|Year : 2019 | Volume
| Issue : 2 | Page : 91-94
Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study
Victor Mogre1, Fred C. J. Stevens2, Paul A Aryee3, Anthony Amalba4, Albert J. J. A. Scherpbier2
1 Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana; Department of Educational Research and Development, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
2 Department of Educational Research and Development, Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
3 Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
4 Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
|Date of Web Publication||18-Nov-2019|
Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale
Source of Support: None, Conflict of Interest: None
Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.
Keywords: Doctors, general practice setting, medical students, nutrition care, nutrition education
|How to cite this article:|
Mogre V, Stevens FC, Aryee PA, Amalba A, Scherpbier AJ. Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study. Educ Health 2019;32:91-4
|How to cite this URL:|
Mogre V, Stevens FC, Aryee PA, Amalba A, Scherpbier AJ. Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study. Educ Health [serial online] 2019 [cited 2020 Jan 22];32:91-4. Available from: http://www.educationforhealth.net/text.asp?2019/32/2/91/271189
| Background|| |
Poor nutrition is a key risk factor implicated in the pathogenesis of several diseases of global public health importance including obesity, diabetes, cancer, stroke, and hypertension among others. The WHO estimates these noncommunicable diseases (NCDs) as among the leading causes of mortality globally, accounting for 60% of all deaths.
Improving the nutrition of individuals is very important and a major step in the prevention and management of these NCDs. Doctors serve as trusted and reliable sources of nutrition and health information and have the opportunity to play a significant role in the nutrition care and well-being of their patients. However, doctors do not frequently provide such nutrition care to their patients partly due to inadequate nutrition education during medical school and lack of time., Medical students also frequently report inadequate nutrition education.
Although it is generally accepted that nutrition is important, health-care studies exploring medical students' (future doctors) perspectives of why they should learn about nutrition and why doctors should provide nutrition care are lacking. It is imperative to explore future doctors' views on these in order to help them know their limits regarding nutrition, help them to recognize the multidisciplinary nature of nutrition care, and provide opportunities to gauge their acceptability or attitudes regarding the provision of nutrition care during practice. We, thus, explored medical students' perspectives, of which health-care professional is responsible for the provision of nutrition care and why doctors should learn about nutrition and provide nutrition care to patients in the general practice setting. The evidence generated will help in the design of educational interventions to improve nutrition education in medical training.
| Methods|| |
We recruited participants from the University for Development Studies/School of Medicine and Health Sciences using a purposive sampling approach. Our participants included only clinical level medical students (referred to as future doctors). All participants were contacted by virtual meeting through face-to-face meetings. The purpose of the research was explained to the students, and informed consent was sought during such meetings. The research was approved by the Navrongo Health Research Centre Institutional Review Board (Ethics Approval ID: NHRCIRB 209). All data were collected using semistructured interviews informed by open-ended questions that explored participants' values, attitudes, experiences, and opinions. All interviews were transcribed verbatim, without identifying information, and transcriptions were entered into MAXQDA version 12 (VERBI GmbH, Berlin, Germany), qualitative data analysis software. Subsequent data analyses were conducted using a comparative strategy.
| Results|| |
From 23 students who agreed to participate, 61% were male students, 39% (n = 9) in clinical year 2, and 30% (n = 7) each in clinical years 1 and 3. Two major themes emerged from the data: whose responsibility it is to provide nutrition care and why doctors should learn and provide nutrition care in the general practice setting.
Responsibility to provide nutrition care in the general practice setting
In general, the future doctors reported that all health professionals (i.e., doctors, nutritionists, dieticians, nurses, physician assistants, nurse practitioners, etc.,) who come into contact with patients in the general practice setting have a role to play and should be responsible for the provision of nutrition care to patients.
“I think all health professionals should give nutritional care to patients including doctors in particular, nutritionist and any other health provider within the hospital should have the knowledge of nutrition and be capable of assisting as the need arises.” (Participant 14, clinical year 3 male student, 29 years).
In terms of ranking, future doctors rated doctors next to nutritionists and dieticians to be more concerned in the provision of nutrition care to patients.
Doctors learning about nutrition and providing nutrition care to patients in the general practice setting
Future doctors had the opinion that because doctors have regular/frequent contacts with patients and usually have a good overview of the patient's medical history, it is important they play a central and active role in the nutrition care of the patients.
“The doctors treat the patients directly with the diseases they present to them in the consulting room. So it's also important that the doctor who knows the kind of diseases that the patient is having can also advise the patient on the type of food they should eat. After that the patient can go and see the nutritionists. But the doctor can also play a major role in advising the patient on what to take because they are taking care of them on a daily or monthly basis” (Participant 17, Clinical year 2 male student, 25 years).
Some future doctors had the opinion that doctors are the first point of contact and should be involved in providing nutrition care such as diagnosing and referring patients to nutritionists and dieticians. They are the gate keepers of the healthcare system and determine the kind of treatment needed for every patient. And as such should have sufficient nutrition-related competencies.
“Doctors have a huge role because usually at the OPD they see the patient first and some of them do not make it to the specialist to get that information. So I think if the doctors are adequately versed with nutrition information, I think they can do more work as in educating the patients about nutrition.” (Participant 15, clinical year 2 female student, 24 years).
Furthermore, future doctors stated that patients have trust in the advice of doctors and are more likely to adhere to the doctor's advice. This is illuminated by a typical experience of a student below.
“What I realize is that patients tend to listen to what doctors say much more. Even more than the nutritionist! So when you refer them there, they go alright. But they come back and they are like wanting you to see “oh this is what he has done.” They want you to approve of it as to whether ”is it the right thing,“ ”should they go on with it?” (Participant 2, clinical year 3 male student, 35 years).
Interestingly, one student reported that providing nutrition care to patients will also help build and maintain patients' trust in the doctor.
“Yes they should. As I said we are the first point of call so if a patient comes and you have to refer the patient he or she loses some sort of trust in you. He or she knows that you are the one to take care of him” (Participant 13, clinical year 2 male student, 25 years).
Furthermore, future doctors recognized that, in providing nutrition care to a patient, a holistic, multidisciplinary approach is required and the doctor as an important stakeholder should be involved in the process.
“Doctors should provide nutrition care. In managing the patient, we believe in the synergistic approach. All hands on deck. So doctors should put a hand in it and should not be like this is a nutritionist job or this is not a doctor's job.” (Participant 5, clinical year 2 male student, 25 years).
Some future doctors also had the opinion that the mere fact that nutrition plays an important role in the treatment outcomes of the patient, it is only ordinary and important for the doctor to be concerned with the nutrition needs of the patient.
“Because in the management of certain conditions, if the nutrition is not taken into consideration, whatever treatment you might be giving won't help. So it is very important.” With medicine, I think nutrition should be a major component because most of the diseases especially here in Ghana are connected to nutritional status.” (Participant 21, clinical year 2 female student, 24 years).
Furthermore, future doctors reported that because doctors are responsible for all aspects of care of the patient, nothing prevents them from providing nutrition care, which, in their opinion, is also part of routine care.
“The other reason is that as a physician you will be managing the patient on all aspects of their health not just a disease condition. Because we know how nutrition plays in disease. You need all that information that's why I think physicians should be involved” ( Participant 18, clinical year 2 male student, 23 years).
| Discussion|| |
It is quite heartening that future doctors in this study have a perception that all health professionals who come into contact with patients in the general practice setting should be concerned about the nutrition care of their patients. Furthermore, their recognition of the fact that nutritionists and dieticians have a more and specialized role to play in the provision of nutrition care to patients deserves commendation. These views show that they recognize the multidisciplinary nature of nutrition care and value the specialized role of the nutritionists/dieticians.
The fact that future doctors felt that doctors (except for nutritionists and dieticians) should be more interested in the nutrition of their patients demonstrates a positive attitude of these future doctors to the provision of nutrition care. Students perception that doctors see patients more regularly and are the first point of contact in the general practice setting and should provide nutrition care, is consistent with previous reports., Furthermore, consistent with previous studies, students stated that patients consider doctors to be credible sources of nutrition information and prefer to receive nutrition advice from doctors. Future doctors' recognition of nutrition care as being an opportunity to ensure holistic care and interprofessional cooperation for patient care is rather stimulating as the general practice setting presents a good opportunity to provide preventive care.,
Our study is not without limitations. Our selection of students from a single medical school may limit the generalizability of our findings. Yet, the findings of this study serve as a proxy for future doctors' readiness to embrace educational interventions to improve nutrition education and to provide nutrition care when they become medical doctors.
The authors wish to thank all students who agreed and consented to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bipartisan Policy Center. Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention Oriented Care. Wahington DC: Bipartisan Policy Center; 2014.
World Health Organization. Global Strategy on Diet, Physical Activity and Health. Geneva: World Health Organization; 2004.
Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of primary care physicians: A national survey. Clin J Sport Med 2000;10:40-8.
Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians: A survey of primary care practitioners. Nutr Clin Pract 2010;25:502-9.
Crowley J, Ball L, Han DY, Arroll B, Leveritt M, Wall C. New Zealand medical students have positive attitudes and moderate confidence in providing nutrition care: A cross-sectional survey. Biomed Educ 2015;2015. [Doi: 10.1155/2015/259653].
Ball L, Desbrow B, Leveritt M. An exploration of individuals' preferences for nutrition care from Australian primary care health professionals. Aust J Prim Health 2014;20:113-20.
Bonevski B, Campbell E, Sanson-Fisher R. Primary care practitioners and health promotion: A review of current practices. Health Promot J Austr 1996;6:22-31.
Ball LE, Hughes RM, Leveritt MD. Nutrition in general practice: Role and workforce preparation expectations of medical educators. Aust J Prim Health 2010;16:304-10.
American Dietetic Association. Nutrition and you: Trends 2008. Report of Results. American Dietetic Association; 2011.
Brotons C, Ciurana R, Piñeiro R, Kloppe P, Godycki-Cwirko M, Sammut MR. Dietary advice in clinical practice: The views of general practitioners in europe. Am J Clin Nutr 2003;77:1048S-51S.