4 areas where doctors lack training—and what to do about it

Naveed Saleh, MD, MS | November 23, 2021

Medical education at both the undergraduate and postgraduate levels is dynamic. Resources are expended to ensure that education evolves with time, but is it enough?

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Medical students around a table

Medical education is still lacking in certain areas, including nutrition, LGBTQ issues, and more.

For example, The AMA’s Accelerating Change in Medical Education initiative joins forces “with visionary partners to create bold innovations” to offer resources for learners and educators. They also hold national events, which help physicians improve their practice of medicine. 

Despite such efforts, however, many physicians still lack appreciation for certain integral fields of healthcare. Here’s a closer look.

Clinical nutrition

Dietary factors are the top cause of death—even beating out smoking—according to research cited in a commentary published in The Lancet. Despite the importance of nutrition, however, medical education on the subject is deficient.

In a systematic review published in The Lancet Planetary Health, authors include 24 studies covering nutrition education in US medical schools and others around the world. The authors found that although there is a limited nutrition curriculum in schools, medical students are highly interested in the subject. Moreover, this interest decreased as students approached graduation from medical school—likely because the importance of nutritional intervention was not stressed.

The authors advised that nutritional interventions should be offered by a team of health professionals. But without a solid foundation in nutrition education, physicians can’t counsel their patients on nutrition basics or make proper referrals.

To improve physician knowledge of nutrition, the authors recommended making “nutrition education compulsory in medical training, establishment of nutrition competencies to provide a benchmark for nutrition knowledge and skills to be included in curricula, and supported by funding for innovative curriculum initiatives.”

For clinicians interested in learning more about clinical nutrition, the Physicians Committee for Responsible Medicine offers free CME on the topic.

LGBTQ issues

Research on cultural competency among physicians with respect to LGBTQ issues is just emerging. In a study published in the Journal of Homosexuality, authors surveyed 127 primary care physicians and found that although 78% answered that they were comfortable treating members of the LGBTQ community, 70.1% did not feel that they knew much about LGBTQ healthcare needs, and 74.8% did not feel informed on the specific management of LGBTQ healthcare issues. A majority also didn’t feel that they knew much about referring patients for LGBTQ issues. Moreover, the respondents scored poorly on knowledge questions reflecting LGBTQ topics.

Disconcertingly, the authors found that providers supported biases, negative attitudes, and inconsistencies in the clinical practice regarding LGBTQ care.

“There is a need for greater LGBTQ-specific education to increase providers' comfortability and competency in the needs, management, and referrals within LGBTQ healthcare,” they wrote. 

Specific strategies to boost understanding of LGBTQ knowledge include mandatory events at healthcare institutes, LGBTQ panels addressing medical students during the preclinical years, and clinical years spent on sexual health rotations or in transgender clinics. These measures would represent a marked improvement to the only 5 hours of such education averaged by most medical school curricula. 

For clinicians interested in learning more about the care of LGBTQ patients, Stanford Medicine offers these resources. Also, click here to learn how to make your practice friendly to transgender patients.

Management

Today’s doctors are expected to create better medical outcomes with fewer resources. This tall order requires strong physician leaders. Leadership, however, is not a management skill usually taught in medical school or beyond. Moreover, job training is devoted to such issues as the provision of resources. Other management training areas that are overlooked include conflict resolution and how to give effective feedback. 

In an article published in the Harvard Business Review, authors discuss how physicians can advance through five levels of leadership: 1) individual practitioner, 2) MD leader, 3) market MD leader, 4) group MD leader, and 5) enterprise MD leader.

“Over time,” wrote the authors, “they [the physicians] develop the capacity to lead beyond the clinical enterprise and a more holistic view of the organization’s needs.”

Ultrasound

Ultrasonography is emerging as an important facet of medical school training, thus reflecting its benefits to the clinical practice of medicine. Medical students who learn about ultrasound early on can better use it in their clinical years. Ultrasound crystallizes knowledge about anatomy and physiology, as well as boosts clinical skills.

According to the authors of a review published in Missouri Medicine, various schools have added ultrasound education to their curricula, but there has been no standardization. On a related note, only 5% of medical school education is dedicated to radiology overall.

The authors wrote, “Ultrasound training has the potential to enhance the learning experience for students and improve the quality of their future patient care.”

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