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From 20 hours to competency: Advancing nutrition education in medical training

Rebecca Stevenson RD, Medical and Scientific Affairs Group MNI

Enhancing nutrition education for healthcare professionals

Despite the critical role that nutrition plays in managing acute and chronic diseases, nutrition education is underrepresented in medical school curricula across Europe and globally. The European Society for Clinical Nutrition and Metabolism (ESPEN) global surveyrevealed a significant gap in nutrition training for medical students, with too few hours dedicated to nutrition throughout undergraduate studies and high variability within different schools1. Most medical schools provide fewer than 20 hours of nutrition education in total, which is insufficient given the significant health benefits it can offer. This gap highlights the urgent need to improve nutrition education for future healthcare professionals.

Why nutrition matters in medical education

Nutrition is a cornerstone of health and plays a critical role in recovery from surgeries and illnesses. Disease-related malnutrition affects 33 million people in Europe, with 1 in 4 hospital patients and 1 in 3 patients with cancer suffering from the condition2. Malnutrition causes high complication rates, mortality, and healthcare costs, with patients suffering from increased risk of infections, longer hospital stays, longer wound healing, and treatment side effects3, 4.  It costs European countries an estimated 170 billion euros annually to treat malnutrition 3, 4. Despite the high prevalence, there is a lack of prevention, diagnosis, and treatment of malnutrition. Factors contributing to this situation include: insufficient dedicated time to clinical nutrition, limited hospital funding, and difficulties with reimbursement of medical nutrition by healthcare systems. The deficit of clinical nutrition training means that future doctors are not adequately prepared to address their patients’ clinical nutrition needs.

Strong nutritional knowledge among healthcare professionals significantly improves nutritional care, as patients can be identified earlier in their care journey and treated with appropriate nutritional support. Effective nutritional interventions not only support improvement in outcomes but also help reduce healthcare resource utilisation through reduced recovery days from illness, shortening hospital stays, and preventing patients from bouncing back into hospital.

The need for enhanced nutrition education

To address these gaps, it is essential to advocate for mandatory nutrition education in all medical schools. This education should cover human nutrition in three domains: basic nutrition, applied or public health nutrition, and clinical nutrition according to ESPEN’s Nutrition Education Study Group (NESG) 5,6. The group came together with European college deans and student representatives as part of the Nutrition education in medical schools (NEMS) project, to understand how they could better equip future doctors with essential nutrition knowledge and practice 5,6. They identified the following key success factors for implementing mandatory training of doctors:

Key factors for successful implementation:

  1. Core nutrition curriculum: Establishing a comprehensive curriculum that covers all aspects of human nutrition.
  2. Variety of teaching methods: Utilising traditional classes, seminars, clinical practice sessions, and novel teaching tools such as internet resources and e-learning. Plus, hands-on learning experience in applying nutritional knowledge in clinical settings.
  3. Multidisciplinary and experienced faculty: Ensuring that the faculty includes experts from various fields to provide a well-rounded education.
  4. Vertical and horizontal integration: Integrating nutrition content vertically across different years of study and horizontally across different subjects.
  5. Ongoing evaluation: Continuously assessing student learning to ensure the effectiveness of the curriculum.

The NEMS project also recognised the need for strong political backing at the highest level to ensure the implementation of nutrition education across medical schools in Europe.

Pilot universities and positive outcomes

La Sapienza in Rome has successfully piloted the integration of nutrition education into its medical curriculum.  Building on this success, Complutense University in Madrid and the University of Tessaloniki in Greece have begun implementing similar initiatives. These institutions have employed diverse teaching models, including traditional classes, seminars, clinical practice sessions, and e-learning.  This integrated approach has enriched the students learning experience, equipping future physicians with improved knowledge of nutrition and its role in patient care. Medical students at these pilot universities have demonstrated enhanced skills in nutritional assessment and counselling, preparing them to address nutritional related issues effectively in clinical practice.

Collaboration and dissemination

Enhanced collaboration between universities and professional societies has facilitated the sharing of best practices and educational resources. ESPEN offers graduate and postgraduate courses to enhance the nutritional knowledge and skills of healthcare professionals, including workshops, e-learning modules, and hands-on training sessions. Recently they have developed a course covering 21 education topics in three areas of human nutrition to support implementation into regular undergraduate classes for non-expert teachers. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) provides courses for healthcare professionals and allied healthcare professionals, such as the Allied Health Professionals (AHP) Course and the AHP Autumn School, focusing on clinical guidelines and multidisciplinary management of paediatric conditions. These organisations offer lifelong learning opportunities to keep professionals up to date with the latest research and best practices.

Conclusion

Improving nutrition education for healthcare professionals during their undergraduate training is essential to address the significant gap in clinical nutrition training. Considering that nutrition is often limited to less than 20 hours in medical curricula, by advocating for mandatory nutrition education, enhancing curricula, and fostering collaboration, we can equip future doctors with the essential nutrition knowledge needed to improve patient outcomes and reduce the prevalence of malnutrition-related complications. Ensuring that healthcare professionals are well-trained in nutrition will lead to better patient care and more efficient healthcare systems.

  1. Cuerda et al – A clinical nutrition education in medical schools: results of an ESPEN survey – ClinNutr (2017); 36:915-6
  2. mni-general-malnutrition-infographic-a4-v8_digital.pdf (accessed 30 April 2025)
  3. Ljungqvist O, de Man F. Under nutrition: a major health problem in Europe. Nutr Hosp 2009; 24:369-70.
  4. https://www.medicalnutritionindustry.org/content/uploads/2023/10/mni_summary_booklet_2018_final_hr.pdf (accessed 30 April 2025).
  5. Cuerda et al. Nutrition Education in medical schools (NEMS). An ESPEN position paper.  Clinical Nutrition 38 (2019). 969-974.
  6. Cuerda et al. Nutrition Education in medical schools (NEMS project. Joining ESPEN and university point of view.
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