Nutrition Education in US Endocrinology Fellowship Programs

Objective : Diet plays a vital role in chronic disease prevention and management. Clinic visits with physicians are an opportune time to initiate diabetes self-management education, however, few physician office visits include diet counseling to patients with diabetes. Endocrinologists are uniquely positioned to educate patients regarding nutrition due to their targeted education in chronic metabolic diseases and their frequent ambulatory patient interactions. The purpose of this study was to define the current state of nutrition education in endocrinology fellowship programs in the United States (US) and assess the need for future nutrition training.

Methods: We conducted a literature review of articles published between January 1990 and November 2020 regarding nutrition education in endocrinology fellowships in the US. We then surveyed endocrinology program directors between February and April 2021 to assess the characteristics of nutrition education currently used by the programs, program directors’ beliefs regarding the need for formal nutrition education, and future directions for nutrition training.

Results:
The initial literature search yielded 452 results; however, none of the articles described nutrition learning experiences for fellowship trainees in US. Thirty-eight program directors from 21 different states responded (25% response rate) to the survey. Twenty-two (58%) programs offered nutrition education. Existing nutrition education offerings were 1-5 total hours (13, 34%), primarily didactic (20, 53%), and were often led by registered dietitian nutritionists (RDNs) (15, 39%). Only three (8%) programs rated their current nutrition education as extremely effective; 95% of respondents believed further nutrition education was needed.
According to respondents, the ideal nutrition education for endocrine trainees should be 1-5 total hours (19, 50%)over multiple sessions (25, 66%), be interactive (24, 63%), and be led by RDNs (26, 68%). The most important topics for independent practice included diet-related behavior modification (21, 55%), components of a healthful diet (19, 50%), and energy expenditure/intake (18, 47%).


Discussion/Conclusion:
Although the majority of the endocrinology fellowship program directors believed further nutrition education is needed, almost half of the surveyed programs did not offer such training. Programs that did offer nutrition education primarily relied on a didactic format, though program director responses called for interactive session formats. Future nutrition interventions should develop universally accessible, multidisciplinary nutrition curricula.