Independent writer and researcher, Richmond, London, United Kingdom.
University of Crete School of Medicine, Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Heraklion, Greece.
Adv Nutr. 2019 Mar 1;10(2):345-350. doi: 10.1093/advances/nmy082.
There is a well-documented pandemic of malnutrition. It has numerous sequelae, including physical and psychological ill health, early death, and socioeconomic burden. The nutrition landscape and dynamics of the nutrition transition are extremely complex, but one significant factor in both is the role of medical management. Doctors have a unique position in society from which to influence this scenario at global, public, and personal levels, but we are failing to do so. There are several reasons for this, including inadequate time; historical educational bias towards disease and therapeutic intervention-rather than diet, lifestyle, and prevention; actual or perceived incompetency in the field of nutrition; confusion or deflection within medicine about whose role(s) it is on a medical team to address nutrition; and public confusion about whom to turn to for advice. But the most fundamental reason is that current doctors (and thus the trainers of medical students) have not received-and future doctors are thus still not receiving-adequate training to render them confident or competent to take on the role. A small number of important educational approaches exist aimed at practicing doctors and medical students, but the most effective methods of teaching are still being evaluated. Without properly trained trainers, we have no one to train the doctors of tomorrow. This is a "catch 22." To break this deadlock, there is an urgent need to make appropriate nutrition training available, internationally, and at all levels of medical education (medical students, doctors-in-training, and practicing doctors). Until this is achieved, the current pandemic of nutrition-related disease will continue to grow. Using important illustrative examples of existing successful nutrition education approaches, we suggest potential approaches to breaking this deadlock.
目前营养不良是一个有据可查的大流行病。它有许多后遗症,包括身体和心理健康不良、早逝和社会经济负担。营养状况和营养转型的动态极其复杂,但其中一个重要因素是医疗管理的作用。医生在社会中处于独特的地位,可以从全球、公众和个人层面影响这种情况,但我们未能做到这一点。造成这种情况的原因有几个,包括时间不足;历史上教育偏向于疾病和治疗干预,而不是饮食、生活方式和预防;在营养领域的实际或感知能力不足;医学内部对医疗团队中谁的角色负责解决营养问题存在混淆或转移;公众对该向谁寻求建议感到困惑。但最根本的原因是,目前的医生(以及因此,医学生的培训师)没有接受足够的培训,未来的医生也因此仍然没有接受足够的培训,使其有信心或能力承担这一角色。虽然存在一些针对执业医生和医学生的重要教育方法,但最有效的教学方法仍在评估中。没有经过适当培训的培训师,我们就没有人来培训明天的医生。这就是一个“两难”的困境。为了打破这种僵局,迫切需要在国际上和各级医学教育(医学生、实习医生和执业医生)中提供适当的营养培训。在实现这一目标之前,与营养相关的疾病的当前流行将继续加剧。通过使用现有的成功营养教育方法的重要示例,我们提出了打破这一僵局的潜在方法。