There have been several major modifications in the Harvard Medical School (HMS) curriculum over the last decade. In 2015, formal instruction in clinical nutrition changed from a stand alone course during the second year of medical school to an integrated theme throughout the four-year curriculum. Division of Nutrition (DON) faculty have actively participated as directors and tutors for the clinical nutrition course and now participate in the development of nutrition educational materials used by other courses in the curriculum.
In 2015 a Nutrition Curriculum Committee was established to develop a nutrition curriculum for medical students during each year of the medical school experience based on the change to the curriculum structure. Committee members varied in their research and clinical interests and represented all of the major HMS teaching hospitals. Areas of interest include gastroenterology, cardiology, obesity medicine, primary care medicine, lifestyle medicine, complementary and alternative medicine, psychiatry, dietetics, endocrinology, surgery and anesthesiology and critical care medicine. The committee worked with established courses and clinical rotation directors, creating novel methods to teach nutrition – for example, doctor-patient role-playing, case-based learning, flipped classroom, etc. The committee has provided both educators and materials that are currently used in the four-year curriculum.
A current “Pathways” curricular map is available here.
The Pathways curriculum begins with the foundational building blocks to study medicine through didactic course work integrated with the basic and social science courses.
Given the recent change in curriculum, the time and duration of nutrition education has been altered to fit the new system-based learning modules. Core nutrition principles are covered in several of the core courses including: Practice of Medicine (POM), Immunity in Defense and Disease (IDD), Essentials, Homeostasis I, Homeostasis II, and in elective or optional workshops for examples in Professional Development Week (PDW) or Transition to Principal Clinical Experience.
Topics include the impact of nutrient deficiencies on anemia and other diseases, role of nutrition in chronic diseases (diabetes, hypertension, osteoporosis, gout, celiac disease, obesity, etc.), enteral and parenteral nutrition, eating disorders, bariatric surgery, and common diets (e.g. Mediterranean diet). In the primary care sessions (Fundamentals of Clinical Care) of POM, educational material covers motivational interviewing concepts, and how to discuss challenges in access to food and healthy plate concepts with patients.
Principal Clinical Experience (PCE) Phase
This 12 month integrated program of study provides students a base clinical exposure to the broad disciplines of medicine and experiences at a single hospital.
Post PCE Phase
For remaining time in medical school, students engage in rigorous coursework with a new and deeper understanding of its importance through advanced integrated science courses (AISCs), clinical electives, and scholarly research projects. Students are required to take two AISCs courses among multiple offerings and have the opportunity to take several clinical electives.
Advanced Integrated Sciences Course (AISC)
Course directors: Marie-France Hivert and Christopher Duggan
The Metabolism, Nutrition and Lifestyle Medicine AISC has been offered since spring 2019. The course covers a broad range of topics including how nutrition and lifestyle choices influence health and diseases throughout the life course; nutrition, physical activity, and behavior change as integral part of management of many medical conditions; novel technologies to measure lifestyle behaviors; and behavioral approaches for clinical integration and for personal health.
Students have the opportunity to participate in a wide variety of specialty clinical programs, including weight management, diabetes care, hyperlipidemia, parenteral nutrition, neonatal intensive care units, celiac disease, and others. In-class sessions include students’ clinically inspired questions, case-based collaborative learning, journal clubs, and experiential learning. Students have the opportunity to gain experience in reviewing critically the current literature, summarizing their review findings, and presenting in front of their peers.
This AISC combines the expertise of multiple faculty members across HMS-affiliated institutions to offer students the opportunity to expand their knowledge and skills to integrate nutrition, physical activity, and other lifestyle behaviors in their future career.
Electives in Nutrition
The variety of interests and backgrounds in nutrition is represented by DON faculty in the major HMS teaching hospitals during clinical rotations. Currently, with the change in the HMS curriculum, most of clinical nutrition education occurs in clinical rotations in the inpatient and outpatient setting. DON faculty precept medical students.
Site: Boston Children’s Hospital
Course Directors: Sarah Fleet, Alan Leichtner
Site: Mass. General Hospital
Course Directors: Stephen Hardy, Esther Israel, Alberto Puig
Site: Boston Children’s Hospital
Course Directors: Christine Lee, Alan Leichtner
Sites: Institution outside of the US
Director: Nicte Mejia