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Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.


Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.


Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).


Internal medicine interns’ perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.


The most recent NHANES data released in April 2006 revealed that approximately two-thirds of US adults are over-weight or obese, with significant increases in the prevalence of obesity among men, children and adolescents [1]. Obesity-related diseases including diabetes, coronary artery disease, stroke, hypertension, and certain cancers are among the leading causes of death in the US [2,3]. Given its’ epidemic proportions, obesity has emerged as one of our nation’s most important public health challenges. More and more, the primary care provider is expected to be a key player in tackling this battle, especially given data suggesting that patients consider physicians to be one of the most credible sources of nutrition information [4]. However, less than half of primary care physicians routinely discuss weight loss with obese patients or provide dietary counseling [4,5]. Why? Although lack of time and lack of patient compliance are the most commonly perceived barriers, 67% of physicians report lack of training in counseling skills and 62% report deficits of knowledge about nutrition as major barriers [4]. Physicians do, however, hold positive views about the importance of nutrition [4,6]. The need for nutrition education for physicians, therefore, has never been more urgent.

Within recent years, nutrition has emerged as an important topic in medical education. In 1997, the National Heart, Lung, and Blood Institute created the Nutrition Academic Award (NAA) in an effort to develop innovative strategies for nutrition education for medical students. Twenty-one medical schools have been recipients of the award since that time [7]. Although more material on nutrition has been integrated into medical school curricula since the inception of the NAA, 51.1% of US medical school graduates in 2005 (compared to 64.4% in 1998) still reported that they received inadequate nutrition education during their undergraduate medical training [8]. Although fewer studies are available, it appears that training in nutrition during residency is even more deficient [9]. This trend is concerning, as medical students’ interest and enthusiasm in nutrition education has been found to wane rapidly in the absence of reinforcement from their clinical house staff and faculty mentors, who also feel inadequate in their own nutrition knowledge and counseling skills [4,10].

To guide the design of an effective nutrition curriculum for residents, we performed a targeted needs assessment to determine the attitudes, self-perceived proficiency, and knowledge related to nutrition and obesity among internal medicine interns. Although prior studies have reported on the relationship between nutrition attitudes and knowledge [11-13], results have been equivocal and there are no studies examining the correlations among attitudes, self-perceived proficiency, and knowledge. This study seeks to further elucidate these relationships.

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