European Journal of Clinical Nutrition (2014) 68, 844–846 © 2014 Macmillan Publishers Limited All rights reserved 0954-3007/14 www.nature.com/ejcn
PUBLIC HEALTH NUTRITION HIGHLIGHTS SHORT COMMUNICATION
Nutrition education in European medical schools: results of an international survey M Chung1,4, VJ van Buul2,4, E Wilms1, N Nellessen3 and FJPH Brouns1 Consumers and patients are unsure of whom to trust for nutritional advice. Although medical doctors are seen as experts in nutrition and their advice is regularly followed, data are lacking on the amount of nutrition education in European medical school curricula. In line with US research, we distributed a survey on required and/or optional nutrition contact hours to medical education directors of all accredited medical schools (N = 217) in Western European Union countries (N = 14). In total, respondents from 32 medical schools (14.7%) from 10 countries indicated that nutrition education, in some form, was required in 68.8% of schools where, on average, 23.68 h of required nutrition education was provided. The results from this small-scale survey are comparable to a 2010 US study; conversely, European educators were satisfied with the amount of nutrition education. We substantiate the increasing concern over the inadequate amounts of nutrition education provided to medical students in Europe. European Journal of Clinical Nutrition (2014) 68, 844–846; doi:10.1038/ejcn.2014.75; published online 30 April 2014
INTRODUCTION Circulatory diseases including hypertension, hypercholesterolemia, diabetes and ischemic heart disease—all of which are strongly diet related—are among the leading causes of death in the European Union, second only to cancer.1 Although diet is clearly a major determinant of health, consumers and academics are unsure of whom to trust for nutritional advice and nutritional advice from doctors is regularly taken.2 In light of this, medical practitioners bear an important social responsibility in advising patients on their diet and nutritional intake. Studies in the United States (US)3,4 have investigated the status of nutrition education in medical curricula and academics have thoroughly discussed the implications of the limited and inadequate amount of nutrition education in US medical curricula.5,6 Several standalone studies7,8 have highlighted the lack of confidence in and inadequacy of nutritional knowledge in European doctors and yet, to date, no studies have been conducted on the level of nutrition education in European medical curricula. This study on the current status of nutrition education in medical curricula from Western countries of the European Union intends to provide a scientifically grounded perspective on this discussion. Our survey aimed to quantify the hours of required nutrition education provided in Western European medical curricula. Owing to the increasing trend toward integrated or problem-based curricula and the broad, multifaceted discipline of nutrition, we defined nutrition education as ‘nutritional and dietetic coursework about the relation of food and nutrients to health and disease, and/or coursework on promoting healthier food choices and habits in patients'. We defined this education as required when it was a ‘core part of the assessable curriculum’. 1
MATERIALS AND METHODS The contact details of accredited Western European medical schools were obtained through the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER).9 In May 2013, all medical schools (n = 217) from the selected countries (cf. Table 1) were contacted by telephone and/or e-mail and a link to our survey was subsequently e-mailed to them. The survey was translated into Spanish and Italian, owing to low English proficiency in these countries. At least two follow-up calls per medical school and e-mails continued through July 2013. The 18-question online survey was adapted from a previous US survey.4 Respondents were asked to provide the number of contact hours of required nutrition education in their medical schools, the ratio of nutrition teaching in preclinical versus clinical years, and to indicate in what type of course nutrition was taught (Table 2). Respondents were also asked to state whether they considered the nutrition teaching in their medical school curriculum to be sufficient.
RESULTS From the 217 schools, representatives from 32 schools responded, resulting in a 14.7% response rate. Self-reported basic demographic data of the medical schools are displayed in Table 1. According to the respondents, nutrition education was, in some form, required only in 22 schools (68.8%). The other respondents indicated that nutrition education was ‘optional only’ (n = 6; 18.8%), ‘not offered’ (n = 3; 9.4%), or ‘don’t know’ (n = 1; 3.1%). The mean hours of required nutrition education for the entire curriculum required to obtain a medical degree are also listed in Table 1. The schools requiring nutrition education provided an average of 23.68 (±17.6) contact hours in the complete curriculum. Contact hours took place equally during the preclinical phase (14.0 ± 12.4)
Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition Toxicology and Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands; 2Department of Marketing and Supply Chain Management, School of Business and Economics, Maastricht University, Maastricht, The Netherlands and 3 Department of Neurology & Medical School, RWTH Aachen University, Aachen, Germany. Correspondence: Professor FJPH Brouns, Department of Human Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO 616, 6200 MD Maastricht, The Netherlands. E-mail: [email protected] 4 These authors contributed equally to this work. Received 18 January 2014; revised 6 March 2014; accepted 21 March 2014; published online 30 April 2014
Nutrition education in European medical schools M Chung et al
845 Table 1.
Basic self-reported information on responding medical schools per country and their total required nutrition education in the medical
curricula Country
Number of responding medical schools
Total number of medical schools
Number of students per universitya
Duration of preclinical phase (in years)a
Duration of clinical phase (in years)a
Total required nutrition education in hoursa
1 2 0 0 1 7 2 0 0 3 1 2 3 10 32
4 10 3 5 32 36 6 38 1 8 8 33 6 27 217
2350 ± 0 2082 ± 1247 — — 1800 ± 0 2064 ± 691 950 ± 71 — — 2733 ± 1102 1880 ± 0 1185 ± 445 1340 ± 350 1259 ± 440 1679 ± 760
2.5 ± 0.0 4.0 ± 1.4 — — 3.0 ± 0.0 1.9 ± 0.4 2.0 ± 0.0 — — 3.3 ± 0.6 2.0 ± 0.0 2.0 ± 0.0 1.7 ± 0.6 2.2 ± 0.4 2.3 ± 0.8
3.5 ± 0.0 2.5 ± 0.7 — — 3.0 ± 0.0 4.3 ± 0.5 3.0 ± 0.0 — — 3 ± 0.0 4.0 ± 0.0 4.0 ± 0.0 3.7 ± 0.8 3.1 ± 0.5 3.5 ± 0.7
50.0 9.0 ± 1.4 — — 40.0 11.3 ± 5.0 0.0 — — 21.7 ± 21.0 0.0 50.0 ± 14.1 12.5 ± 7.8 22.0 ± 16.8 23.68 ± 17.6
Austria Belgium Denmark Finland France Germany Ireland Italy Malta Netherlands Portugal Spain Sweden United Kingdom Total All values are mean ± s.d.
a
Table 2.
Distribution of required hours of nutrition education
Course
Designated nutrition course Physiology/pathophysiology/pathology Biochemistry Integrated curriculum (for example, problem-based learning) Clinical practice Other Total
Number of universities
Amount of nutrition education (in contact hours)a
16 20 19 20
9.6 ± 14.0 6.4 ± 8.5 3.4 ± 4.4 3.1 ± 3.5
16 17 22b
5.7 ± 8.3 1.41 ± 2.7 23.7 ± 17.6
All values are mean ± s.d. bMost universities (n = 18) offered more than one course in which nutrition education was provided.
a
and clinical phase of the medical training (9.4 ± 10.7). The average hours of required nutrition education are comparable to the US medical curricula as assessed in surveys from 2006 (23.9 h) and 2010 (19.6 h).3,4 Unlike their US counterparts, the European respondents expressed that they did not feel that this amount was insufficient. DISCUSSION In our small-scale survey, we found that, on average, 23.68 h of nutrition education was required in European medical schools and we question whether this amount is adequate. Unfortunately, there is no benchmark for ‘adequate amount of nutrition education’ in Europe; in the United States, however, ‘adequate nutrition education’ was determined in 1985 to be 25 h by the National Academy of Sciences.3,4 Later, the American Society for Clinical Nutrition conducted a survey where administrators and nutrition educators recommended 37–44 h of nutrition education.10 The European average therefore falls short of both these US recommendations. It should be noted that there are several limitations of the study. First, a low response rate (14.7%) was obtained. Despite measures taken to accommodate countries with low English knowledge, the extensive language barriers within the EU are believed to have been © 2014 Macmillan Publishers Limited
the main hindrance to a higher response rate. Second, sampling bias may have had a role in the response to the survey. In this respect, the universities with a relatively high amount of required nutrition education might have been more inclined to participate in this survey; for fear of scrutiny, those with low or even no required nutrition education were perhaps consequently less likely to respond. Finally, it can be questioned as to whether the amount of required nutrition education is a good marker against which solid nutrition knowledge is measured. In this light, registered dieticians who have a substantially higher amount of required nutrition education (for example, years vs hours) may also have inadequate knowledge of human nutrition and food science. Future research should focus on diminishing these limitations. Moreover, research is needed on European nutrition education in medical specialist education (for example, training of general practitioners) as this may contribute to a better understanding of total nutrition education and to a comparison of the nutrition knowledge of medical doctors with other health professionals (such as dieticians). CONCLUSIONS From our data we conclude that, although the scientific principles related to nutrition are taught in some medical schools, the amount of nutrition education provided to medical students is of concern. Thus, an officially recommended curriculum for nutrition education in medical schools to provide a solid basis for nutritional advice is warranted. With this, a benchmark of ‘adequate amount of nutrition education’ in the EU is needed to determine whether medical schools meet recommendations. CONFLICT OF INTEREST The authors declare no conflict of interest.
ACKNOWLEDGEMENTS We express our gratitude to Kelly Adams, MPH, RD, Assistant Project Director and Research Associate, Department of Nutrition, University of North Carolina at Chapel Hill for the original survey. In addition, we thank Dr Bridget Maher, Lecturer Clinical Science and Practice, School of Medicine, University College Cork for her invaluable input. We further thank Laura Borile and Gabriella Ortiz, research assistants at the Department of Human Biology, Maastricht University for translating the survey and helping with data collection in Italy and Spain.
European Journal of Clinical Nutrition (2014) 844 – 846
Nutrition education in European medical schools M Chung et al
846
AUTHOR CONTRIBUTIONS FJPHB and VJvB designed the research. MC, VJvB and NN conducted the research. All authors analyzed the data and VJvB performed statistical analysis. MC, VJvB, EW and NN wrote the base paper. MC was primarily responsible for final editing and FB and VJvB were primarily responsible for final content. All authors read and analyzed the cited literature; all authors read and approved the final manuscript.
REFERENCES 1 European Commission, Eurostat Causes of death statistics - statistics explained 2013. Available from: http://epp.eurostat.ec.europa.eu/statistics_explained/index. php/Causes_of_death_statistics (updated 14 May 2013; cited 2 June 2013). 2 Hiddink G, Hautvast J, Van Woerkum C, Fieren C, Van’t Hof M. Consumers’ expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr 1997; 65: 1974S–1979SS. 3 Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in US medical schools: latest update of a national survey. Acad Med 2010; 85: 1537–1542. 4 Adams KM, Lindell KC, Kohlmeier M, Zeisel SH. Status of nutrition education in medical schools. Am J Clin Nutr 2006; 83: 941S–944S.
European Journal of Clinical Nutrition (2014) 844 – 846
5 Perez-Rodrigo C, Aranceta J. Nutrition education in schools: experiences and challenges. Eur J Clin Nutr 2003; 57: S82–S85. 6 Taren DL, Thomson CA, Koff NA, Gordon PR, Marian MJ, Bassford TL et al. Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training. Am J Clin Nutr 2001; 73: 1107–1112. 7 Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P et al. Overweight and Obesity: Knowledge, Attitudes, and Practices of General Practitioners in France. Obes Res 2005; 13: 787–795. 8 Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E et al. Insufficient nutritional knowledge among health care workers?. Clin Nutr 2008; 27: 196–202. 9 Foundation for Advancement of International Medical Education and Research FAIMER International Medical Education Directory 2011. Available from: http://www.faimer.org/resources/imed.html (updated October 12, 2011; cited 20 April 2013). 10 Weinsier RL, Boker JR, Brooks CM, Kushner RF, Visek WJ, Mark DA et al. Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators. Am J Clin Nutr 1989; 50: 707–712.
© 2014 Macmillan Publishers Limited
PUBLIC HEALTH NUTRITION HIGHLIGHTS SHORT COMMUNICATION
Nutrition education in European medical schools: results of an international survey M Chung1,4, VJ van Buul2,4, E Wilms1, N Nellessen3 and FJPH Brouns1 Consumers and patients are unsure of whom to trust for nutritional advice. Although medical doctors are seen as experts in nutrition and their advice is regularly followed, data are lacking on the amount of nutrition education in European medical school curricula. In line with US research, we distributed a survey on required and/or optional nutrition contact hours to medical education directors of all accredited medical schools (N = 217) in Western European Union countries (N = 14). In total, respondents from 32 medical schools (14.7%) from 10 countries indicated that nutrition education, in some form, was required in 68.8% of schools where, on average, 23.68 h of required nutrition education was provided. The results from this small-scale survey are comparable to a 2010 US study; conversely, European educators were satisfied with the amount of nutrition education. We substantiate the increasing concern over the inadequate amounts of nutrition education provided to medical students in Europe. European Journal of Clinical Nutrition (2014) 68, 844–846; doi:10.1038/ejcn.2014.75; published online 30 April 2014
INTRODUCTION Circulatory diseases including hypertension, hypercholesterolemia, diabetes and ischemic heart disease—all of which are strongly diet related—are among the leading causes of death in the European Union, second only to cancer.1 Although diet is clearly a major determinant of health, consumers and academics are unsure of whom to trust for nutritional advice and nutritional advice from doctors is regularly taken.2 In light of this, medical practitioners bear an important social responsibility in advising patients on their diet and nutritional intake. Studies in the United States (US)3,4 have investigated the status of nutrition education in medical curricula and academics have thoroughly discussed the implications of the limited and inadequate amount of nutrition education in US medical curricula.5,6 Several standalone studies7,8 have highlighted the lack of confidence in and inadequacy of nutritional knowledge in European doctors and yet, to date, no studies have been conducted on the level of nutrition education in European medical curricula. This study on the current status of nutrition education in medical curricula from Western countries of the European Union intends to provide a scientifically grounded perspective on this discussion. Our survey aimed to quantify the hours of required nutrition education provided in Western European medical curricula. Owing to the increasing trend toward integrated or problem-based curricula and the broad, multifaceted discipline of nutrition, we defined nutrition education as ‘nutritional and dietetic coursework about the relation of food and nutrients to health and disease, and/or coursework on promoting healthier food choices and habits in patients'. We defined this education as required when it was a ‘core part of the assessable curriculum’. 1
MATERIALS AND METHODS The contact details of accredited Western European medical schools were obtained through the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER).9 In May 2013, all medical schools (n = 217) from the selected countries (cf. Table 1) were contacted by telephone and/or e-mail and a link to our survey was subsequently e-mailed to them. The survey was translated into Spanish and Italian, owing to low English proficiency in these countries. At least two follow-up calls per medical school and e-mails continued through July 2013. The 18-question online survey was adapted from a previous US survey.4 Respondents were asked to provide the number of contact hours of required nutrition education in their medical schools, the ratio of nutrition teaching in preclinical versus clinical years, and to indicate in what type of course nutrition was taught (Table 2). Respondents were also asked to state whether they considered the nutrition teaching in their medical school curriculum to be sufficient.
RESULTS From the 217 schools, representatives from 32 schools responded, resulting in a 14.7% response rate. Self-reported basic demographic data of the medical schools are displayed in Table 1. According to the respondents, nutrition education was, in some form, required only in 22 schools (68.8%). The other respondents indicated that nutrition education was ‘optional only’ (n = 6; 18.8%), ‘not offered’ (n = 3; 9.4%), or ‘don’t know’ (n = 1; 3.1%). The mean hours of required nutrition education for the entire curriculum required to obtain a medical degree are also listed in Table 1. The schools requiring nutrition education provided an average of 23.68 (±17.6) contact hours in the complete curriculum. Contact hours took place equally during the preclinical phase (14.0 ± 12.4)
Department of Human Biology, Faculty of Health, Medicine and Life Sciences, School of Nutrition Toxicology and Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands; 2Department of Marketing and Supply Chain Management, School of Business and Economics, Maastricht University, Maastricht, The Netherlands and 3 Department of Neurology & Medical School, RWTH Aachen University, Aachen, Germany. Correspondence: Professor FJPH Brouns, Department of Human Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO 616, 6200 MD Maastricht, The Netherlands. E-mail: [email protected] 4 These authors contributed equally to this work. Received 18 January 2014; revised 6 March 2014; accepted 21 March 2014; published online 30 April 2014
Nutrition education in European medical schools M Chung et al
845 Table 1.
Basic self-reported information on responding medical schools per country and their total required nutrition education in the medical
curricula Country
Number of responding medical schools
Total number of medical schools
Number of students per universitya
Duration of preclinical phase (in years)a
Duration of clinical phase (in years)a
Total required nutrition education in hoursa
1 2 0 0 1 7 2 0 0 3 1 2 3 10 32
4 10 3 5 32 36 6 38 1 8 8 33 6 27 217
2350 ± 0 2082 ± 1247 — — 1800 ± 0 2064 ± 691 950 ± 71 — — 2733 ± 1102 1880 ± 0 1185 ± 445 1340 ± 350 1259 ± 440 1679 ± 760
2.5 ± 0.0 4.0 ± 1.4 — — 3.0 ± 0.0 1.9 ± 0.4 2.0 ± 0.0 — — 3.3 ± 0.6 2.0 ± 0.0 2.0 ± 0.0 1.7 ± 0.6 2.2 ± 0.4 2.3 ± 0.8
3.5 ± 0.0 2.5 ± 0.7 — — 3.0 ± 0.0 4.3 ± 0.5 3.0 ± 0.0 — — 3 ± 0.0 4.0 ± 0.0 4.0 ± 0.0 3.7 ± 0.8 3.1 ± 0.5 3.5 ± 0.7
50.0 9.0 ± 1.4 — — 40.0 11.3 ± 5.0 0.0 — — 21.7 ± 21.0 0.0 50.0 ± 14.1 12.5 ± 7.8 22.0 ± 16.8 23.68 ± 17.6
Austria Belgium Denmark Finland France Germany Ireland Italy Malta Netherlands Portugal Spain Sweden United Kingdom Total All values are mean ± s.d.
a
Table 2.
Distribution of required hours of nutrition education
Course
Designated nutrition course Physiology/pathophysiology/pathology Biochemistry Integrated curriculum (for example, problem-based learning) Clinical practice Other Total
Number of universities
Amount of nutrition education (in contact hours)a
16 20 19 20
9.6 ± 14.0 6.4 ± 8.5 3.4 ± 4.4 3.1 ± 3.5
16 17 22b
5.7 ± 8.3 1.41 ± 2.7 23.7 ± 17.6
All values are mean ± s.d. bMost universities (n = 18) offered more than one course in which nutrition education was provided.
a
and clinical phase of the medical training (9.4 ± 10.7). The average hours of required nutrition education are comparable to the US medical curricula as assessed in surveys from 2006 (23.9 h) and 2010 (19.6 h).3,4 Unlike their US counterparts, the European respondents expressed that they did not feel that this amount was insufficient. DISCUSSION In our small-scale survey, we found that, on average, 23.68 h of nutrition education was required in European medical schools and we question whether this amount is adequate. Unfortunately, there is no benchmark for ‘adequate amount of nutrition education’ in Europe; in the United States, however, ‘adequate nutrition education’ was determined in 1985 to be 25 h by the National Academy of Sciences.3,4 Later, the American Society for Clinical Nutrition conducted a survey where administrators and nutrition educators recommended 37–44 h of nutrition education.10 The European average therefore falls short of both these US recommendations. It should be noted that there are several limitations of the study. First, a low response rate (14.7%) was obtained. Despite measures taken to accommodate countries with low English knowledge, the extensive language barriers within the EU are believed to have been © 2014 Macmillan Publishers Limited
the main hindrance to a higher response rate. Second, sampling bias may have had a role in the response to the survey. In this respect, the universities with a relatively high amount of required nutrition education might have been more inclined to participate in this survey; for fear of scrutiny, those with low or even no required nutrition education were perhaps consequently less likely to respond. Finally, it can be questioned as to whether the amount of required nutrition education is a good marker against which solid nutrition knowledge is measured. In this light, registered dieticians who have a substantially higher amount of required nutrition education (for example, years vs hours) may also have inadequate knowledge of human nutrition and food science. Future research should focus on diminishing these limitations. Moreover, research is needed on European nutrition education in medical specialist education (for example, training of general practitioners) as this may contribute to a better understanding of total nutrition education and to a comparison of the nutrition knowledge of medical doctors with other health professionals (such as dieticians). CONCLUSIONS From our data we conclude that, although the scientific principles related to nutrition are taught in some medical schools, the amount of nutrition education provided to medical students is of concern. Thus, an officially recommended curriculum for nutrition education in medical schools to provide a solid basis for nutritional advice is warranted. With this, a benchmark of ‘adequate amount of nutrition education’ in the EU is needed to determine whether medical schools meet recommendations. CONFLICT OF INTEREST The authors declare no conflict of interest.
ACKNOWLEDGEMENTS We express our gratitude to Kelly Adams, MPH, RD, Assistant Project Director and Research Associate, Department of Nutrition, University of North Carolina at Chapel Hill for the original survey. In addition, we thank Dr Bridget Maher, Lecturer Clinical Science and Practice, School of Medicine, University College Cork for her invaluable input. We further thank Laura Borile and Gabriella Ortiz, research assistants at the Department of Human Biology, Maastricht University for translating the survey and helping with data collection in Italy and Spain.
European Journal of Clinical Nutrition (2014) 844 – 846
Nutrition education in European medical schools M Chung et al
846
AUTHOR CONTRIBUTIONS FJPHB and VJvB designed the research. MC, VJvB and NN conducted the research. All authors analyzed the data and VJvB performed statistical analysis. MC, VJvB, EW and NN wrote the base paper. MC was primarily responsible for final editing and FB and VJvB were primarily responsible for final content. All authors read and analyzed the cited literature; all authors read and approved the final manuscript.
REFERENCES 1 European Commission, Eurostat Causes of death statistics - statistics explained 2013. Available from: http://epp.eurostat.ec.europa.eu/statistics_explained/index. php/Causes_of_death_statistics (updated 14 May 2013; cited 2 June 2013). 2 Hiddink G, Hautvast J, Van Woerkum C, Fieren C, Van’t Hof M. Consumers’ expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr 1997; 65: 1974S–1979SS. 3 Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in US medical schools: latest update of a national survey. Acad Med 2010; 85: 1537–1542. 4 Adams KM, Lindell KC, Kohlmeier M, Zeisel SH. Status of nutrition education in medical schools. Am J Clin Nutr 2006; 83: 941S–944S.
European Journal of Clinical Nutrition (2014) 844 – 846
5 Perez-Rodrigo C, Aranceta J. Nutrition education in schools: experiences and challenges. Eur J Clin Nutr 2003; 57: S82–S85. 6 Taren DL, Thomson CA, Koff NA, Gordon PR, Marian MJ, Bassford TL et al. Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training. Am J Clin Nutr 2001; 73: 1107–1112. 7 Bocquier A, Verger P, Basdevant A, Andreotti G, Baretge J, Villani P et al. Overweight and Obesity: Knowledge, Attitudes, and Practices of General Practitioners in France. Obes Res 2005; 13: 787–795. 8 Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E et al. Insufficient nutritional knowledge among health care workers?. Clin Nutr 2008; 27: 196–202. 9 Foundation for Advancement of International Medical Education and Research FAIMER International Medical Education Directory 2011. Available from: http://www.faimer.org/resources/imed.html (updated October 12, 2011; cited 20 April 2013). 10 Weinsier RL, Boker JR, Brooks CM, Kushner RF, Visek WJ, Mark DA et al. Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators. Am J Clin Nutr 1989; 50: 707–712.
© 2014 Macmillan Publishers Limited
