the will is there, and that medical students recognise that their training is inadequate preparation for effective clinical practice.
Resetting the terrain
In our blueprint for a sustainable health system we acknowledge that the complexity and multi-factorial nature of chronic diseases is well-recognised. However, there is little agreement in primary care, or among health professionals and the public, what should be the multiple areas of focus required to ensure an individual either maintains good health and resilience — or has the best chance of restoring health from a diseased or less than optimal state of health. A wider, systems approach to medicine that views humans as the complex organisms we are, moulded and modulated by complex interactions between our genes, our food, lifestyles and changing environments, is sorely needed.
ANH-Intl’s whole-system ‘terrain re-setting’ approach takes into account the importance of a tiered delivery system: self-care, guided self-care and practitioner-led care and interventions. All of which have to be part of any sustainable health system if we are to turn the healthcare tide. As Courtenay Heading from Jurby Wellness expresses so succinctly, “Excess human body weight and disease now has more costly names, including: obesity and diabetes. Both are global problems and with huge emotional tolls, physical burdens and financial costs. Those costs are in the hundreds of £/$/€ billions each year and still growing. Some people are growing fat – on that spending alone. The obesity epidemic is overwhelming health services and budgets – resulting in mis-allocation of huge resources.”
Nutritank’s mission to create a network of interconnected society branches (‘Nutritanksocs’) as an innovation hub for food, nutrition and lifestyle education resets a different terrain. That of clinical education for medical doctors, which is essential if primary healthcare is ever to become sustainable – and effective – for the range of chronic diseases decimating the population. The medical students signing up for Nutritank membership all have a desire to empower young people and communities to make a change through education. They also aim to promote the need for greater nutrition and lifestyle medicine training within medical education. Halleluja! It’s the same desire that we, and so many of you, have held so dear and for so long. But reaching any tipping point takes time and is, at least in part, a numbers game.
Backed by heavy-weights
It’s early days, but Nutritank and its network of societies has all the hallmarks of success – including an A list of medical heavy-weights with track records of being on the right side of the nutrition and lifestyle divide.
In the esteemed line-up you’ll see household names such as BBC Doctor in the House star, Dr Rangan Chatterjee, Dr Michael Mosely, Dr Aseem Malhotra, Prof Sumantra Ray and Dr Rupy Aujla of the Doctor’s Kitchen fame and provider of the first culinary medicine course for medical students.
When faced with the question of whether nutrition and lifestyle medicine could be squeezed into an already packed medical curriculum, Michael Mosely said, “It’s easy to take some things out of courses to fit nutrition in. A change is coming.” Dr Chatterjee added, “Given that the health landscape of the UK has changed dramatically in the last 30/40 years. We can’t say anymore we don’t have time in the curriculum”.
So, how’s this? Given the dire need to move away from the failing ‘pill for every ill’ model, the 2 plus years out of 6 spent on drug pharmacology in the medical curriculum could be cut in half to allow for education on nutrition and lifestyle intervention. Then in the 3 years of clinical training – medical students could learn how to put it into practice.
Tipping point you ask? We’ll leave the last word with Fiona Godley, Editor in Chief of the British Medical Journal, who was central to the Sunday Times and BMJ attacks on Andrew Wakefield over the possible MMR/autism link. Dr Godley does more than acknowledge the lack of nutrition training for medical students, she says that, “What has changed is the recognition of the place of good food in people’s health”. She also recognises that the science of food research is inherently problematic, and that the public are confused too. Given the growing body of research that needs to be published in open access, she reveals that there will be a new open access journal launching in June 2018, BMJ Nutrition online.
What you can do…
Don’t think as a member of the public you can’t assist these young, soon-to-be doctors. You can. And not just in the UK. Much of the reason these young medical students are clamouring for more information is they know where the science is at, they know what patients’ needs are – and they know just how much is missing from their training.
So the next time you go see a conventional doctor – in clinic – or socially – just keep asking the questions. Here’s an example: “Doctor, what can I eat, or how should I eat to make my [insert ailing body part/system] to feel better? Is there anything I can do in terms of specific activity, or relaxation practices? Can you recommend some things I can do to help me sleep better than don’t involve sleeping pills”.
So please, just keep asking those kinds of questions – because that’s the grassroots pressure that has triggered the latest revolution. And we all need that revolution to keep rolling!
