Journal of Biomedical Education The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. An Evaluation of Formative “In-Class” versus “E-Learning” Activities to Benefit Student Learning Outcomes in Biomedical Sciences Wed, 13 Sep 2017 06:45:43 +0000 In conventional teaching, curriculum design that incorporates formative activities with prompt feedback is proven to have a positive effect on learning outcomes. Nevertheless, there is limited evidence that activities involving e-learning also have this positive effect and this is particularly the case within the discipline of hematopathology. The aim of this study was to evaluate the effectiveness of e-learning formative activities in hematopathology and to assess if, by using this resource, learning is enhanced. To address the research question, an e-learning module for anemia was developed to determine if it significantly increased knowledge, expressed by improved grades. Seventy-three students from health science programs that were enrolled in first-year hematology participated in the study. Students were encouraged to participate in two formative activities: one held in class and the other developed online as an e-learning module. Results showed a statistically significant increase in mean summative assessment score () and final grade () for students who completed the formative e-learning module. Interactive e-learning modules not only assist with engagement but also significantly improve grade outcomes. From this study, e-learning resources are an option for all educators but, in particular, those who have reduced face-to-face contact hours to teach the basic sciences. Rebecca Donkin and Elizabeth Askew Copyright © 2017 Rebecca Donkin and Elizabeth Askew. All rights reserved. Nutrition Practice and Knowledge of First-Year Medical Students Sun, 27 Aug 2017 10:33:04 +0000 Objectives. To compare the knowledge of Australian dietary recommendations to the dietary practices of first-year medical students. Design. Over a period of four years, anonymous online surveys were completed by medical students attending a first-year nutrition lecture. Background. There is little information on the nutritional knowledge and dietary practices of medical students. Setting. First-year postgraduate university medical students, Geelong, Victoria, Australia. Participants. Between the years 2012 and 2016, 32%–61% of first-year students completed the survey. Phenomenon of Interest. Student’s knowledge of dietary guidelines and related practices. Analysis. The frequency of response was assessed across the different year cohorts using descriptive statistics. Results. Between 59% and 93% of first-year students correctly identified the recommended daily servings for fruit, and between 61% and 84% knew the vegetable recommendations. In contrast only 40%–46% met the guidelines for fruit and 12%–19% met the guidelines for vegetables. Conclusions and Implications. Discrepancies between students’ nutrition knowledge and behavior can provide learning opportunities. With low rates of fruit and vegetable consumption in medical students, increased awareness of links between nutrition and health, together with encouragement to make behavioral changes, may increase the skills of graduates to support patients in improving dietary intake. Robyn Perlstein, Scott McCoombe, Susie Macfarlane, Andrew Colin Bell, and Caryl Nowson Copyright © 2017 Robyn Perlstein et al. All rights reserved. Stimulated Hyposalivary Flow Rates in Healthcare Students in an Interprofessional Awareness Educational Program Curriculum Tue, 18 Jul 2017 06:46:16 +0000 Purpose. Hyposalivation influences quality of life and medication compliance. However, oral health knowledge (in general) and knowledge about hyposalivation (in particular) are often lacking in nondental healthcare professional’s curricula. Additionally, hyposalivation has not been adequately studied in young adults. The purpose for this study is twofold: to use an interprofessional educational curriculum to increase nondental healthcare students’ knowledge about oral health and salivary testing and determine whether hyposalivation is different between sexes in young adults. Method. First-year medical and pharmacy students () learned the process of saliva collection and provided samples in an interprofessional program. Results. There were 14.4% of participants with hyposalivation; 72.0% were female. Males had higher flow rates (). There failed to be a significant difference between the sexes with frank hyposalivation. There failed to be a significant difference in hyposalivation and medication use/nonuse. Conclusions. Hyposalivation is a biomedical, public health concern. However, in this young population, there was no significant difference between sexes or in medication use/nonuse. Through participation in the program, the students learned about salivary flow rates and the need for collaboration among professionals to prevent negative impacts of hyposalivation and oral health. R. Constance Wiener, Susan Morgan, Lauren Swager, Christina DeBiase, and Christa L. Lilly Copyright © 2017 R. Constance Wiener et al. All rights reserved. Nutrition Education in Australian Midwifery Programmes: A Mixed-Methods Study Tue, 27 Dec 2016 09:16:24 +0000 Little research has explored how nutrition content in midwifery education prepares midwives to provide prenatal nutrition advice. This study examined the nature and extent of nutrition education provided in Australian midwifery programmes. A mixed-methods approach was used, incorporating an online survey and telephone interviews. The survey analysis included 23 course coordinators representing 24 of 50 accredited midwifery programmes in 2012. Overall, the coordinators considered nutrition in midwifery curricula and the midwife’s role as important. All programmes included nutrition content; however, eleven had only 5 to <10 hours allocated to nutrition, while two had a designated unit. Various topics were covered. Dietitians/other nutrition experts were rarely involved in teaching or reviewing the nutrition content. Interviews with seven coordinators revealed that nutrition education tended to be problem-oriented and at times based on various assumptions. Nutrition content was not informed by professional or theoretical models. The development of nutrition assessment skills or practical training for midwifery students in providing nutrition advice was lacking. As nutrition is essential for maternal and foetal health, nutrition education in midwifery programmes needs to be reviewed and minimum requirements should be included to improve midwives’ effectiveness in this area. This may require collaboration between nutrition experts and midwifery bodies. Jamila Arrish, Heather Yeatman, and Moira Williamson Copyright © 2016 Jamila Arrish et al. All rights reserved. Portfolio-Associated Faculty: A Qualitative Analysis of Successful Behaviors from the Perspective of the Student Thu, 03 Nov 2016 11:22:17 +0000 Purpose. While some aspects of what makes for an effective portfolio program are known, little is published about what students value in the faculty-student-portfolio relationship. Lack of student buy-in and faculty engagement can be significant challenges. The purpose of this study was to identify behaviors and types of engagement that students value in their relationships with portfolio-associated faculty. Methods. Medical students (174) participating in the Ohio State University College of Medicine Portfolio Program described behaviors observed in their portfolio-associated faculty in a survey completed at the end of the first year of their four-year program. Narrative responses were coded and categorized into themes, followed by member checking. Results. A total of 324 comments from 169 students were analyzed. Four themes were identified: (1) creating a supportive environment; (2) inspiring academic and professional growth; (3) investing time in students; and (4) providing advice and direction. Conclusions. The themes identified suggest that students value certain types of coaching and mentoring behaviors from their portfolio-associated faculty. The themes and their specific subcategories may be useful in making decisions regarding program development and guiding recruitment and training of these faculty coaches. Jack Kopechek, Sorabh Khandelwal, Carmine Alexander Grieco, Douglas M. Post, John A. Davis, and Cynthia H. Ledford Copyright © 2016 Jack Kopechek et al. All rights reserved. Attitudes and Perceived Barriers among Medical Students towards Clinical Research: A Cross-Sectional Study in an Egyptian Medical School Wed, 05 Oct 2016 12:32:08 +0000 Background. Despite the key role played by physician-investigators in bridging basic and clinical sciences, their number has declined significantly in the last decades especially in developing countries. Thus, we aimed to investigate attitudes and perceived barriers towards participation in clinical research among medical students in an Egyptian medical school. Methods. We employed a cross-sectional design, in which 420 students from the Faculty of Medicine, Ain Shams University completed a self-administrated questionnaire to assess their attitudes, perceived barriers, and knowledge about clinical research. The results were analyzed considering the students’ gender, year of enrollment, and high school background. Results. Seventy medical students from each year of enrollment participated in the study. The majority of students (74.2%) agree that undergraduates should participate in clinical research. However, only 23.8% reported engagement in related activities. Students showed low knowledge scores of on a scale of six questions. They highlighted several barriers against research participation including lack of time, proper mentoring, and funding. Conclusion. Although the majority of students showed positive attitudes towards clinical research, they reported low participation in related activities, associated with low knowledge scores. Several barriers should be addressed as lack of time, funding, and proper mentoring. Abdelrahman Ibrahim Abushouk, Abdelrahman Nazmy Hatata, Ibrahim Mahmoud Omran, Mohammed Mahmoud Youniss, Khaled Fayez Elmansy, and Abdullah Gad Meawad Copyright © 2016 Abdelrahman Ibrahim Abushouk et al. All rights reserved. The Predictive Validity of a Two-Step Selection Process to Medical Schools Wed, 28 Sep 2016 13:53:32 +0000 Background. A two-step selection process, consisting of cognitive and noncognitive measures, is common in medical school admissions. Objective. To estimate the validity of this process in predicting academic performance, taking into account the complex and pervasive effect of range restriction in this context. Methods. The estimation of the validity of the two-step process included a sequential correction for range restriction and an estimation of the predictive validity of the process in its entirety. Data were collected from 1,002 undergraduate students from four cohorts (2006/07–2009/10) at three medical schools in Israel. Results. The predictive validity of the composite of the cognitive measures with respect to Year 1 performance was high, resulting entirely from the predictive validity of the admission test (a standard measure of ability). The predictive validity of the noncognitive measure was moderate. The predictive validity of the process in its entirety was high, its value dependent on the weights given to the cognitive and noncognitive measures. Conclusion. A cognitive admission test has a high predictive validity with respect to Year 1 performance. The addition of a noncognitive measure in the second step does not markedly diminish the predictive validity of the selection process with respect to academic achievement. Tamar Kennet-Cohen, Elliot Turvall, Yonatan Saar, and Carmel Oren Copyright © 2016 Tamar Kennet-Cohen et al. All rights reserved. Initial Characterization of Internal Medicine Resident Resilience and Association with Stress and Burnout Mon, 29 Aug 2016 13:04:30 +0000 Introduction. Burnout is prevalent in medical trainees. Little data exists on resident resilience. Methods. Anonymous surveys were provided to a convenience sample of internal medicine residents. Resilience was assessed using the Connor-Davidson resilience scale. Responses were categorized into low (<70), intermediate (70–79), and high (80–100) resilience. Results. 77 residents from six institutions completed surveys. 26% of residents had high resilience, 43% intermediate, and 31% low. The mean resilience score was and lower than the general population (mean , ). Trainees with high resilience were more likely to never have stress interfere with their relationships outside of work (high: 40%; low: 0%; ). High resilience residents were more likely to have the skills to manage stress and burnout (high: 80%; low: 46%; ) and less likely to feel inferior to peers (high: 20.0%; low: 70.8%; ). There was a trend towards those with high resilience reporting less burnout (high: 40.0%; intermediate: 27%; low: 16.7%; ). Only 60% report a program outlet to discuss burnout. Conclusions. There is a wide range of resilience among IM residents and scores were lower than the general population. Low resilience is associated with more stress interfering with relationships, feeling inferior to peers, and fewer skills to manage stress and burnout. Amber-Nicole Bird and Amber T. Pincavage Copyright © 2016 Amber-Nicole Bird and Amber T. Pincavage. All rights reserved. Using the ADDIE Model of Instructional Design to Teach Chest Radiograph Interpretation Mon, 20 Jun 2016 09:35:09 +0000 Interpreting basic chest radiographs is an important skill for internal medicine residents to help them adequately diagnose and manage respiratory diseases. Educators need tools to ensure that they take a systematic approach when creating a curriculum to teach this, as well as other skills, knowledge, or attitudes. Using an instructional design model helps educators accomplish this task by giving them a guide they can follow to ensure that the curriculum meets the needs of the learners. Using the creation of a curriculum to teach chest radiograph interpretation as an example, this paper illustrates how educators can use the ADDIE model of instructional design to help develop their own curricula. Lawrence Cheung Copyright © 2016 Lawrence Cheung. All rights reserved. Canadian M.D.-Ph.D. Programs Produce Impactful Physician-Scientists: The McGill Experience Sun, 05 Jun 2016 13:35:35 +0000 On June 18, 2015, the Canadian Institutes of Health Research (CIHR) announced that it would terminate funding to M.D.-Ph.D. programs due to budget constraints, against the recommendations from two advisory panels. CIHR’s M.D.-Ph.D. program grants, which amounted to an annual average of $1.8 million in the form of 14 six-year studentships, represent only 0.15% of CIHR’s $1.2 billion operating budget. As over half of M.D.-Ph.D. trainees are dependent on these studentships, this poses a threat to physician-scientist training in Canada. In response to the current volatile funding climate, we surveyed McGill University’s M.D.-Ph.D. program alumni to assess its success in producing physician-scientists. In this program, 60.0% of graduates who have completed training have become physician-scientists, the majority being retained in Canada. These individuals have attained positions with sufficiently protected time for research and had grant success and significant publications for early- to mid-career investigators. This suggests that the current M.D.-Ph.D. system is an effective way of producing competent physician-scientists. As physician-scientists have remarkably contributed to Canadian healthcare innovation despite making up a fraction of physicians and researchers, vulnerability in the M.D.-Ph.D. pipeline would invariably affect the health of Canadians. Tianwei E. Zhou, Paul A. Savage, and Mark J. Eisenberg Copyright © 2016 Tianwei E. Zhou et al. All rights reserved. Workplace Based Assessment in an Asian Context: Trainees’ and Trainers’ Perception of Validity, Reliability, Feasibility, Acceptability, and Educational Impact Tue, 29 Dec 2015 06:44:24 +0000 Workplace based assessment (WPBA) is commonplace in postgraduate training in many countries but is not widely practised and established in Asia. The WPBA tools that are used by the local programme are Mini-Clinical Examination (Mini-CEX), Directly Observed Practical Skills (DOPSs), Multisource Feedback (MSF), and Case Based Discussion (CBD). This cross-sectional study utilised a questionnaire to obtain feedback from both assessors and trainees. Participants rated the tools on a 5-point scale on validity, reliability, feasibility, educational impact, and acceptability. 30 assessors and 23 trainees participated in the study. The percentages of adequate ratings given by trainees for validity, reliability, feasibility, educational impact, and acceptability were 100%, 99%, 91%, 100%, and 100%, respectively, for all tools. There was no difference in perceptions between trainees and assessors for all WPBA tools except MSF (). The common themes that have arisen suggested that applicability of WPBA could be affected by faculty development, endorsement from governing bodies, pervading cultural mindsets, and the complex relationships between doctors and patients; teachers and students; and educators and clinicians. The high level of satisfaction from our respondents indicates that WPBA can be successfully integrated in an Asian postgraduate training programme despite systemic, cultural, and language barriers. Jackson Tan, Connie Tengah, Vui Heng Chong, Adrian Liew, and Lin Naing Copyright © 2015 Jackson Tan et al. All rights reserved. An Exploration of the Scientific Writing Experience of Nonnative English-Speaking Doctoral Supervisors and Students Using a Phenomenographic Approach Thu, 24 Dec 2015 07:59:24 +0000 Nonnative English-speaking scholars and trainees are increasingly submitting their work to English journals. The study’s aim was to describe their experiences regarding scientific writing in English using a qualitative phenomenographic approach. Two focus groups (5 doctoral supervisors and 13 students) were conducted. Participants were nonnative English-speakers in a Swedish health sciences faculty. Group discussion focused on scientific writing in English, specifically, rewards, challenges, facilitators, and barriers. Participants were asked about their needs for related educational supports. Inductive phenomenographic analysis included extraction of referential (phenomenon as a whole) and structural (phenomenon parts) aspects of the transcription data. Doctoral supervisors and students viewed English scientific writing as challenging but worthwhile. Both groups viewed mastering English scientific writing as necessary but each struggles with the process differently. Supervisors viewed it as a long-term professional responsibility (generating knowledge, networking, and promotion eligibility). Alternatively, doctoral students viewed its importance in the short term (learning publication skills). Both groups acknowledged they would benefit from personalized feedback on writing style/format, but in distinct ways. Nonnative English-speaking doctoral supervisors and students in Sweden may benefit from on-going writing educational supports. Editors/reviewers need to increase awareness of the challenges of international contributors and maximize the formative constructiveness of their reviews. Elizabeth Dean, Lena Nordgren, and Anne Söderlund Copyright © 2015 Elizabeth Dean et al. All rights reserved. Stress among Medical Students and Its Association with Substance Use and Academic Performance Wed, 02 Dec 2015 09:26:32 +0000 Background. Chronic stress among medical students affects academic performance of students and leads to depression, substance use, and suicide. There is, however, a shortage of such research evidence in Ethiopia. Objective. We aimed to estimate the prevalence and severity of stress and its association with substance use and academic performance among medical students. Methods. A cross-sectional survey was conducted on a sample of 329 medical students at Jimma University. Data were collected using the General Health Questionnaire (GHQ-12), Medical Students Stress Questionnaire (MSSQ-20), and Drug Abuse Surveillance Test (DAST). Data were analyzed using SPSS version 20.0. Logistic regression analysis and Student’s -test were applied. Results. The mean age of the respondents was 23.02 (SD = 2.074) years. The current prevalence of stress was 52.4%. Academic related stressor domain was the main source of stress among 281 (88.6%) students. Stress was significantly associated with khat chewing [AOR = 3.03, 95% CI (1.17, 7.85)], smoking [AOR = 4.55, 95% CI (1.05, 19.77)], and alcohol intake [AOR = 1.93, 95% CI (1.03, 3.60)]. The prevalence of stress was high during the initial three years of study. Stress was significantly () but negatively () correlated with academic achievement. Conclusion. Stress was a significant problem among medical students and had a negative impact on their academic performance. Year of study, income, and substance use were associated with stress. Counseling and awareness creation are recommended. Leta Melaku, Andualem Mossie, and Alemayehu Negash Copyright © 2015 Leta Melaku et al. All rights reserved. The Influence of a Continuing Medical Education Campaign on New Strategies to Improve Appropriate Use of Antibiotics Thu, 12 Nov 2015 11:08:13 +0000 Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME) campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0%) compared with those who had attended neither (54%, ). However, there was no “dose effect” on the rate of implementing a new strategy. Conclusions. Overuse of antibiotic therapy has important public health implications. Results suggest that mixed interactive and didactic CME program was effective in increasing awareness of antibiotic overuse and strategies for reducing antibiotic administration. Brenda A. Bucklin, Ronald S. Gibbs, Carolyn Wieber, and Leslie Myers Copyright © 2015 Brenda A. Bucklin et al. All rights reserved. Assessing Origins of Quality Gaps in Discharge Summaries: A Survey of Resident Physician Attitudes Tue, 20 Oct 2015 13:28:21 +0000 Because little is known about attitudes of primary authors of discharge summaries in academic institutions, namely, trainees and physician assistants (PAs), we sought to explore values, possible areas for improvement, and interest in formal discharge summary education. A survey composed of Likert scale analyses, dichotomous relationships, and open-ended questions was designed using focus groups and validated via expert committee review. Of 135 total residents (PGY 1–3), 79 residents and 10 PAs in a large academic hospital in New York City completed it. Of surveyed trainees, 77.2% reported that quality discharge summaries are useful in primary care. Interns had less outpatient experience with discharge summaries compared to PGY 2 and PGY 3 (23.7% versus 63.4%, ) and were less comfortable authoring discharge summaries for patients who were not as familiar to them (47.4% versus 24.4%, ). The majority (54.8%) of interns as well as all PAs reported never receiving feedback on discharge summaries. Finally, 63.2% of interns and 90% of PAs responded that formal teaching would be helpful. Interns’ greater discomfort may speak to their poor understanding of core components of a useful discharge summary, which teaching sessions may improve. Alternatively, shifting the authorship responsibility from interns to seniors could be explored as a quality improvement initiative. Mallory Otto, Madeline Sterling, Eugenia Siegler, and Brian Eiss Copyright © 2015 Mallory Otto et al. All rights reserved. Sources of Stress and Coping Strategies among Undergraduate Medical Students Enrolled in a Problem-Based Learning Curriculum Mon, 21 Sep 2015 11:49:25 +0000 Background. Medical education is rated as one of the most difficult trainings to endure. Throughout their undergraduate years, medical students face numerous stressors. Coping with these stressors requires access to a variety of resources, varying from personal strengths to social support. We aimed to explore the perceived stress, stressors, and coping strategies employed by medical students studying in a problem-based learning curriculum. Methodology. This is a cross-sectional study of randomly selected medical students that explored demographics, perceived stress scale, sources of stress, and coping strategies. Results. Of the 378 medical students that participated in the study, males were 59.3% and females 40.7%. Nearly 53% of the students often felt stressed, and a third felt that they could not cope with stress. Over 82% found studying stressful and 64.3% were not sleeping well. Half of the students reported low self-esteem. Perceived stress scores were statistically significantly high for specific stressors of studying in general, worrying about future, interpersonal conflict, and having low self-esteem. Coping strategies that were statistically significantly applied more often were blaming oneself and being self-critical, seeking advice and help from others, and finding comfort in religion. Female students were more stressed than males but they employ more coping strategies as well. Conclusions. Stress is very common among medical students. Most of the stressors are from coursework and interpersonal relationships. Low self-esteem coupled with self-blame and self-criticism is quite common. Samira S. Bamuhair, Ali I. Al Farhan, Alaa Althubaiti, Sajida Agha, Saeed ur Rahman, and Nadia O. Ibrahim Copyright © 2015 Samira S. Bamuhair et al. All rights reserved. Nutrition Education for the Health Care Professions Sun, 09 Aug 2015 13:38:57 +0000 Martin Kohlmeier, Caryl A. Nowson, Rose Ann DiMaria-Ghalili, and Sumantra Ray Copyright © 2015 Martin Kohlmeier et al. All rights reserved. The Rationale, Feasibility, and Optimal Training of the Non-Physician Medical Nutrition Scientist Sun, 09 Aug 2015 07:04:36 +0000 Dietary components have potential to arrest or modify chronic disease processes including obesity, cancer, and comorbidities. However, clinical research to translate mechanistic nutrition data into clinical interventions is needed. We have developed a one-year transitional postdoctoral curriculum to prepare nutrition scientists in the language and practice of medicine and in clinical research methodology before undertaking independent research. Candidates with an earned doctorate in nutrition science receive intensive, didactic training at the interface of nutrition and medicine, participate in supervised medical observerships, and join ongoing clinical research. To date, we have trained four postdoctoral fellows. Formative evaluation revealed several learning barriers to this training, including deficits in prior medical science knowledge and diverse perceptions of the role of the translational nutrition scientist. Several innovative techniques to address these barriers are discussed. We propose the fact that this “train the trainer” approach has potential to create a new translational nutrition researcher competent to identify clinical problems, collaborate with clinicians and researchers, and incorporate nutrition science across disciplines from “bench to bedside.” We also expect the translational nutrition scientist to serve as an expert resource to the medical team in use of nutrition as adjuvant therapy for the prevention and management of chronic disease. Susan E. Ettinger, Jennifer A. Nasser, Ellen S. Engelson, Jeanine B. Albu, Sami Hashim, and F. Xavier Pi-Sunyer Copyright © 2015 Susan E. Ettinger et al. All rights reserved. Working with Individuals Who Provide Nursing Care to Educate Older Adults about Foodborne Illness Prevention: The Food Safety Because You Care! Intervention Thu, 06 Aug 2015 07:03:21 +0000 Older adults are more susceptible to foodborne infections than younger adults and many older adults do not follow recommended food safety practices. This study implemented the Food Safety Because You Care! program with 88 individuals in the United States who provide nursing care to older adult patients and subsequently surveyed them. The majority of respondents had favorable opinions of the program. Following program exposure, many of the respondents advised their older adult patients about food safety. The findings from this study suggest that the program is a useful tool that can assist those who provide nursing care as they interact with their older patients and lead them to positively influence older adults’ food safety practices. However, more research is needed to examine changes in providers’ behaviors as a result of program exposure and the accompanying effect on older adults’ food safety practices. Kelly C. Wohlgenant, Sandria L. Godwin, Sheryl C. Cates, and Richard Stone Copyright © 2015 Kelly C. Wohlgenant et al. All rights reserved. Hydration: Knowledge, Attitudes, and Practices of UK Dietitians Thu, 06 Aug 2015 06:59:03 +0000 Aim. The aim of this study was to investigate dietitians’ knowledge, attitudes, and practices (KAP) regarding hydration and patient care. Methods. A cross-sectional online survey was administered to UK dietitians via the British Dietetic Association monthly newsletter and included 18 items on hydration knowledge (), attitudes (), and practices (). KAP scores were calculated by adding the total number of correct knowledge responses and by ranking attitude and practice responses on a Likert scale. Results. 97 dietitians completed the online survey and displayed varying levels of KAP regarding hydration and patient care. The mean unweighted scores were knowledge 5.0 (±1.3) out of 8; attitude 13.9 (±1.3) out of 16; practice 14.9 (±2.6) out of 24. Dietitians appeared to be guided by clinical reasoning and priorities for nutrition care. Conclusions. There may be scope to further assess and potentially enhance the KAP of dietitians regarding hydration and patient care. Innovative approaches to hydration promotion are warranted and may include focusing on dietitians’ personal hydration status, increasing communication with other healthcare professionals, and partnering with patients to take a proactive role in hydration monitoring. Pauline Douglas, Lauren Ball, Lynn McGuffin, Celia Laur, Jennifer Crowley, Minha Rajput-Ray, Joan Gandy, and Sumantra Ray Copyright © 2015 Pauline Douglas et al. All rights reserved. The State of Nutrition Education at US Medical Schools Thu, 06 Aug 2015 06:46:15 +0000 Purpose. To assess the state of nutrition education at US medical schools and compare it with recommended instructional targets. Method. We surveyed all 133 US medical schools with a four-year curriculum about the extent and type of required nutrition education during the 2012/13 academic year. Results. Responses came from 121 institutions (91% response rate). Most US medical schools (86/121, 71%) fail to provide the recommended minimum 25 hours of nutrition education; 43 (36%) provide less than half that much. Nutrition instruction is still largely confined to preclinical courses, with an average of 14.3 hours occurring in this context. Less than half of all schools report teaching any nutrition in clinical practice; practice accounts for an average of only 4.7 hours overall. Seven of the 8 schools reporting at least 40 hours of nutrition instruction provided integrated courses together with clinical practice sessions. Conclusions. Many US medical schools still fail to prepare future physicians for everyday nutrition challenges in clinical practice. It cannot be a realistic expectation for physicians to effectively address obesity, diabetes, metabolic syndrome, hospital malnutrition, and many other conditions as long as they are not taught during medical school and residency training how to recognize and treat the nutritional root causes. Kelly M. Adams, W. Scott Butsch, and Martin Kohlmeier Copyright © 2015 Kelly M. Adams et al. All rights reserved. A Survey of Medical Students’ Use of Nutrition Resources and Perceived Competency in Providing Basic Nutrition Education Thu, 06 Aug 2015 06:42:29 +0000 Purpose. The aims of this study were to assess where medical students obtain their nutrition information and their self-perceived level of competency in providing basic nutrition education to patients. Methods. A survey was distributed to all first through fourth year medical students at Case Western Reserve University (). For statistical analysis, data was expressed as percentages of total responses and binomial regression was used to answer the study hypotheses. Results. The survey response rate was 47%. Forty-two percent of respondents selected a majority of professional nutrition resources () as their most commonly used nutrition resources, 38% selected a majority of consumer resources (), and 20% selected “I do not use nutrition resources” (). The most popular nutrition resource selected was consumer websites. Seventy percent of respondents reported feeling competent in their ability to provide basic nutrition education to patients (). Conclusion. Medical students seem to feel competent in their ability to give basic nutrition education to patients, but they may be obtaining nutrition information from unreliable consumer-based resources. To help increase the provision of sound nutritional guidance, medical students should be taught to use reliable nutrition resources, as well as the value of referring patients to registered dietitians. Rebecca Connor, Lynn Cialdella-Kam, and Stephanie R. Harris Copyright © 2015 Rebecca Connor et al. All rights reserved. New Zealand Medical Students Have Positive Attitudes and Moderate Confidence in Providing Nutrition Care: A Cross-Sectional Survey Thu, 06 Aug 2015 06:39:50 +0000 Throughout the world, medical students and doctors report inadequate nutrition education and subsequently lack of knowledge, attitude, and skills to include nutrition in patient care. This study described New Zealand’s students’ attitudes to and self-perceived skills in providing nutrition care in practice as well as perceived quantity and quality of nutrition education received in training. 183 medical students from New Zealand’s largest medical school (response rate 52%) completed a 65-item questionnaire, partially validated, using 5-point Likert scales. Students believed incorporating nutrition care into practice is important, yet they were less confident patients improve nutrition behaviours after receiving this care. Students were confident in skills related to nutrition in health and disease but less confident in skills related to general food knowledge. Greater quantity and quality of nutrition education received was associated with greater self-perceived skills in providing nutrition care to patients but not with attitudes towards incorporating nutrition care into practice. This cohort of New Zealand medical students places similarly high importance on nutrition care as students and doctors from other countries. Further investigations beyond graduation are required to inform whether additional nutrition education is warranted for these doctors. Jennifer Crowley, Lauren Ball, Dug Yeo Han, Bruce Arroll, Michael Leveritt, and Clare Wall Copyright © 2015 Jennifer Crowley et al. All rights reserved. Learner-Directed Nutrition Content for Medical Schools to Meet LCME Standards Wed, 05 Aug 2015 14:25:55 +0000 Deficiencies in medical school nutrition education have been noted since the 1960s. Nutrition-related non-communicable diseases, including heart disease, stroke, cancer, diabetes, and obesity, are now the most common, costly, and preventable health problems in the US. Training medical students to assess diet and nutritional status and advise patients about a healthy diet, exercise, body weight, smoking, and alcohol consumption are critical to reducing chronic disease risk. Barriers to improving medical school nutrition content include lack of faculty preparation, limited curricular time, and the absence of funding. Several new LCME standards provide important impetus for incorporating nutrition into existing medical school curriculum as self-directed material. Fortunately, with advances in technology, electronic learning platforms, and web-based modules, nutrition can be integrated and assessed across all four years of medical school at minimal costs to medical schools. Medical educators have access to a self-study nutrition textbook, Medical Nutrition and Disease, Nutrition in Medicine© online modules, and the NHLBI Nutrition Curriculum Guide for Training Physicians. This paper outlines how learner-directed nutrition content can be used to meet several US and Canadian LCME accreditation standards. The health of the nation depends upon future physicians’ ability to help their patients make diet and lifestyle changes. Lisa A. Hark, Darwin D. Deen, and Gail Morrison Copyright © 2015 Lisa A. Hark et al. All rights reserved. Nutrition Knowledge, Attitudes, and Confidence of Australian General Practice Registrars Wed, 05 Aug 2015 13:29:18 +0000 Nutrition knowledge, attitudes, and confidence were assessed in General Practice Registrars (GPRs) throughout Australia. Of approximately 6,000 GPRs invited to complete a nutrition survey, 93 respondents (2%) completed the online survey, with 89 (20 males, 69 females) providing demographic and educational information. Fifty-one percent had graduated from medical school within the last two years. From a list of 11 dietary strategies to reduce cardiovascular risk, respondents selected weight loss (84%), reducing saturated fats (90%), a maximum of two alcoholic drinks/day (82%), and increasing vegetables (83%) as “highly appropriate” strategies, with only 51% indicating that salt reduction was “highly appropriate.” Two-thirds of registrars felt “moderately” (51%) or “very” confident (16%) providing nutrition advice. Most of them (84%) recalled receiving information during training, but only 34% recalled having to demonstrate nutritional knowledge. The results indicate that this group of Australian GPRs understood most of the key dietary recommendations for reducing cardiovascular risk but lacked consensus regarding the recommendation to reduce salt intake and expressed mixed levels of confidence in providing nutritional advice. Appropriate nutrition education before and after graduation is recommended for GPRs to ensure the development of skills and confidence to support patients to make healthy dietary choices and help prevent chronic diseases. Caryl A. Nowson and Stella L. O’Connell Copyright © 2015 Caryl A. Nowson and Stella L. O’Connell. All rights reserved. Student Perceptions of Nutrition Education at Marshall University Joan C. Edwards School of Medicine: A Resource Challenged Institution Wed, 05 Aug 2015 13:28:18 +0000 Nutrition education is an essential component of medical education if new physicians are to be equipped to address common chronic diseases, including obesity and the associated diabetes, cardiovascular disease, and cancer. Most medical students recognize this need and desire nutrition education; however, finding time in a medical school curriculum and funding are challenging. Available, free online resources and small group exercises can be utilized to provide basic, up-to-date nutrition information to medical students. W. Elaine Hardman, Bobby L. Miller, and Darshana T. Shah Copyright © 2015 W. Elaine Hardman et al. All rights reserved. Nutri One-on-One: The Assessment and Evaluation of a Brief One-on-One Nutritional Coaching in Patients Affected by Metabolic Syndrome Wed, 05 Aug 2015 13:26:22 +0000 Nutri One-on-One was a program with the aim to positively modify medical clinic patients’ nutritional habits and lifestyles through a brief one-on-one health coaching session. Each session was conducted by utilizing motivational interviewing techniques to allow for tailored nutrition education and goal setting. These sessions were followed by a phone call to participants at 1 month following the session. The outcomes assessed were participant perception of achieving personal nutrition and lifestyle goals, retention of knowledge, and participants’ satisfaction with the program. Physicians working in the clinic were assessed for satisfaction with the program. Most of the physicians were generally satisfied with the program and found it to be an asset to their practice. Participants perceived that they achieved their goals, were pleased with the program, and retained knowledge. Jennifer King, Jeffrey E. Harris, David Kuo, and Farzaneh Daghigh Copyright © 2015 Jennifer King et al. All rights reserved. Enabling Valuation of Nutrition Integration into MBBS Program Wed, 05 Aug 2015 13:26:09 +0000 Good nutrition is the foundation for good health. While basic nutritional assessment is part of many medical consultations, it remains underutilized despite becoming increasingly recognized as important for chronic disease prevention and management. Many studies identify shortfalls in physicians’ knowledge and attitudes toward nutrition as a result of inadequate emphasis in medical school. Additional teaching about nutrition and nutritional assessment procedures was integrated within a first year module of a MBBS program. Blended learning techniques were employed to facilitate student engagement and sessions were evaluated via student response system technology (clickers) or minute paper feedback. The initial survey to all medical students documented that less than half (45%) felt they could discuss nutrition with patients. The majority regularly consulted the internet for nutrition information, while only 163 utilised peer-reviewed journals. With the first year cohort “clickers” revealed that 91% felt nutrition important to health care and 82% felt it important in general practice. 71% found using clickers an interesting enhancement, whilst 70% noted the nutrition content informative. Early nutrition teaching was well received by students. Long-term increases in nutritional information dissemination, particularly by influential health care workers, might benefit not only economies but also the health of society as a whole. Niikee Schoendorfer and Jennifer Schafer Copyright © 2015 Niikee Schoendorfer and Jennifer Schafer. All rights reserved. University Education in Human Nutrition: The Italian Experience—A Position Paper of the Italian Society of Human Nutrition Wed, 05 Aug 2015 13:23:50 +0000 As a broad range of professionals in clinical and nonclinical settings requires some expertise in human nutrition, the university system must offer academic courses tailored to these different specific needs. In the Italian university system there is still uncertainty with regard to the learning objectives regarding human nutrition. In the ministerial decrees defining the criteria for establishing university courses, the indications about education in human nutrition are rather inconsistent, sometimes detailed, but often just mentioned or even only implied. Education in human nutrition requires both an appropriate duration (number of university credits included in the degree format for different disciplines) and course units that are designed in order to achieve specific expertise. The university system should appropriately design and distinguish the nutritional competencies of the different types of graduates. Physiology and biochemistry are the academic disciplines mostly involved in teaching fundamentals of human nutrition, while the discipline sciences of applied nutrition and dietetics more strictly focuses on applied nutrition and clinical nutrition. Other academic disciplines that may contribute to education in human nutrition, depending on the type of degree, are internal medicine (and its subspecialties), hygiene, endocrinology, food technologies, food chemistry, commodity science, and so forth. Luca Scalfi, Furio Brighenti, Nino Carlo Battistini, Alessandra Bordoni, Alessandro Casini, Salvatore Ciappellano, Daniele Del Rio, Francesca Scazzina, Fabio Galvano, and Nicolò Merendino Copyright © 2015 Luca Scalfi et al. All rights reserved. Developing Research Competence in Undergraduate Students through Hands on Learning Wed, 05 Aug 2015 13:23:37 +0000 Evidence-based practice is the foundation of nutrition and dietetics. To effectively apply evidence-based practice, health professionals must understand the basis of research. Previous work has identified the lack of involvement of dietitians in research. As part of a curriculum redevelopment in undergraduate nutrition and dietetics courses, research skill teaching was enhanced. This study evaluated the effect of a new, year two level nutrition research methods unit on the perceived research skills of students. The unit consisted of two key components: a student-led class research project and a small group systematic literature review. Prior to commencement and on completion of the course, students completed a modified version of the Research Skills Questionnaire. Results demonstrated that self-perceived competence increased by a small degree in a set of specific research skills as well as in broader skills such as information gathering and handling, information evaluation, ability to work independently, and critical thinking. The new research unit was also evaluated highly on a student satisfaction survey. Despite these positive findings, students indicated that their general feelings towards research or a career in research were unchanged. In summary, this unit enhanced students’ perceived research skills. Further exploration of students’ attitude towards research is warranted. Zoe E. Davidson and Claire Palermo Copyright © 2015 Zoe E. Davidson and Claire Palermo. All rights reserved.