Nutrition
Home Contact Us Contents AFP private

Home
Up

Nutrition

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine. It has been adapted with personalized goals and objectives for the Altoona Family Physician Residency Program
 

Rotation Description

 Altoona Family Physicians nutritional curriculum is longitudinal and integrated into Patient Care, in the hospital and outpatient settings, and taught at didactic conferences as part of the Medical Knowledge Competency. Nutritional status of the patient is an integral part of case presentations in the AFP and WFP office settings, inpatient rounds and other clinical activities. Qualified nutrition professionals teach nutrition at didactic conferences and are available for consultation at Altoona Regional Health System Nutritional Services Department.  Faculty model integration of nutrition information into Patient Care.


Nutrition plays a major role in both health promotion and disease prevention, in addition to being a therapeutic tool in the treatment of medical, surgical and emotional illness. We strive to develop the basic skills necessary to assess nutritional status and provide nutrition therapy.

 

Patient Care

Goal 1.The resident will provide nutritional advice that is compassionate, appropriate and effective for the treatment of health problems and promotion of health

Objectives

Objective 1. The resident will demonstrate knowledge of nutrition and application to patient’s health in the hospital, outpatient settings (AFP and WFP) as measured by evaluation of faculty and staff, direct observation and precepting of patient care notes.

Medical Knowledge Competency

Goal 2. The resident will acquire the following attitudes, knowledge and skills. These will be imparted by faculty teaching during patient care, attendance at didactic conferences and reading assignments.

Objective 1.  The Nutrition reading assignment from Family Medicine Essentials is monograph 283. Exercise and Nutrition

 Objective 1. Resident’s nutritional knowledge base will be measured by Pretests and post tests from the Home study monograph 283 Exercise and Nutrition of the AAFP. The monograph is to be studied until the resident reaches 100% scoring. Results will be given by the resident to administrative personnel. If the resident acquires 100 percent on their pre test and post test before reading the monograph, he or she may elect to choose other materials for self study or pull original articles, critically appraise them and present how they would apply the information clinically at Family Medicine Rounds.

 

Objective 2. The residents and faculty will discuss nutritional aspects of patient care at Family Practice Rounds as measured by evaluation by attending faculty.

 

Objective 3. The residents will attend nutrition didactic conferences as scheduled by the associate program director as measured by conference attendance tracking. Speakers will include Altoona Hospital Nutritionist, Certified Lactation Nurse and other guests.

 

 Topics will include but not be limited to:

 

  1. Healthy eating throughout the life cycle: infants, childhood, teens, adults, pregnancy and lactation and geriatrics
  2. Prevention and treatment of obesity in children and adults
  3. Nutritional concerns with diabetes
  4. Nutrition and its role in hypertension
  5. Nutrition and its role in coronary artery disease
  6. Nutrition in chronic illness such as COPD, Cancer, Alcoholism and liver disease, and renal disease.
  7. Enteral and parenteral nutrition assessment and therapy
  8. Nutritional support of the hospitalized and critically ill patient
  9. Eating disorders-bulimia and anorexia
  10.  La Lecher lectures: Support of lactation and maternal nutritional need

Attitudes

The resident should develop Attitudes that recognize the following:

  1. Nutrition is an integral part of:
    1. Health promotion and disease prevention-Mortality and morbidity could be significantly reduced through primary prevention targeting dietary risk factors throughout the life cycle.
    2. Medical treatment of disease-nutritional status has a large impact on the ability to respond to medical interventions.
    3. Treatment and prevention of obesity- the leading factor in most of the major causes of morbidity and mortality.
  2. Dietary intake is influenced by a variety of patient factors, including:
    1. Culture (family, community, ethnicity, religion)
    2. Socioeconomic (ability to purchase food, living situation)
    3. Psychosocial and mental health (depression, anorexia, dementia, bulimia)
    4. Knowledge
    5. General health and lifestyle (co-morbid conditions, diseases, habits)
  3. Nutrition consultants should be utilized when appropriate to help provide counseling for at-risk patients. Nutritionists, registered dieticians and licensed dieticians have specialized training in public health nutrition, wellness and disease prevention, medical nutrition therapy, and nutrition education and counseling for patients and the general public

Knowledge

The resident should develop knowledge of:

  1. General principles of nutrition, including:
    1. The roles of dietary components: carbohydrates, fats, proteins, vitamins, minerals, water and fiber
    2. Dietary reference intakes
    3. Nutritional content of foods
    4. Dietary recommendations, e.g., dietary guidelines for Americans, DASH diet, servings of fruits and vegetables. “Rainbow plate”       
  2. Nutritional assessment
    1. Medical/social history and physical examination
    2. Anthropometrics (height/weight, body mass index [BMI], head circumference, body-fat distribution)
    3. Ordering and evaluating laboratory tests (inpatient and outpatient)
  3. Nutritional issues of different stages of the life cycle
    1. Infancy-e.g., breastfeeding, bottle-feeding, adding solids, allergy prevention
    2. Children-e.g., picky eating, pica, snacks
    3. Adolescents-e.g., healthy choices, eating disorders
    4. Adults-e.g., portion size, habits, convenience foods
    5. Pregnancy-e.g., weight gain, folic acid, iron, calcium
    6. Lactation-e.g., nutritional needs, support, counseling
    7. Elderly-e.g., psychosocial issues, co-morbid conditions, swallowing disorders
  4. The role of nutrition in the prevention and treatment of specific diseases
    1. Cancer
    2. Cardiovascular disease
    3. Dental disease
    4. Diabetes
    5. Gastrointestinal disorders
    6. Hematologic disorders
    7. Hypertension
    8. Liver disease
    9. Obesity
    10. Osteoporosis
    11. Renal disease
  5. Secondary malnutrition caused by systemic diseases
    1. Alcoholism
    2. Cancer
    3. HIV/AIDS
    4. Malabsorption and gastrointestinal diseases
    5. Pulmonary disease
  6. Weight loss strategies and counseling
    1. Behavior modification and goal setting
    2. Diet drugs (prescription, herbal and over-the-counter)
    3. Popular diets and supplements
    4. Surgical approaches
  7. Disordered eating
    1. Anorexia nervosa
    2. Binge eating
    3. Bulimia
  8. Use of dietary supplements, including:
    1. Vitamin and mineral deficiency, toxicity, and recommended intakes
    2. Guidelines for herbal, alternative and other supplements, including drug interactions, safety and efficacy
    3. Evidence-based nutrition resources and signs of quackery
  9. Preventing and recognizing and treating foodborne illness
  10. Allergies and food intolerance
  11. Physical activity and sports
    1. Recommendations for health and weight loss
    2. Nutritional needs for various levels of activity (i.e., elite athletes) and for different ages
    3. Hydration
  12. Enteral and parenteral nutrition
  13. Community nutrition resources, e.g., food bank, Meals on Wheels, Women, Infants and Children (WIC) supplemental food program

Skills

The resident should develop skills in:

  1. Integrating nutrition assessment and intervention into the medical history, review of systems, physical examination, laboratory evaluation and plan of care.
  2. Assessing the nutritional status and writing diet prescriptions for inpatients, e.g., hospitals, nursing homes and other supervised living situations.
  3. Ordering and interpreting laboratory and metabolic studies related to nutritional assessment.
  4. Ordering and managing oral supplements and tube feeding, and understanding when and how to order and monitor total parental nutrition.
  5. Counseling patients and family members about specific nutritional needs related to stages of the life cycle, lifestyle and habits, disease prevention and/or disease.
  6. Counseling patients on safe lifestyle approaches to weight management and balancing caloric intake and physical activity.
  7. Advising patients about appropriate use of and, when needed, prescribing vitamin, mineral and other dietary and botanic supplements.
  8. Collaborating with registered dieticians and certified diabetes educators, and referring patients to community nutrition resources, including Internet sites.

 

Practice Based Learning and Improvement

Goal 3. The resident must demonstrate the ability to investigate and evaluate the nutritional care of patients, to appraise and assimilate the latest scientific evidence through the critical appraisal curriculum and apply this, as needed, in the field of nutrition and to continuously improve patient care based on constant self evaluation and life-long learning.

Objective 1. The resident will identify his or her strengths and limits in expertise via pre- and post tests and study of the Home Study Monograph. Progress will be measured via these scores. The resident will also have progress monitored by evaluations by faculty and office staff.

Objective 2. The resident will use the Monograph assignments and nutritional curriculum to improve knowledge and seek out faculty advisor if a more individual study plan is needed.

Objective 3. The resident will participate in nutritional education of the patients and their families at appropriate encounters. This will be measure by observation by staff and attendings in the 360 degree evaluation and review of progress notes by attendings

Objective 4. The resident will appraise and assimilate evidence from scientific studies, assigned readings and lectures regarding nutrition and be able to apply it to their patient’s care as measured by observation by staff and attending evaluation and review of progress notes by attendings

Interpersonal and Communication Skills

Goal 4. The resident must demonstrate Interpersonal and Communication Skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals

Objective 1. The resident will provide time effective and understandable nutritional referrals to their patients in the outpatient setting as measured by observation by preceptor and review of progress notes and 360 degree evaluation including staff and patient satisfaction survey.

Professionalism

Goal 5. The resident will demonstrate an adherence to carrying out professional responsibilities and adherence to ethical principles.

Objective 1. The resident will demonstrate sensitivity to the ethnic and cultural nutrional diversity and respect and foster good nutrition in the patient’s cultural context as measured by observation by preceptor and review of progress notes , staff feedback and patient satisfaction survey (360 degree evaluation.)

Systems-based Practice

Goal 6. Residents will demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Objective 1. The resident will consult nutrition professionals appropriately and communicate effectively with them to enhance patient safety and improve quality of patient care. This will be measured by faculty evaluation and clinical staff evaluation.

Resources

  1. Physician's curriculum in clinical nutrition- A competency based approach for primary care, Kansas City, MO: Group on Nutrition Education, Society of Teachers of Family Medicine, 1995.
  2. Manual of Clinical Dietetics, 5th edition. Chicago, IL: The American Dietetic Association, 1996.
  3. Mahan LK and Escott-Stump S. Krause's Food, nutrition and diet therapy, 10th ed. Harcourt, Brace and Co. 1999.
  4. Modern Nutrition in Health and Disease, 9th Edition, Williams and Wickins, 1999.
  5. Medical Nutrition and Disease, Blackwell Science Inc., 1996.

Web Sources

  1. American Dietetic Association: http://www.eatright.org
  2. Arbor Nutrition Guide: http://www.arborcom.com
  3. National Center for Complementary and Alternative Medicine: http://nccam.nih.gov
  4. Office of Disease Prevention and Health Promotion: http://www.odphp.osophs.dhhs.gov
  5. USDA Center for Nutrition Policy and Promotion: http://www.usda.gov/cnpp
  6. CNN health-related site: http://www.cnn.com/HEALTH

Published 8/89
Revised 7/95
Revised 06/00

Revised and adapted June 2008 KS