Developing Nutrition Curriculum in a Family Medicine Residency
Introductions <ul><li>Tufts Family Medicine Residency  </li></ul><ul><li>Boston area </li></ul><ul><li>24 residents  </li>...
Road Map <ul><li>Define our problems </li></ul><ul><li>What are the national recommendations </li></ul><ul><li>Discuss our...
Defining the problem? <ul><li>Identifying the lack of nutrition education in the residency setting </li></ul><ul><li>Ident...
What are the Guidelines? <ul><li>American Academy of Family Physicians </li></ul><ul><li>Association of Departments of Fam...
What are the Guidelines? Attitude <ul><li>Nutrition is an integral part of:  </li></ul><ul><ul><li>Health promotion and di...
What are the Guidelines? Attitude <ul><li>Dietary intake is influenced by a variety of patient factors, including:  </li><...
What are the Guidelines? Attitude <ul><li>Nutrition consultants should be utilized when appropriate to help provide counse...
What are the Guidelines? Knowledge <ul><li>General principles of nutrition  </li></ul><ul><li>Nutritional assessment  </li...
What are the Guidelines? Knowledge <ul><li>Disordered eating  </li></ul><ul><li>Use of dietary supplements </li></ul><ul><...
What are the Guidelines?  Skills <ul><li>Integrating nutrition assessment and intervention into the medical history, revie...
What are the Guidelines?  Skills <ul><li>Counseling patients and family members about specific nutritional needs related t...
Bottomline Basically good family medicine
 
Nutrition Challenges in Practice <ul><li>Can’t know or do it all, so need to know how to refer </li></ul><ul><li>Not stron...
Challenges Particular to Family Medicine in teaching nutrition <ul><ul><li>Get buy in from residents that this is importan...
Challenges Particular to Family Medicine Teaching Nutrition <ul><li>Faculty Training </li></ul><ul><li>Need buy-in of high...
What we did at Tufts… <ul><li>Started a Nutrition education taskforce </li></ul><ul><ul><li>Got buy in from faculty </li><...
Nutrition Curriculum Taskforce  <ul><li>Dr. Margo Woods (Tufts school for nutrition) </li></ul><ul><li>Erika Damon (nutrit...
Nutrition curriculum goals <ul><li>Goal 1 – increase the precepting of nutritional interventions by our faculty </li></ul>...
What is the dash diet
DASH Diet
Creation of the curriculm <ul><li>Based on the Dash diet </li></ul><ul><li>3 messages </li></ul><ul><li>Focus on 4 chronic...
What is problem <ul><li>Hypertension </li></ul><ul><li>Obesity </li></ul><ul><li>Diabetes </li></ul><ul><li>High Cholester...
Phase 1 Faculty Development <ul><li>Faculty in-services </li></ul><ul><li>Precepting skills </li></ul><ul><li>How DASH app...
Faculty Development <ul><li>I think we did 4 inservces </li></ul><ul><li>Donuts to yogurt </li></ul>
Phase 2 Case Based Lectures <ul><li>Jade please list the lectures that occurred in the curriculum </li></ul><ul><li>???8 o...
Case Based Lectures <ul><li>Cardiovascular disease </li></ul><ul><li>Jade what did you do for your lectures- should we giv...
Case Based Lectures <ul><li>Diabetes Mellitus </li></ul><ul><li>Jade what did you do for your lectures- should we give spe...
Case Based Lectures <ul><li>Obesity </li></ul><ul><li>Jade what did you do for your lectures- should we give specifics for...
Case Based Lectures <ul><li>Hypertension </li></ul><ul><ul><li>Case example </li></ul></ul><ul><ul><li>Dietary history wit...
Fit-day.com <ul><li>Residents asked to keep their own record for one week. </li></ul><ul><li>Goals: </li></ul><ul><li>Bene...
Standardized Patients <ul><li>Faculty </li></ul><ul><li>Students </li></ul>
Physcial Exam Form changes <ul><li>SOCIAL -  </li></ul><ul><li>Occupation/Lives with –  </li></ul><ul><li>Tobacco    Y  ...
Nursing Inservices <ul><li>BMI </li></ul>
Preceptors Chart Review <ul><li>Changed routine chart review </li></ul>
How did we evaluate residents <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire </li></ul><ul><li>B...
Attitude Survey <ul><li>McGaghie, W. et al </li></ul><ul><li>45 items survey with 5 subscales </li></ul>
Behavior Survey <ul><li>We developed our own </li></ul><ul><li>Jade Cut and paste a few example of some sentences </li></ul>
Knowledge Survey <ul><li>Jade cut and past </li></ul><ul><li>Jade Cut and paste a few example of some sentences </li></ul>
How did we evaluate faculty <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire </li></ul><ul><li>Dif...
Obstacles
Solutions
Results residents <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire  </li></ul><ul><li>Behavior Que...
Results faculty <ul><li>Jade </li></ul><ul><li>How many predicated </li></ul><ul><li>Any trends in their personal question...
<ul><li>Jade can you put down unique faculty facts like how many precept, </li></ul><ul><li>how many had knowledge of nutr...
Our future directions <ul><ul><li>Integrating Nutrition as a Basic Skill </li></ul></ul><ul><ul><li>Chart review </li></ul...
Transition to small groups
Create Your Own Curriculum
Challenges in your setting?
Think Outside the Box <ul><li>What are your needs? </li></ul><ul><li>Who has skills your residents need or need to know ab...
IDEAS
Resources <ul><li>There are lots of them out there </li></ul>
STFM Group on nutrition <ul><li>Guidelines and curriculum </li></ul><ul><li>Web base training </li></ul><ul><li>Model Curr...
STFM  Nutrition Education  <ul><li>Integrating nutrition education within other STFM groups and maintaining resources for ...
<ul><li>http://www.nhlbi.nih.gov/funding/training/naa/ </li></ul>http://www.nhlbi.nih.gov/funding/training/naa/ Nutrition ...
 
Nutrition Resources <ul><li>Physician's curriculum in clinical nutrition- A competency based approach for primary care, Ka...
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FP and Ophthalmology Caring to Screen in Diabetes - the FOCuSeD Quality Improvement Project.

  1. 1. Developing Nutrition Curriculum in a Family Medicine Residency
  2. 2. Introductions <ul><li>Tufts Family Medicine Residency </li></ul><ul><li>Boston area </li></ul><ul><li>24 residents </li></ul><ul><li>8 full time faculty </li></ul>
  3. 3. Road Map <ul><li>Define our problems </li></ul><ul><li>What are the national recommendations </li></ul><ul><li>Discuss our solutions </li></ul><ul><li>Small group discussions </li></ul>
  4. 4. Defining the problem? <ul><li>Identifying the lack of nutrition education in the residency setting </li></ul><ul><li>Identifying the lack of precepting by faculty on nutrition </li></ul><ul><li>Identifying the lack of communication with dietitians on our staff </li></ul>
  5. 5. What are the Guidelines? <ul><li>American Academy of Family Physicians </li></ul><ul><li>Association of Departments of Family Medicine </li></ul><ul><li>Association of Family Practice Residency Directors </li></ul><ul><li>Society of Teachers of Family Medicine. </li></ul>
  6. 6. What are the Guidelines? Attitude <ul><li>Nutrition is an integral part of: </li></ul><ul><ul><li>Health promotion and disease prevention-Mortality and morbidity could be significantly reduced through primary prevention targeting dietary risk factors throughout the life cycle. </li></ul></ul><ul><ul><li>Medical treatment of disease-nutritional status has a large impact on the ability to respond to medical interventions. </li></ul></ul><ul><ul><li>Diagnosis and role-appropriate management of: </li></ul></ul>
  7. 7. What are the Guidelines? Attitude <ul><li>Dietary intake is influenced by a variety of patient factors, including: </li></ul><ul><ul><li>Culture </li></ul></ul><ul><ul><li>Socioeconomic </li></ul></ul><ul><ul><li>Psychosocial and mental health </li></ul></ul><ul><ul><li>Knowledge </li></ul></ul><ul><ul><li>General health and lifestyle </li></ul></ul>
  8. 8. What are the Guidelines? Attitude <ul><li>Nutrition consultants should be utilized when appropriate to help provide counseling for at-risk patients. </li></ul>
  9. 9. What are the Guidelines? Knowledge <ul><li>General principles of nutrition </li></ul><ul><li>Nutritional assessment </li></ul><ul><li>Nutritional issues of different stages of the life cycle </li></ul><ul><li>The role of nutrition in the prevention and treatment of specific diseases </li></ul><ul><li>Weight loss strategies and counseling </li></ul>
  10. 10. What are the Guidelines? Knowledge <ul><li>Disordered eating </li></ul><ul><li>Use of dietary supplements </li></ul><ul><li>Preventing and recognizing and treating foodborne illness </li></ul><ul><li>Allergies and food intolerance </li></ul><ul><li>Physical activity and sports </li></ul><ul><li>Community Resources </li></ul>
  11. 11. What are the Guidelines? Skills <ul><li>Integrating nutrition assessment and intervention into the medical history, review of systems, physical examination, laboratory evaluation and plan of care. </li></ul><ul><li>Assessing the nutritional status and writing diet prescriptions for inpatients </li></ul><ul><li>laboratory and metabolic studies related to nutritional assessment. </li></ul>
  12. 12. What are the Guidelines? Skills <ul><li>Counseling patients and family members about specific nutritional needs related to stages of the life cycle, lifestyle and habits, disease prevention and/or disease. </li></ul><ul><li>Counseling patients on safe lifestyle approaches to weight management and balancing caloric intake and physical activity. </li></ul><ul><li>Advising on vitamin, mineral and other dietary and botanic supplements. </li></ul><ul><li>Collaborating with registered dieticians and certified diabetes educators </li></ul>
  13. 13. Bottomline Basically good family medicine
  14. 15. Nutrition Challenges in Practice <ul><li>Can’t know or do it all, so need to know how to refer </li></ul><ul><li>Not strong reimbursement from Insurance </li></ul><ul><li>Understand that much of patient’s nutrition occurs outside your office </li></ul>
  15. 16. Challenges Particular to Family Medicine in teaching nutrition <ul><ul><li>Get buy in from residents that this is important </li></ul></ul><ul><ul><li>Many have no training in medical school </li></ul></ul><ul><ul><li>Culture of the residency </li></ul></ul>
  16. 17. Challenges Particular to Family Medicine Teaching Nutrition <ul><li>Faculty Training </li></ul><ul><li>Need buy-in of higher-ups </li></ul><ul><li>Need buy-in of patients </li></ul><ul><li>Where do you teach it in the curriculum </li></ul>
  17. 18. What we did at Tufts… <ul><li>Started a Nutrition education taskforce </li></ul><ul><ul><li>Got buy in from faculty </li></ul></ul><ul><ul><li>Got buy in from residency director </li></ul></ul><ul><ul><li>Got buy in from residents </li></ul></ul>
  18. 19. Nutrition Curriculum Taskforce <ul><li>Dr. Margo Woods (Tufts school for nutrition) </li></ul><ul><li>Erika Damon (nutritionist on staff) </li></ul><ul><li>2 faculty </li></ul><ul><li>1 resident </li></ul>
  19. 20. Nutrition curriculum goals <ul><li>Goal 1 – increase the precepting of nutritional interventions by our faculty </li></ul><ul><li>Goal 2 – integrate more didactics and case based learning for the residents </li></ul><ul><li>Goal 3 – Use standardized patients with the residents and faculty </li></ul>
  20. 21. What is the dash diet
  21. 22. DASH Diet
  22. 23. Creation of the curriculm <ul><li>Based on the Dash diet </li></ul><ul><li>3 messages </li></ul><ul><li>Focus on 4 chronic conditions </li></ul><ul><li>Develop scripts </li></ul><ul><li>Develop patient information sheets </li></ul><ul><li>Posters for patient education </li></ul>
  23. 24. What is problem <ul><li>Hypertension </li></ul><ul><li>Obesity </li></ul><ul><li>Diabetes </li></ul><ul><li>High Cholesterol </li></ul>
  24. 25. Phase 1 Faculty Development <ul><li>Faculty in-services </li></ul><ul><li>Precepting skills </li></ul><ul><li>How DASH applies to 4 conditions </li></ul><ul><li>Piloting with own patients scripts </li></ul><ul><li>Piloting with their own patients the patient information sheets </li></ul>
  25. 26. Faculty Development <ul><li>I think we did 4 inservces </li></ul><ul><li>Donuts to yogurt </li></ul>
  26. 27. Phase 2 Case Based Lectures <ul><li>Jade please list the lectures that occurred in the curriculum </li></ul><ul><li>???8 one-hour lectures to residents over 4 months </li></ul><ul><li>Topics </li></ul><ul><ul><li>Personal nutrition assessment, usual intake, behavioral skills </li></ul></ul><ul><ul><li>DM, hypertension, obesity, CVD </li></ul></ul><ul><li>Included case discussion, diet analysis and recommendations based on the DASH diet </li></ul>
  27. 28. Case Based Lectures <ul><li>Cardiovascular disease </li></ul><ul><li>Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general? </li></ul>
  28. 29. Case Based Lectures <ul><li>Diabetes Mellitus </li></ul><ul><li>Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general? </li></ul>
  29. 30. Case Based Lectures <ul><li>Obesity </li></ul><ul><li>Jade what did you do for your lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general? </li></ul>
  30. 31. Case Based Lectures <ul><li>Hypertension </li></ul><ul><ul><li>Case example </li></ul></ul><ul><ul><li>Dietary history with usual intake </li></ul></ul><ul><ul><li>Analysis </li></ul></ul><ul><ul><li>Practical dietary revision ideas </li></ul></ul>
  31. 32. Fit-day.com <ul><li>Residents asked to keep their own record for one week. </li></ul><ul><li>Goals: </li></ul><ul><li>Benefits seen: </li></ul>
  32. 33. Standardized Patients <ul><li>Faculty </li></ul><ul><li>Students </li></ul>
  33. 34. Physcial Exam Form changes <ul><li>SOCIAL - </li></ul><ul><li>Occupation/Lives with – </li></ul><ul><li>Tobacco  Y  N ? Quit </li></ul><ul><li>ETOH –  Y  N CAGE Pos  Neg  </li></ul><ul><li>Drugs /Firearms </li></ul><ul><li>DV screen (safe?) </li></ul><ul><li>Nutrition: ? Weight concerns </li></ul><ul><li>Servings Fruits/veg ___ Soda____ Fiber_____ </li></ul><ul><li>Exercise / x week </li></ul><ul><li>UV protection/ seatbelts </li></ul>
  34. 35. Nursing Inservices <ul><li>BMI </li></ul>
  35. 36. Preceptors Chart Review <ul><li>Changed routine chart review </li></ul>
  36. 37. How did we evaluate residents <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire </li></ul><ul><li>Behavior Questionnaire </li></ul>
  37. 38. Attitude Survey <ul><li>McGaghie, W. et al </li></ul><ul><li>45 items survey with 5 subscales </li></ul>
  38. 39. Behavior Survey <ul><li>We developed our own </li></ul><ul><li>Jade Cut and paste a few example of some sentences </li></ul>
  39. 40. Knowledge Survey <ul><li>Jade cut and past </li></ul><ul><li>Jade Cut and paste a few example of some sentences </li></ul>
  40. 41. How did we evaluate faculty <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire </li></ul><ul><li>Different questionnaires </li></ul><ul><ul><li>Behavior Questionnaire </li></ul></ul>
  41. 42. Obstacles
  42. 43. Solutions
  43. 44. Results residents <ul><li>Knowledge Questionnaire </li></ul><ul><li>Attitude Questionnaire </li></ul><ul><li>Behavior Questionnaire </li></ul>
  44. 45. Results faculty <ul><li>Jade </li></ul><ul><li>How many predicated </li></ul><ul><li>Any trends in their personal questionnaires </li></ul><ul><li>ETC </li></ul>
  45. 46. <ul><li>Jade can you put down unique faculty facts like how many precept, </li></ul><ul><li>how many had knowledge of nutrition </li></ul><ul><li>How did they get that knowledge </li></ul><ul><li>etv </li></ul>
  46. 47. Our future directions <ul><ul><li>Integrating Nutrition as a Basic Skill </li></ul></ul><ul><ul><li>Chart review </li></ul></ul><ul><ul><li>Faculty development </li></ul></ul>
  47. 48. Transition to small groups
  48. 49. Create Your Own Curriculum
  49. 50. Challenges in your setting?
  50. 51. Think Outside the Box <ul><li>What are your needs? </li></ul><ul><li>Who has skills your residents need or need to know about? </li></ul><ul><li>Who would be a good “dance partner”? </li></ul>
  51. 52. IDEAS
  52. 53. Resources <ul><li>There are lots of them out there </li></ul>
  53. 54. STFM Group on nutrition <ul><li>Guidelines and curriculum </li></ul><ul><li>Web base training </li></ul><ul><li>Model Curriculum </li></ul><ul><li>Supporting literature </li></ul>
  54. 55. STFM Nutrition Education <ul><li>Integrating nutrition education within other STFM groups and maintaining resources for family medicine educators to use in enhancing nutrition education. </li></ul><ul><li>STFM Physician's Curriculum on Clinical Nutrition </li></ul><ul><li>The group maintains a password protected web site with new strategies for teaching nutrition in clerkships and residencies. Contact [email_address] for a free ID and password. </li></ul><ul><li>Listserve: contact [email_address] or [email_address] . </li></ul>
  55. 56. <ul><li>http://www.nhlbi.nih.gov/funding/training/naa/ </li></ul>http://www.nhlbi.nih.gov/funding/training/naa/ Nutrition Curriculum Guide For Training Physicians
  56. 58. Nutrition Resources <ul><li>Physician's curriculum in clinical nutrition- A competency based approach for primary care, Kansas City, MO: Group on Nutrition Education, Society of Teachers of Family Medicine, 1995. </li></ul><ul><li>Manual of Clinical Dietetics, 5th edition. Chicago, IL: The American Dietetic Association, 1996. </li></ul><ul><li>Mahan LK and Escott-Stump S. Krause's Food, nutrition and diet therapy, 10th ed. Harcourt, Brace and Co. 1999. </li></ul><ul><li>Modern Nutrition in Health and Disease, 9th Edition, Williams and Wickins, 1999. </li></ul><ul><li>Medical Nutrition and Disease, Blackwell Science Inc., 1996 </li></ul>

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