Dear Sir
Does the provision of dieticians in the NHS eliminate the need for junior doctors to learn about nutrition and apply their knowledge to manage nutritional problems facing their patients?
Is there a deficit of knowledge and/or interest among junior doctors? Or is the nutrition teaching spoon-fed at medical school/and in the foundation years satiating?
A survey was distributed among 20 foundation year one (F1) doctors working in a London teaching hospital in March 2011 to explore this issue. The doctors recently graduated from ninne different medical schools. Nine of the 20 entered their medicine degrees as graduates, which may have a bearing on the curriculum they have been exposed to and/or prior knowledge and interest in this area.
Regarding medical school teaching, 12/20 rated the nutrition aspects of the curriculum as insufficient. In keeping with this, 70% felt more nutrition teaching was needed. F1 doctors were aware of the presence of nutrition on the F1 curriculum, however this did not seem to influence their attitudes towards attaining experience in managing nutritional issues.
An even greater proportion (90%) of the doctors questioned thought there was a need for more teaching on nutrition as an F1 doctor, which may best delivered with a clinical approach to it. The majority felt this should be delivered by the following groups in decreasing order of preference: dieticians, doctors (particularly gastroenterologists), and nurses; with suggestions of a multidisciplinary team approach to this teaching.
So, why is this important?
As junior doctors, knowledge and its application are essential to build skills and confidence in clinical practice.
As the foundation curriculum highlights, it is crucial to be well rounded and able to manage a range of conditions comfortably. With insufficient preparation for working in a particular field (as appears to be within the current F1 cohort for nutrition), there is an unsurprising lack of confidence among the F1 group when faced with managing nutritional issues; only (20%) questioned reported to feel ‘comfortable’ managing nutritional issues on the ward and 55% reported feeling ‘uncertain.’
Further evidence of lack of exposure and teaching is clear from the skills developed; 60% having not inserted an NG tube (when questioned over 6 months into the F1 job); and only 6/20 doctors felt confident with this skill.
Disconcerting as these points seem, I hope they will prompt medical education to address the coverage of nutritional issues in the medical school and F1 curriculum. Additional teaching in this area could, for example, be delivered as clinical sessions (shadow days) with dieticians at F1 induction and/or for final year students.
By ensuring newly graduated junior doctors have an understanding of the important role of the dietician, along with an ability to appropriately refer patients for their expert opinion, there are potential beneficial effects on the multi-disciplinary team and ultimately, patient management.
By addressing these issues, junior doctors would, in addition, be equipped with the ability to confidently recognise, prevent and manage nutritional issues within their own patients, thus improving their own clinical skills and abilities.
Amber Appleton, St George's Hospital, Tooting, London SW17 0QT, UK. E-mail: [email protected]