来自住院医师培训项目负责人问卷调查的毕业后医学教育营养培训现状：正规营养教育课程是必要的
背景：营养学带头人推测毕业后营养医学教育未能较好实行是因为大多数内科和外科专科医师没有充足教育资源进行营养实践培训。针对这个问题，通过一项需求评估调查明确美国毕业后医学教育中的营养教育资源和投入情况。
方法：在线调查36个问题被发送至495个毕业后医学教育评审会（ACGME）认证的住院医师培训项目负责人，其中包括麻醉、家庭医学、内科、儿科、产科/妇科以及普外科。调查内容包括人口统计学资料、教育资源以及开放式提问。与类似主题研究的应答率一致，仅有14%（72个项目）。
结果：大多数（80%）回答问卷的培训项目负责人来自于初级保健培训项目，其余来自外科（17%）和麻醉专科（3%）。住院医师培训项目负责人们自己欠缺营养方面的知识。一些形式上的营养教育高达78%，只有26%有正规课程培训，同时仅有53%的课程培训中有医师参与教学。16个培训项目中无明确的营养专家，10个培训项目中不进行任何营养培训。培训方式也有所不同，从1h讲座到1月的轮转。77%的住院医师培训项目负责人承认并未达到必需的营养教育目标。大多数人觉得无论现在还是将来住院医师均需要进行临床营养的高级课程教育。
结论：目前毕业后医学教育中的营养教育情况普遍较差。虽然大多数培训项目缺乏专家和投入正规课程的时间，但都意识到了营养教育的必要性。在住院医师培训期间需要进行广泛、多样、普及的营养培训项目。
JPEN J Parenter Enteral Nutr. 2016;40(1):95-9.
Current Status of Nutrition Training in Graduate Medical Education From a Survey of Residency Program Directors: A Formal Nutrition Education Course Is Necessary.
Daley BJ, Cherry-Bukowiec J, Van Way CW 3rd, Collier B, Gramlich L, McMahon MM, McClave SA; A.S.P.E.N. Task Force on Postgraduate Medical Education.
University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee; University of Michigan, Ann Arbor, Michigan; University of Missouri-Kansas City, Kansas City, Missouri; Virginia Tech Carillion School of Medicine, Roanoke, Virginia; University of Alberta, Edmonton, Alberta, Canada; Mayo Clinic, Rochester, Minnesota; University of Louisville, Louisville, Kentucky.
INTRODUCTION: Nutrition leaders surmised graduate medical nutrition education was not well addressed because most medical and surgical specialties have insufficient resources to teach current nutrition practice. A needs assessment survey was constructed to determine resources and commitment for nutrition education from U.S. graduate medical educators to address this problem.
METHODS: An online survey of 36 questions was sent to 495 Accreditation Council for Graduate Medical Education (ACGME) Program Directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. Demographics, resources, and open-ended questions were included. There was a 14% response rate (72 programs), consistent with similar studies on the topic.
RESULTS: Most (80%) of the program directors responding were from primary care programs, the rest surgical (17%) or anesthesia (3%). Program directors themselves lacked knowledge of nutrition. While some form of nutrition education was provided at 78% of programs, only 26% had a formal curriculum and physicians served as faculty at only 53%. Sixteen programs had no identifiable expert in nutrition and 10 programs stated that no nutrition training was provided. Training was variable, ranging from an hour of lecture to a month-long rotation. Seventy-seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future.
CONCLUSIONS: Nutrition education in current graduate medical education is poor. Most programs lack the expertise or time commitment to teach a formal course but recognize the need to meet educational requirements. A broad-based, diverse universal program is needed for training in nutrition during residency.
KEYWORDS: administration; graduate medical education; nutrition support practice; outcomes research/quality
PMID: 25672985
DOI: 10.1177/0148607115571155
