Nutrition Information For Doctors, Dentists -but Is It Enough?

Students of the U-M medical and dental schools receive several hours of classes on nutrition. The School of Medicine differs from the School of Dentistry in that it has no specific courses on the subject. "But nutrition is given in the -context of a lot of other things students have to learn," says Profespr David Schteingart, director of the Medical School's clinical medicine program. "In the first two years there are a minimum of ten to 12 hours of nutritionrelated lectures. In the junior year there are another six to eight hours related to nutrition," Schteingart says. . These hours are parts of courses in clinical medicine and basic science, including biochemistry and physiology. 'What is taught has to do with nutritional requirements in the population at large, and changes in requirements when people are sick. "They also study protein-calorie malnutrition (a shortage of both protein and calories seen in África and other areas and, to a lesser extent, in some parts of the U.S.), the problems of malnutrition experienced by patients who are in the hospital for a long time, and the nutritional problems of industrialized societies with access to food items that may lead to diseases (such as obesity, diabetes and arteriosclerosis), says Schteingart. The public health aspects of nutrition are also taught medical students, but not to the extent Profesor John Robson, director of the Human Nutrition Program at the School of Public Health would like. Robson, who presents a one-hour class on public health nutrition to medical students, explains the difference between this aspect of nutrition and the aspects generally taught at the medical and dental schools like this: "The Medical School and Dental School are interested in nutritional problems in individuals, whereas we are interested in. nutrition problems affecting whole communities. "We teach the relationship of disease to the things that cause it. It may be a lack of knowledge about diet but it's more likely to be a lack of money, or someone else in t.he family is ill so getting more of the resources . . . We want to get doctors to look at remote causes." Robson points out that there has been " national concern over the "paucity of public health nutrition in the medical curriculum, ow mucn progress nas ueeu made in recent years." He continúes: "In 1971, Dr. William Darby, president of the Nutrition Foundation, anticipated that the accelerated interest in improving nutrition teaching would lead to 'a ground swell in utilization of the science of nutrition in practice of many branches of medicine.' "And his prediction has materialized in some institutions. For example, Mt. Sinai School of Medicine in New York now provides medical students with 112 hours of instruction in nutrition, as well as an eight-week apprenticeship which relates to the public health aspects of nutrition problems in the community. "But Philip R. Lee, M.D., Chancellor of the University of California in San Francisco, notes that there are still many problems inhibiting the improvement of nutrition education in medical schools, nót the least of which is the 'competition for time within the total medical curriculum.'" At the U-M, Robson says, he appreciates the problems of an overloaded curriculum, but hopes there might be same increase in the small amount of public health nutrition education now given medical students. Schteingart, speaking of all aspects of nutrition education for medical students, appreciates the importance of the subject. "There should be more awareness on the part of physicians about nutritional problems, which may be sometimes subtle. They have an important interplay with patients' other medical problems but they go unrecognized. "One of the largest pockets of malnut-i rition in the country is in the hospitals,"j Schteingart says. " There, people who are being fed n travenously, or have other eating H lems, can be given diets that "interfereM with the process of healing," accordingH to Schteingart. He also says hospital 1 tients are often not weighed periodically, I so medical staff doesn't know of weight I changes that may indícate health I changes. But this problem has received more I tention lately, Schteingart says. "People are looking at the nutritional I aspects of patiënt care much more than I they did before. But it depends on the level of basic nutrition education given to doctors. " This education level has been raised at U-M in the last two or three years. Medical students now receive more lectures on nutrition than they used to, Schteingart says. But he, too, points out the problem of fitting the nutrition classes into the I gram. "The main limiting factor in teaching nutrition has been the time limitation within the curriculum. Students have a large amount of material to learn. Nutrition competes with cardiology, respiratory diseases (and other fields of study). "We need to' geta balanced curriculum and it may not allow us to do too much of anvthins." Walter J. Loesche, a professor of '■ crobiology in the Dental School who holds a doctórate in nutrition and tej aches some of the school's nutrition I courses, is not so aware of time conI straints on nutrition in the dental curI riculum. "Nutrition being so incredibly imporI tant, we probably don't teach enough. I But there's no great interest in nutrition fo'r a good number of students," says I Loesche. 1%. I i ■ y" I I "" Y I f! Editor 's Note: What are the major NUIMIIvJll III nutrition related activities in Washti enaw County? Dimensions reporter VAli Mary Ansley describes what is being V V Q Si TO il Q W tmlt and researched at Univer: sity of Michigan and what local gov m, ernment nutrition services are being j I f I I Y T off erd in this five-p series begining ' V J U I I I Y today. By the time current dental students gradúate, they will have spent about 25 hours in nutrition lectures, Loesche says. He féels this compares well with most other dental schools, which probably have only a few lectures on nutrition as part of a biochemistry course. And U-M's Dental School has been a leader in nutrition education for some time. Until 1969, when he retired, Professor Philip Jay made the Dental School famous for the study of nutrition as related to dental decay, Loesche says. After Jay's retirement, there were a couple of years sparse in nutrition teaching, but Loesche's appointment in 1971 meant full nutrition courses were taught I again. I As would be expected, some of the I Dental Schools nutrition lectures concern I table sugar and similar foods and how I they relate to caries. The use of fluoride I -about which Loesche comments I re's no reason why it shouldn't be I ed as an essential nutriënt" - is also I discussed, along with other dental 1 ed nutrition. I And in the school's pedodontic I try for children) clinic, students take I short diet histories of the patients. Ifl they find a child is eating a lot of sugar, I they point out to the parents that this is I unhealthy, Loesche says. But the students als.o learn about more I general nutrition. The components of I food and how it is digested and I ized, world undernutrition and possible I solutions, obesity and arteriesclerosis I are all discussed. Unlike medical students, some U-M I dental students take courses in nutrition I in Robson's Human Nutrition Program I at the School of Public Health. Dental hygiënist students take 30 hours I of classes in the program. The program I also offers a 45 lecture hour nutritional I science course for gradúate students in I dentistry. 1 Within and among the Schools of I cine. Public Health and, to a lesser extent, Dentistry, there is some debate on how much and what types of nutrition education medical and dental students should receive. Most professors would probably agree, though, that ideally the students should learn more about the way foods affect the body than they now do. But the situation is generally better than it has been in the past. Graduating doctors and dentists from the U-M know at least something of the important science of nutrition. I (Tomorrow: How can the Washtenaw County Health Department help you with 1 nutrition problems?)