#587：医学培训中应如何教授营养学？——阿卡什·帕特尔

大家好，欢迎收听Sigma营养电台。

Hello, and welcome to Sigma Nutrition Radio.

这是本播客的第587期节目。

This is episode 587 of the podcast.

我是主持人Danny Lennon，非常感谢大家收听我们的节目。

My name is Danny Lennon, and you are very welcome to the show.

今天，我们将讨论医学教育中营养学培训的相关话题，这个讨论其实已经持续很长时间了。

Today, we're gonna be talking about all of the conversation that goes on around nutrition education within medical training, which has, of course, been going on for a long period of time.

关于这个话题存在各种不同观点，不仅涉及可以采取哪些措施，还包括是否需要采取行动。

Various different opinions on this topic, not only what can be done, but if something needs to be done.

最近这个议题变得更加突出，不仅引起了医学项目和学术界的关注，现在更是进入了政策讨论和某些政治对话的范畴。

And this has come more to the forefront even in recent times with not only interest within medical programs and academia, but now more in policy and certain political conversations.

我们开始看到围绕这个问题的专门讨论。

We're starting to see discussions particularly around this.

为了深入探讨这个话题，今天我们邀请到了迈阿密大学米勒医学院四年级医学生Akash Patel加入讨论。

To talk through this idea, today, I'm going to be joined by Akash Patel, who is a fourth year medical student at the University of Miami Miller School of Medicine.

他最近进行并发表了一项试点研究，探讨在医学培训项目中整合更多营养学内容的可能性，评估学生们的兴趣、对他们开展的系列讲座的反馈，以及他们希望未来看到的发展方向。

And he recently ran and published a pilot trial looking at the potential integration of more nutrition within a medical training program, gauging the interest of the students, the feedback on some of the lecture series that they ran and things that they would like to see going forward.

他也密切关注了这一领域已发表的文献，这些文献提出了针对医学生和医学从业者应具备的营养学能力标准，并广泛围绕这一话题展开讨论。

He's also been very aware of some of the literature that's been published in this area that has laid out proposed nutrition competency for medical students and trainees who are going to be go on into careers in medicine and much around this conversation more generally.

因此他非常适合来探讨这些持续进行的对话、提出的潜在构想，以及各种类型的路线图。

And so he's perfectly placed to talk through some of these conversations that have been going on, potential ideas put forward, various types of roadmaps.

如果要改变医学课程设置，应该具体改变哪些内容？

And if something was going to change within a medical curriculum, what things should those be?

这些目标如何实现？

How could they be achieved?

实现这些目标是否现实？

Are they realistic to be achieved?

最佳整合方式是什么？

And what is the best way to integrate that?

我们将深入讨论所有这些议题，希望能就‘是否需要采取行动’这一问题得出一些结论。

So we're gonna be talking through all of this stuff and hopefully getting to a point that covers some of this discussion as to whether does something need to be done?

如果是这样，那么可能在多大程度上实现？

If so, to what extent is it possible?

以及这些变革可能带来的利弊。

And some of the both pros as well as potential cons of some of these changes.

希望您能喜欢。

So, hopefully, you enjoy.

在本期节目的描述框中，您会找到阿卡什发表的那项试点研究链接，以及我们讨论中会提及的其他论文，供您查阅。

In the description box of this episode, you will find a link to that pilot trial that Akash has published, as well as some of those other papers that we're going to reference throughout this discussion, which you can check out.

如果您是Sigma Nutrition高级订阅用户，将获得本期配套的详细学习笔记、完整文字稿，以及对话结束后提供的核心观点摘要。

If you are a Sigma Nutrition premium subscriber, you'll be getting a set of detailed study notes to accompany this episode as well as an episode transcript and the key ideas segment that will happen after this conversation is over.

若您通过公开渠道收听本播客，并希望深化对本期及所有往期内容的理解，不妨了解Sigma Nutrition高级会员服务。

If you're listening over on the public feed of the podcast and you're interested in deepening your learning of not only this episode, but all our podcast episodes, then maybe check out Sigma Nutrition Premium.

我会在描述框放置服务链接，您可详细了解高级会员权益，包括学习笔记、每月专属节目等所有福利。

I'll put a link to that in the description box where you can check out exactly what you get with that when you are a premium member, all the benefits from our study notes, from exclusive episodes each month, etcetera.

当然，这也是支持本播客工作的方式。

And, of course, it's the way to support the work of the podcast.

所以我们依赖我们的忠实听众。

So we rely on our regular listeners.

我们不投放广告，因此非常感谢那些选择成为高级订阅用户并帮助维持节目运行的听众。

We don't run ads, and we are therefore very, very grateful for those of you who choose to be a premium subscriber and help continue this thing keep running.

所有这些链接都会放在描述栏里供大家查看。

So that will all be linked up in the description box for you to check out.

现在，让我们开始与阿卡什·帕特尔的对话吧。

But for the moment, let's dive into this conversation with Akash Patel.

我们开始吧。

And here we are.

阿卡什·帕特尔，非常感谢你今天抽空来参加我们的播客。

Akash Patel, thank you so much for taking the time out to come and join me on the podcast today.

谢谢邀请。

Thank you for having me.

我听过很多期Sigma Nutrition的节目，能参与其中感觉很棒。

I've listened to a lot of episodes of Sigma Nutrition, so it's cool to be on here.

是啊。

Yeah.

正如我刚才提到的，很高兴我们这次能进行一次更正式的交谈，而不是像之前那样零散的沟通。我们会深入探讨许多有趣的话题，我相信大多数从事健康相关专业的人都会对这些讨论有所耳闻。

As I was mentioning to you, it's great that we're getting to actually have a more formalized chat here as opposed to some of our previous communication, and we'll get into a lot of interesting topics that I think most people who are in a health related professional field will have heard some of these conversations come up.

双方观点可能都存在争议点，稍后我很想听听你的看法。

There's probably points of debate on both sides, which I'd love to get your take on a bit later.

你还做过一些非常有趣的创新性工作，我们稍后会具体讨论。

And you've done some really interesting kind of innovative work that we're going to discuss specifically.

不过在开始之前，能否先向大家介绍一下你自己，包括你的背景以及与我们今天讨论话题相关的任何兴趣领域？

But before all that, could you maybe give people an introduction to who you are, your background and any of your interests that will then relate to our topic of discussion today.

好的。

Sure.

简单介绍一下我自己。

So a little bit about me.

我现在是迈阿密大学医学院四年级的学生。

I'm a fourth year medical student at the University of Miami right now.

在纽约长大。

Grew up in New York.

本科在华盛顿特区就读。

Did my undergrad in DC.

当时是医学预科生。

Studied I was premed there.

主修商科会计专业，辅修生物和化学。

Studied business with an accounting major, bio and chemistry minors.

后来来到迈阿密，正在攻读医学博士和工商管理硕士学位。

And then I came down to Miami where I'm getting my MD and my MBA.

今年五月刚毕业，个人对医学领域非常感兴趣，特别是疾病预防、慢性病防治以及生活方式医学方面。

So I graduated May and a lot of personal interests in medicine related to prevention and chronic disease prevention and lifestyle medicine as well.

太棒了。

Fantastic.

在深入探讨你的具体工作之前，正如我所说，这个话题涉及许多人都感兴趣的领域——我们近期看到医学教育中对营养学培训日益增长的关注。

And so before we get to your specific work, I think it touches on, like I said, that topic that's of interest to a lot of people, this even increasing attention that we've seen more more recently in nutrition education within medical training.

正如我提到的，我们会有一些具体要讨论的要点。

And like I mentioned, there's some points specifically that we'll debate.

但在深入之前，你能先给大家一个概览吗？

But before we get into that, can you maybe give people at a very overview level?

因为这显然取决于人们所在的位置、具体的医学课程等等因素。

Because this obviously depends on where people are placed, the specific medical program, all that type of stuff.

但作为一个关于为何这是个讨论话题的入门解释，你能给我们介绍一下目前许多医学课程中常见的营养教育现状吗？

But as a kind of general entry as to why this is even a topic of conversation, can you maybe give us an insight into the current typical situation in relation to nutrition education that might be common within many medical programs?

之所以说这是个问题，正如你提到的，是因为存在脱节。

The reason why it's a bit of a situation, like you mentioned, is because of the disconnect.

比如当你看到有多少疾病与饮食和不良饮食相关时，如果你看《全球疾病负担》这类研究，饮食风险因素往往是导致伤残调整生命年的首要原因。

When you look at, for example, how much of disease is related to diet and suboptimal diet, if you look at studies like the global burden of disease, dietary risk factors tend to be the leading cause of disability adjusted life years.

因此你会期望医学教育应该包含对健康影响最大的因素。

And so it seems to be that you would expect in medical training to include the things that influence health most.

所以这对我来说确实是个很大的脱节点。

And so that was definitely a big disconnect for me.

我进入医学院时的期待与实际看到的情况存在巨大落差——营养学并未受到足够重视。

My expectation going into medical school versus seeing that that actually wasn't a huge emphasis.

请注意，我们确实为患者提供了许多挽救生命的卓越治疗，但其中生活方式医学的内容却相对匮乏。

And mind you, we do a lot of amazing life saving care to provide to patients, but you don't see as much of the lifestyle medicine in there.

这就是我们当前面临的脱节现状。

And so that's the disconnect that we're working with.

就现有医学课程而言，这个问题已持续数十年——人们一直呼吁加强对医师的营养学教育。

In terms of what's actually existing in medical curricula, this has been an ongoing issue for decades actually where there's been a call for more nutrition education for physicians.

现有课程大多不涉及饮食、食物和宏量营养素如何影响疾病风险的内容。

Most of what does exist is not by way of diet and foods and macronutrients and how they influence disease risk.

现有的营养学教育主要集中在特定营养问题上，例如营养缺乏症的背景。

What does exist is specific nutrition in terms of, for example, the con in the context of nutrient deficiencies.

比如糙皮病（维生素B3缺乏症）或硫胺素缺乏症这类情况。

So pellagra or, like, a vitamin b three deficiency or a thiamine deficiency.

这些病症的临床表现及其病因是怎样的。

How these these would present clinically and what would be the causes of those.

所以这是一个非常孤立、非常狭窄的营养学范畴，而非大多数人认为的临床技能——实际指导患者改变饮食模式。

So So it's a very isolated scope, a very narrow scope rather, of nutrition, but not what most people think about in terms of the clinical skills to actually counsel patients on dietary patterns and make those changes.

正如我们稍后可能会讨论的，不同人对这个问题有不同的看法，包括应该采取什么措施，甚至是否应该采取行动，我们可以稍后详谈。

And as we'll maybe talk to later, various people have different opinions on this about what should be done, but also whether something should be done, and we can get to that.

但从大多数人思考的角度来看，如果我们已经发现了一个潜在问题，即你指出的这种脱节现象，那么已经有人提出了各种可能的解决方案。

But from the perspective that most people are thinking about, okay, if we've identified a potential issue here, this potential disconnect that you've outlined, then there's been various hypotheses put forward about things we can do.

当然，接下来我们需要实际观察这些方案的实施效果。

But of course, then we have to go and see how these would actually play out.

而你已经迈出了这一步，参与并发表了这类试点研究，探索初步可行的措施。

And you've actually taken that step and been involved with this kind of pilot that you've published around some of these initial steps to see what can be done.

你能给大家简单介绍一下这个试点项目吗？包括这个想法是如何产生的，以及与之相关的一些核心概念。

Can you give people an entry into this a bit about the pilot program, how that kind of idea came about, and some of the initial kind of key concepts related to it.

好的，当然可以。

Yeah, absolutely.

就像我说的，这种脱节现象在我医学院第一年时就变得非常明显。

So like I said, there was this disconnect that became very apparent to me during my first year of medical school.

在我医学院的第二年，我一直在思考如何真正做出一些改变来解决这个我热切希望弥补的差距？

And then during my second year of medical school, I was thinking about how can I actually create some change to address this gap that exists and that I'm passionate about addressing?

于是我联系了学校的行政部门，非常感谢我就读的学校非常乐于接受学生的反馈。

And so I'd approached administration at my school, which I'm really thankful that I go somewhere where they're very receptive to student feedback.

我知道很多学生试图在他们的医学院推动变革时遇到了更多阻碍，所以我对此确实心怀感激。

I know a lot of students have tried to implement change at their medical schools and meet more barriers, so I'm definitely grateful for that.

是的。

Yeah.

他们基本上告诉我，让我提供一些想法。

They basically told me, give us some ideas.

比如，你如何看待这个方案融入课程体系？

Like, how do you see this playing out into the curriculum?

我们可以尝试哪些初步措施？

What are some initial things we can do some trial and error with?

于是我准备了一些营养学材料，最终形成的结果就是在医学院开设了一个系列讲座。

So I came up with some nutrition materials, and basically what it ended up amounting to was a lecture series at the medical school.

这就是最初开展这个系列讲座的阶段。

And so that was the initial phase of delivering this lecture series.

学生们反馈非常好。

There was great feedback from students.

我收集了一些数据。

I collected some data.

教职员工对此非常感兴趣，希望能看到更多内容。

Faculty was really interested in seeing more of it.

这种势头帮助我们开始思考如何建立更持久长效的机制。

And so that momentum then helped us lead into how can we create something more permanent and long term?

因为系列讲座的效果非常有限。

Because a lecture series is effective to a very limited level.

这是因为这是一种非常被动的学习方式。

And that's because it's very passive learning.

而且，如果这些讲座没有长期持续开展，学生们可能一时兴奋或记住讲座内容，但很快就会遗忘殆尽。

And also, if it's not spread out over a long period of time, then students might be excited for a little bit or remember things from the lecture, and then it dies out pretty quickly.

它还依赖于有人来授课。

And it's also dependent on someone being there to deliver the lectures.

所以目前一直是我在授课，但如果我毕业了，这个项目就会中断，效果就大打折扣。

And so as of right now, I've been delivering the lectures, but if I graduate and that dies out, then it's not very effective.

因此，关于如何将饮食营养课程有效纳入医学院课程体系，其实与处理医学院其他科目的思路非常相似。

So thinking a lot about how to effectively implement a robust curriculum on diet and nutrition into medical school really is very similar to how we would treat any other topic in medical school.

它必须贯穿整个课程体系。

It has to be layered throughout the curriculum.

必须是长期持续的。

It has to be longitudinal.

其中很大部分必须是强制性的，且具有可持续性。

There has to be a good portion of it that's mandatory and has to be sustainable.

所以不能只依赖某一位教员。

So it can't be dependent on one faculty member.

如果他们离职，项目就会随之终止。

And if they leave, then it just dies out.

因此，在与行政部门的合作中，我开始考虑所有这些不同的因素，学习更多关于医学教育的知识，以及如何真正建立一个正式的课程体系——就像大多数事情一样，这比看起来要复杂得多。

So these are all different considerations I started to have working with the administration, learning more about medical education and how to actually create a formal curriculum, which as most things are, it's more complicated than it seems.

我知道很多人会想，直接多教医生一些营养学知识不就行了。

I know for a lot of people, they're like, just teach doctors more nutrition.

而我之前对这个问题的理解确实很天真。

And I definitely had a naive concept of that.

我当时觉得，是啊，这很简单。

I'm like, yeah, it's simple.

多教他们一些营养学知识。

Just teach them more nutrition.

但当你真正深入探讨如何构建课程体系时，不仅仅是设计课程，还要教授相关技能，对吧？

But when you actually get into the nitty gritty of how does that look in terms of creating a curriculum and not just creating curriculum, but teaching the skills, right?

你必须将知识与患者互动的技能相结合。

You have to pair the knowledge with the skills of interacting with patients.

所以我们在医学院有一种叫标准化病人的设置，基本上就是请演员来扮演患者，这些付费演员能让我们实际练习这些咨询技巧。

And so one thing that we have in medical school are called standardized patients, which are basically actors that come in and act as patients, and they're paid actors to actually practice these counseling skills.

另一个需要考虑的组成部分是评估。

And then another component to consider assessments.

你还需要评估学生的知识水平，确保这些技能在进入住院医师阶段前达到一定水准，假设存在你想要满足的某种能力标准。

You also have to assess students' knowledge, make sure that these skills are at a certain level before they go into residency, assuming that there's a certain competency that you want to be met.

太棒了。

Fantastic.

所以我确实想深入探讨你提出的这些想法。

So and I do wanna get into some of these ideas that you've put forth.

但就试点项目而言，你提到获得了积极反馈，存在那种最初的热情和收益。

But just in relation to the pilot, you mentioned that there was this kind of positive feedback and there was some that that initial excitement and benefit.

能否具体说明你是如何评估的？比如收集了哪些数据，以及从参与者那里获得的其他见解——无论是正式还是非正式的。

Can you maybe give us an idea of specifically some of the ways you went about evaluating that some of that data you collected and maybe some other insights whether formal or informal that you may have collected from people.

从正式层面来说，我们主要收集了调查数据。

Formally speaking, we collected mostly survey data.

具体是在讲座前后进行的会前与会后调查数据。

So it was pre and post session survey data before and after the lectures.

因此我们既测试了学生的知识水平，也评估了他们对营养教育的认知。

And so we tested both student knowledge as well as perception of nutrition education.

从知识层面来看，他们在我们评估的循证营养主题上的知识水平有明显显著提升。

So from the knowledge standpoint, there was a clear significant increase in their knowledge level of evidence based nutrition topics that we were assessing.

从认知角度，我们询问了几个问题。

And then from the perception standpoint, we asked a few questions.

我们提出的问题包括：你们从社交媒体获取信息的比例有多大？

We asked questions along the lines of what proportion of your information do you get from social media?

在进入医学院之前，你对包含营养与生活方式医学的医学教育有何期待？

What was your expectation of medical education including nutrition and lifestyle medicine before coming into medical school?

这是否是你希望看到更多内容的方向？

Is this something that you would like to see more of?

我们收集的数据基本结论是：这正是学生们期待的内容，他们明确希望增加这方面教学，且目前对相关咨询缺乏信心。

And basically the overall gist of the data that we collected was that this was something that students were expecting and that they definitely wanted to see more of and that they didn't currently feel comfortable counseling on.

我认为学生只是其中一环，如果我们查看该领域已发表的关于医生和患者的其他调查数据，结果都指向同一结论——医生常感到准备不足。

And so I think students are one component, but if we look at other survey data that's been published on physicians and patients in this realm, It all aligns with the same thing, which is that physicians often feel underprepared.

我们已发布的患者调查数据显示，患者普遍期望他们的医生在营养学方面受过良好训练。

And the survey data that we have published from patients is that there's an expectation that their physician is going to be well trained in nutrition.

虽然过去几年情况可能有所变化，但传统上调查数据一致表明：患者期望医生具备扎实的营养学知识，并视其为营养信息的主要可信来源。

And so this might have changed in the last few years, but traditionally, that was what survey data consistently showed is that patients expected their physician to be well trained in nutrition and trusted them as their primary source of nutrition info.

当然，现在这种信任已更多转向社交媒体等渠道。

And, obviously, that shifted now more towards social media channels and things like that.

但这表明，无论是医学生、医生还是患者自身，在‘知识来源’与‘应有来源’之间都存在错位。

But it just shows that both for medical trainees, for doctors, and for patients themselves, there's this misalignment in terms of where is this knowledge coming from and where should it be coming from.

你提到了你规划的路线图，并强调了可持续性及规模化扩展等关键要素。

You alluded to this kind of road map that you've laid out, and you mentioned some of these important things around sustainability and how this might scale up.

我想你还略微提及了那些至关重要的结构性支持。

And I think you alluded a bit to those structural supports that are critical.

能否请你进一步谈谈这种复杂性？当我们最初想着‘增加些营养教育’时可能并未意识到的那些层面？

Could you maybe speak a bit more to that of this complexity that maybe we don't realize at first when we think, oh, let's go and just put in some more nutrition education?

如果要实现可持续发展和规模化，哪些结构性支持是真正关键的呢？

What are some of those structural supports that are really crucial if this is going to be sustainable and scale?

在探讨有效课程构成之前，我认为首先需要承认一个根本障碍——医学课程本身的空间就极其有限。

Before I get into what makes up an effective curriculum, I think it's important to also acknowledge that it's very the first barrier is that there's so little room in a medical curriculum to start with.

因此你实际上是在争夺教学空间。

And so you're fighting for space.

一直以来都有这样的统计数据存在，比如医学知识大约每77天就会翻倍。

And there's these statistics that have always been out there, like medical knowledge doubles roughly seventy seven days or something like that.

因此社会对医生为保持医学前沿知识所需掌握内容的期望，正以指数级速度增长。

And so the expectation of what physicians should know to keep on top of medical knowledge is constantly growing at an exponential rate.

这就带来了一个日益严峻的挑战：我们该如何在这四年里持续有效地教授最重要的内容。

And so there's this increasing struggle of how can we continue to effectively teach the most important things in these four years.

所以当你突然提出'我认为还应该增加这个教学内容'时...

And so now if you come in and say, hey, here's another thing that I think should be taught.

请注意，LCME（制定医学院必须达到的能力标准的医学教育联络委员会）并未将营养学列为必修能力项。

And mind you, one that's not required by the LCME, the liaison committee for medical education that sets the competencies that need to be met at medical school, it's not required for nutrition to be met as one of those competencies.

这使得'我们应该增加这个'的提案变得更加难以推动。

And so it makes it even tougher of a case to say, hey.

是啊。

Yeah.

你们应该把这纳入课程，这就是它的价值所在。

You should include this in your curriculum, and this is why it's worth it.

我是说，这也不在我们的执业考试范围内。

I mean, it's also not tested on our board exam.

所以我认为这是当前的一大障碍。

So I think that's one of the big barriers right now.

因此如果LCME方面能推动将营养学能力纳入要求，那将是重大进步，因为这能激励医学院校自主开设相关课程。

And so if from the LCME side, there is a push to include nutrition competencies, then I think that would be a huge step because it'll incentivize medical schools to start including it themselves.

但就目前而言，从执业认证角度对学生没有任何激励。

But as of right now, there's no incentive from the board certification side of their students.

接下来我可以谈谈如何构建一个有效的课程体系。

And then I can go into what would make up an effective curriculum.

实际上通过梳理文献中各大医学院早期项目的现有成果——毕竟过去二十年里人们一直在尝试创建试点项目，各校成效参差不齐——我有了新的认识。

And really what I realized is when I scoured the literature of what exists out there at different medical programs in terms of early initiatives, because people have been doing this for the last two decades where they're trying to create their own pilot programs at different schools, some more than successful than others.

我意识到其中很大一部分的实施非常薄弱，比如只是一次性的营养课程，或者可能在教学厨房里有几节课，但都没有形成非常系统的体系。

I realized that a large portion of it would be very weakly implemented in the sense that it's a one off nutrition session or it's maybe a few sessions in a teaching kitchen, but there was nothing very robust.

这一点实际上在今年美国医学院协会的一项调查中得到了反映。

And this was actually reflected in a survey by the AAMC this year.

也就是美国医学院协会。

That's the Association of America American Medical Colleges.

他们发现100%的学校都教授某种形式的营养内容或让学生接触相关内容。

They found that a 100% of schools teach some sort of nutrition content or have exposure to it.

但其中不到50%的学校在多门课程中设置相关内容，只有17%的学校真正实现了医学院预科与临床培训阶段的纵向整合教学。

But then it was less than 50% have it across multiple courses, and then only 17 actually had longitudinal integration across preclinical and clinical training in medical school.

因此我认为这凸显了接触与能力培养之间的差异。

And so I think that highlights that there's a difference between exposure and competency.

你可以接触这些内容，但真正的能力培养需要通过重复教学、重复反馈与评估，以及像我所说的测试他们的咨询技巧来实现。

You can be exposed to this, but true competency is achieved by repetitive teaching, repetitive feedback and assessment, and also testing, like I said, their counseling skills.

考虑到所有这些因素，我认为需要实施的措施必须采取多管齐下的方式，不能仅限于单一的教学场景。

And so that with all that in mind, kind of the things that I think about that need to be implemented are it has to be a multipronged approach, so not just in one type of teaching setting.

我们可以探讨几种我认为应该整合在一起的不同方法。

And we can go through a few of the different methods that I think would be good to integrate together.

同时这必须是一个必修组成部分，因为如果现在只是选修课程，不是每个人都能接触到它。

As well as a mandatory component, because if it's just an optional course now, not everybody's getting exposed to it.

它必须具有可持续性，因此需要建立一个稳固的架构，确保不依赖于任何可能随时离职的教职人员。

It has to be sustainable, so there has to be a robust structure in place to make sure that it's not dependent on one faculty member that could leave at any time.

它必须比所有在任教职人员的任期更长久。

It has to outlive all of the faculty members that are there.

我认为这些是主要组成部分，同时还需要贯穿整个学习周期。

I think these are the main components as well as being longitudinal.

这就是我们在医学院教授其他任何内容的方式——如果我们真的希望达到这种能力标准的话。

And so this is how we would teach anything else in medical school if we really wanted this competency to be met.

我们不会只在一节课上学习比如慢性肾病之类的知识。嗯。

We don't just learn, like, chronic kidney disease in one lecture Mhmm.

然后你就再也不接触这个内容了。

And then you never do it again.

你会学习慢性肾脏病的知识

You learn about chronic kidney disease.

你会反复接触相关内容

You get repeated exposure.

然后通过病例学习，讨论慢性肾脏病患者的案例

Then you do cases where you learn about a patient with chronic kidney disease and talk through the cases.

接着可能会安排标准化病人问诊，由专业演员扮演慢性肾脏病患者，之后在肾脏科轮转时你还会遇到这类病例

And then you might have a standardized patient encounter where the patient that's a paid actor has chronic kidney disease, and then you see chronic kidney disease when you do your nephrology rotation.

因此要真正培养医生的这项技能，就必须达到同等程度的重复训练，而不是仅仅在课程表上打个勾表示他们接触过这个内容

So that same level of repetition needs to be met to actually develop skills for physicians if you're gonna be serious about including this in the curriculum as opposed to just checking the box of, yes, they're exposed to it.

没错

Right.

因为我想这正是风险所在——我们可能会说要在某些课程中增加营养学教育

And because I guess that's one of those risks, right, that we could say, oh, we're going to increase nutrition education in some of these programs.

然后就只是塞进去几节课

We'll put in some of these lectures.

正如你所说，这只是一个象征性的姿态，因为到头来，我们真的能培养出营养知识更丰富、能力更强的医生吗？还是仅仅像你说的那样，让他们接触过某些讲座，而非真正掌握相关能力。

And as you say, it's a token gesture as because at the end, are we really getting more educated, more competent physicians with nutrition knowledge or just the exposure, as you said, they've been exposed to certain lectures rather than developing a competency.

所以这也许就是关键区别所在——我们不想做这种走过场的表面功夫。

And so that's, maybe that crucial distinction there that we don't want this check the box exercise.

我们真正需要的是能融入课程体系的内容。

We actually want something integrated.

这又回到了你之前提到的观点，其他人也在担忧：这部分内容该放在哪里，能放在哪里。

That kind of circles back to a point you've already mentioned that other people have concerns about where does this fit in, where can it be fit in.

我认为这涉及到几个问题。

And this relates to, I think, a couple of topics.

首先是课程本身已经非常紧凑了。

One is, right, the idea the program is already so packed.

如果我们要以必修形式纳入这门课，并且要保证教学连贯性、接触频率和学习深度足以产生实际效果，那么如果不替换现有内容，该削减哪些部分？

If we're gonna include this in a obligatory manner, in a way that is consistent and then is enough exposure, enough touch points, enough learning that is gonna be meaningful, what has to be replaced if not?

如果不替换其他内容，我们岂不是要让本已超负荷的课程体系更加不堪重负？

And if something else is not replaced, then are we just gonna be overloading an already jam packed program for people?

因此存在这类担忧。

And so there's that type of concern.

有哪些方法能最好地考虑到这一点，或许能开发出避免落入这种特定陷阱的方案？

What are some of the ways that might be best able to, take into that into account and maybe develop something that doesn't fall into that particular trap?

是的。

Yeah.

我认为最有效且不占用太多空间的方式之一，是许多学校采用的基于案例的学习方法。

So I think one of the most efficient ways that doesn't take up too much space per se, but still is effective, is a lot of schools participate in case based learning.

这是一种非常流行的教学方法。

It's very popular teaching method.

举例来说，如果我们医学院一年级上午有一节关于高血压的讲座，之后我们会分成小组在实体教室（而非Zoom分组讨论室）与导师一起，通过一系列问题来研讨病例。

So for example, if we have a lecture in the morning during our first year medical school on hypertension, Then we would break out into small rooms physically in person, not, Zoom breakout rooms, but you would break out into rooms with the facilitator, and we would work through a case with all these questions.

它会提供患者病史，然后提问：你想询问哪些问题？

So it gives you the patient history, and then it's like, what questions would you like to ask?

什么？

What?

然后你会逐步推进整个病例，从病史到治疗方案再到计划等等。

And then you slowly move through the whole case getting from history to treatment to plan and all that stuff.

所以我认为非常有效的是——至少我现在在学校正在做的是——我收集了所有学生在第一年学习的病例。

And so what I think is very effective is if you can what I'm working on right now in my school at least is I have all the cases that the students go through in their first year.

我正在研究其中哪些疾病与饮食高度相关。

And I'm looking at where are there diseases that they're looking at that are highly related to diet.

因此只需在这些病例中整合一两个关于饮食的问题，并将其贯穿整个课程，我发现这是一种极其高效的方式，因为它无法被轻易忽略。

And so just integrating one to two questions on diet in those cases and weaving it throughout the curriculum, I find is a super efficient way because it can't be easily dropped because it's woven throughout.

通过重复接触，他们会在潜意识层面反复认识到饮食的重要性（抱歉），这种重复接触会在潜意识中强化饮食和生活方式对未来患者的重要性。

It is repetitive exposure, so they're seeing the importance of diet on repetitive, excuse me, on a repetitive basis, which at a subconscious level reinforces the importance of diet and lifestyle in their future patients.

所以我认为这是个非常有效的方法，因为它不会增加太多时间，同时还能让你有机会在他们思考真实病例时加入一些基于证据的问题。

And so I think that's a really effective method because it doesn't add a lot of time, but it also gives you an opportunity to add in some evidence based questions as they're thinking through a realistic patient case.

这正好涉及我本想问你的问题：如果我们考虑制定一个潜在的教学大纲，应该包含哪些内容？更重要的是，哪些内容不应该包含？

And that that touches on something I was gonna ask you about of if we were thinking about a potential syllabus, what should be included and importantly, what shouldn't be included?

因为我们显然无法奢望包含营养学四年制课程中的所有内容。

Because we obviously don't have the luxury of including everything someone would get in a four year dietetics program.

因此，鉴于我们有限的时间，我们会非常精挑细选，确保学习内容能带来最大效益。

And so we're going to be very selective given the amount of time we have, but also that it gives us the most bang for our buck for that learning.

正如你刚才提到的，我们可以通过关注那些与营养关系最密切、医生未来最常接触的内容，并思考其与典型患者诊疗的关联来实现这一点。

And as you've just alluded to, there's ways to do that of thinking about those things that have the biggest relation to nutrition that are going to be encountered by doctors going forward and then thinking how that relates into a typical patient interaction.

能否请你再从你的角度详细谈谈，具体应该包含哪些内容？以及我们如何精准聚焦这个问题，确保所选内容既能深入学习又具备可操作性？

Can you maybe talk a bit more about for your perspective again, what specifically are those things that maybe should be included and how we can really narrow down that question to make sure we're just selecting something we're getting able to learn in enough detail.

幸运的是，我们不必从头开始这项工作，因为去年《美国医学会杂志》发表了一篇共识声明。

So fortunately, we don't have to do that work because there was actually a paper published last year in JAMA, and it was a consensus statement.

这是由医学教育界人士和营养专家共同制定的，明确了营养学相关核心能力标准。

It was a bunch of people in medical education as well as nutrition experts that came together to determine what these core competencies should be related to nutrition that should be met.

这篇论文影响深远，几乎已成为众多医学院营养教学内容的指导纲领——毕竟这个领域实在太广泛了。

And so that was a huge paper in terms of its impact because it's almost become a guide for a lot of medical schools on the what of what to teach related to nutrition because it's so broad.

我意识到我们在营养学教学实施上存在严重的碎片化问题。

And so one of the things that I've realized is that we're very fragmented in our implementation of nutrition.

具体来说，虽然我在自己的医学院启动了试点项目，但全国各地的医学院师生都在尝试各种差异显著的实施方案，彼此间缺乏联系。

And what I mean by that is I've started this pilot initiative at my medical school, but there are students and faculty all over the country at different medical programs trying out different forms of implementation that look very different than mine, and it's very disconnected.

因此，如果我们真的希望这些能力标准能在全国范围内达成，就需要某种形式的标准化。

And so if we actually want this to be a competency, these competencies that are met at a national level, there needs to be some sort of standardization.

我们之间如此脱节，以至于在我自己机构启动这项倡议后，有人联系我说，嘿。

And we're so disconnected that I had people after I started my initiative at my own institution reach out to me and say, hey.

其实我们一直在研究这个。

We've actually been working on this.

所以即便在同一机构内，我们虽然追求相似目标，却如此缺乏联系。

And so even within the same institution, we're working on similar goals, but we're that disconnected.

因此我认为关键一点是：我们需要全面推动标准化工作。

And so I think that that's one thing is that we really need to work on standardization across the board.

我觉得那份JAMA共识声明——虽然我已发给您，但我们可以把它分享给听众放在节目备注里，这会很棒——真正提供了'应该实施什么'的指导。

I think that that JAMA consensus statement, which I sent to you, but I think we can share it with your audience in the show notes, which would be great, really is providing the what of what should be implemented.

而我们正在审稿中的论文最终将阐明'如何实施'。

And then our paper that is laying out that's in the review process right now ultimately lays out the how.

应该如何将这些内容纳入课程体系？

How should you implement this into your curriculum?

比如，应该采用哪些不同的教学方式，既不会占用太多空间，又能有效地将其融入课程体系。

Like, which different teaching modalities should you use that won't take up a lot of space but will effectively implement this into the curriculum.

因此我认为这两者结合起来，确实为我们指明了前进的方向——营养教育的'内容'与'方法'。

And so I think those two together really are the blueprint for our steps forward, the what and the how of nutrition education.

我很想听听您对一些不同观点和看法的见解，因为表面上我们常觉得'这理所当然'。

I'd love to hear your insight on a couple of the various different ideas and opinions that I've heard made because I think on the surface, we often think, oh, of course, this is a no brainer.

我们应该在医学培训中增加更多营养教育，这似乎是双赢的局面。

We should get more nutrition education into medical training, and it's kind of a win win all around.

对吧？

Right?

我们显然希望医生在这一领域具备更强的专业能力。

We obviously want doctors who have more competency in this area.

但话虽如此，显然也有人持不同立场。

But that said, there are obviously then other positions that people have taken.

我认为其中很多观点不无道理，不仅提到了课程本身的繁忙程度，还涉及医学培训必须涵盖的其他内容。

I think a lot of them might be fair in saying and not only alluding to how busy the program already is, all those other things that has to go into medical training.

但即便有这样的观点——在理想情况下，我们本应拥有能与医生协作的营养专业人士体系。

But even on the idea that, well, look, we're in a system where in an ideal world, we already have nutrition professionals that should be able to interact doctors.

我们有注册营养师和其他营养专家，他们能提供比任何医学培训更深入的专业知识。

We have registered dietitians, other nutritional professionals that can go deeper than any medical training can offer.

因此如果我们确实要提供某种营养教育，我认为有几个不同的方案可以考虑。

And so if we are to offer some type of nutrition education, I think it a couple of different ideas, but we get put forward.

某种程度上这可能给医生增加额外负担，让他们现在需要负责营养咨询工作。

Is that we're now in some degree, maybe giving doctors an extra burden in what they now have to be in charge of counseling around nutrition.

另一种情况可能是我们提供的营养教育不足，导致医生高估自己能提供的服务——相较于营养师，或者人们担心这模糊了何时该找注册营养师、何时该与家庭医生讨论的界限。

Or in other cases, maybe we're not giving them enough nutrition education and maybe they overestimate then what they're able to offer as as opposed to a dietitian or people worrying about how this infringes on that kind of line between when in something a case for an RD and when is it a case for to talk through with my family physician or my GP.

这些问题或许都能解决，但我想知道您如何应对这些观点，以及我们该如何拆解思考这些问题。

And so these are all maybe things that can be worked out, but I'm wondering how have you interacted with those types of opinions and ideas put forward and maybe what's the best way for us to pull these apart and think about them.

我完全理解注册营养师的立场，而我为医生和医学生增加营养教育的目标从来不是取代营养师的职能。

I totally understand the registered dietitian perspective, and my goal with adding nutrition education for physicians and medical trainees was never to replace the role of a dietitian.

注册营养师接受的培训水平清楚地表明——他们才是这个领域的专家。

I mean, the level of training that registered dietitians get is clear that it's clear that they're the experts.

实际上，我们需要围绕同一目标展开两个独立讨论：一方面要加强对医生的营养学基础培训，另一方面也要改善与注册营养师的专业协作。

And really, there's two separate conversations that need to be had with the same goal, which is that we need to train doctors more in nutrition, at least to a foundational level, but we also need to improve interprofessional collaboration with registered dietitians.

因此我们需要推动这两类医疗从业者在多学科团队中更紧密地合作。

So we need to work on getting these two health care providers to work together more in a multidisciplinary team.

我认为这两者其实是相辅相成的。

And I think that one really feeds into the other.

通过让医生接受更好的营养培训并达到相应能力水平，即便在诊疗中只能提供一分钟的快速饮食建议，他们也能播下健康的种子。

So by exposure exposing doctors to better nutrition training and achieving this level of competency, even if they're restricted in a visit where they can only give one minute, let's say, of dietary counseling, something quick and efficient, they can really plant the seeds.

这时医生就能理解注册营养师的价值，并会说：'嘿...'

And now the doctor understands the value of a registered dietitian and says, hey.

'你的胆固醇指标一直在上升。'

Your cholesterol's been going up.

'我们已开始给你服用低剂量他汀类药物，但你也需要做些饮食调整。'

We started you on a low dose of a statin, but there's also some dietary changes that you could make.

'我现在没时间详细说明，但很乐意为你引荐我们在这个领域的专业医疗人员。'

I don't have time to talk about them right now, but I'd love to connect you with our health care professional who's an expert in this goal in this field.

嗯

Mhmm.

我认为这正是未来的发展方向

And I think that's really where I see it going.

所以问题在于，在讨论营养与医学教育时，营养师经常被忽视，这才是症结所在

And so I think the problem is that in these conversations about nutrition and medical education, dietitians often get left out, and that's the issue.

我完全认为这对专门攻读营养学的人是一种不公

And I totally think that that's a disservice to the people who go to school for this specifically.

因此我们需要更广泛地讨论：既要明确培训医生的价值，也要思考如何更好地利用我们的营养服务资源

And so it needs to be more of a broader discussion of why there's value in training physicians, but also how do we get better use of our dietetic services?

我们该如何打通这些转诊渠道？

How do we facilitate these referral pathways?

我发现很多问题都源于医生面临的信息黑箱——他们既不清楚患者哪些诊断能获得保险覆盖以纳入营养师服务

I find that a lot of that goes back to this huge black box for physicians where one, they don't know what diagnoses would be covered for their patient depending on what insurance they have to get a dietitian on board.

某些诊断可能不在医疗营养疗法覆盖范围内，但私人保险可能涵盖一些与饮食密切相关的常见疾病

So medical nutrition therapy might not be covered for some diagnoses, but it might be for their private insurers for some pretty basic diagnoses, things that are very diet related diseases.

因此我认为，在整合医疗团队方面，我们错失了许多潜在机会。

And so I think we're leaving a lot on the table with regard to what opportunities we have to integrate our medical teams together.

我认为另一个重要原因在于，当我说重要时，指的是对医生进行营养学培训，因为归根结底，他们是患者的首要联系人。

And I think another reason why it's really important is because when I say important, mean training doctors on nutrition is because ultimately, they are the primary point person for their patient.

他们才是负责协调团队的人，决定患者可能需要看哪些专科医生，是否需要咨询营养师，并启动所有这些转诊流程。

And so they're the ones who are going to orchestrate the team and decide what specialists you might need to see, what whether you need to see a dietitian and initiate all these referrals.

因此，他们作为主要联系人，认识到饮食对患者健康的重要性至关重要。

And so them seeing the importance of diet in their patient's health is crucial as that person.

这并不是说营养师在多学科团队中的重要性低于医生或护士。

And so that's not to say that a dietitian is any less important to the multidisciplinary team than a physician than is a nurse.

团队中每个人都扮演着非常关键的角色，但医生是患者首要接触并信任的决策者，由他们决定患者还应该看哪些专家。

Everyone has a very crucial role in that team, but the doctor is the primary point person that that patient's going to see and trust to decide who else they should see.

因此我认为这些讨论需要共同进行。

And so I think these conversations need to be had together.

嗯。

Mhmm.

既要教育医生，也要让他们明白营养师在护理中的重要性。

That there's value in both educating the doctor and educating them on why dietitians are so important to involve into care.

对。

Right.

而且我认为这两者并不互相排斥。

And I think those things aren't mutually exclusive.

对吧？

Right?

有些情况下转诊给注册营养师绝对是最佳选择，我们能提供大量护理服务。

That there's gonna be situations where a referral to a registered dietitian is absolutely the best thing to do, and we can provide people a lot of care.

但即便我们有这个选择，有时由于各种后勤原因无法实现，甚至在某些情况下患者无法在需要时获得及时转诊。

But even if we had the option and sometimes for various reasons logistically, there's not an option, even in some cases for people to get that referral in a time point that's needed.

但即便解决了这个问题，医生仍会遇到这种情况：患者在就诊时，甚至可能在评估快结束时，突然询问他们听到的某个营养建议或询问该怎么做。

But even if we had that, doctors are still going to have a situation where a patient comes to them and maybe even towards the end of an assessment, asks them something about nutrition that they've heard or what they should do.

正如你之前提到的，我认为如果能建立一种机制让医生更有信心基于证据回答这类问题，首先这对他们自身就有帮助。

And I think, as you alluded to earlier, if we could have a situation where doctors feel more confident being able to give an evidence based response to this, first of all, that helps them.

其次，即使在这些较简短的互动中，也能为患者提供比‘我们只接受最基础培训’更好的信息质量。

And then secondly, even in those smaller interactions, it's gonna give the patient better quality information than if we go with, well, let's have very minimal training.

然后对于任何营养或其他问题，我们都会转介出去。

And then for any nutrition or other thing, we'll refer out.

会有很多情况下这样做并不实际，而且也不合适。

There's there's gonna be a lot of cases where that's not plausible, and it's also just wouldn't be the right thing too.

不可能为患者每个关于营养的小问题都安排转诊。

You can't get a referral for every small question someone might have around nutrition.

所以我认为正如你所言，它们是相辅相成的。

So I think as you lose it, they kind of fit together.

确实如此。

Definitely.

就像你说的，这为无法接触到营养师时提供了一定的安全保障。

And like you said, it gives a bit of a safety net there for when you don't have access to a dietitian.

而且我在医院和门诊做了几年临床轮转，经常看到患者咨询营养问题。

And there's I've done a few years now of clinical rotations working in the hospital and outpatient settings, and I see all the time patients asking about nutrition.

有趣的是，由于我热衷于营养学且比那些未接受相关培训或对此缺乏兴趣的普通医生更熟悉营养学文献，看到他们提供错误信息、非常过时的建议或某些类似社交媒体上传播误导性内容的回应总是很有意思。

And it's interesting to see, at least because I'm passionate about nutrition and familiar with the nutrition literature a little bit more than the average physician who hasn't gone through that training or taken a personal interest in it, it's always interesting to see them give incorrect information, very outdated things or certain responses that are the things that we would hear from someone giving, creating misinformation on social media.

作为医学生也很有趣，因为存在这种等级制度，你只能旁观并心想：从饮食角度给这位患者的建议完全错误。

And it's always interesting as a med medical student because there's that hierarchy there of sitting back and being like, that was completely wrong from a dietary standpoint to recommend to this patient.

但这也正是不断激励我的动力之一，让我觉得：好吧。

But it also is one of those things that keeps fueling me to be like, okay.

这就是我们需要解决的问题之一。

This is part of the problem that we need to fix.

我们需要做到的是，即使我刚才目睹的场景中那位医生不需要营养师介入（因为问题不需要那种专业水平），他们本可以不提供那种错误信息。

We need to like, even if that physician in that scenario that I just witnessed didn't need a dietitian on board because it didn't require that level of expertise, they could have not provided that incorrect information.

显然他们在某些基础信息方面存在知识缺口，这些信息他们本可以提供。

There was clearly a gap there in some of the foundational information that they could have provided.

所以，即使我们考虑到——你之前提到过一些关于血压或胆固醇等方面的例子。

So so even if we're to think of and you mentioned a few examples earlier around maybe blood pressure or cholesterol and so on.

但如果我们设想这样一种情况：当我们达到某种程度的营养学教育水平，对医师和医生们掌握的技能感到满意，然后这种能力开始渗透到实践中，我们就能看到这种效果。

But if we were to imagine a situation where we do get to a point where we have, let's say, degree of nutrition education that we are really happy with the competencies that physicians and doctors are coming out with, and then that starts filtering down into practice, and we're seeing this effect.

再次强调，这一切都是假设性的想象。

And again, this is all a hypothetical imagining.

但这可能会产生什么样的影响呢？

But what type of effect could that have of?

显然，我们无法给出任何准确程度的预测。

And it's obviously impossible to say with any degree of accuracy.

但我们应该如何思考这种变革可能带来的规模，或者最终对患者本身产生的实际意义？

But what is a way to think about the scope for how big of a change this could be or the actual meaningful outcome at the end to patients themselves?

是的。

Yeah.

回到全球疾病负担研究，2017年的数据显示饮食风险因素导致了约2.5亿伤残调整寿命年。

Going back to the global burden of disease study, I think the one that was up to 2017 showed that dietary risk factors were responsible for something around two hundred and fifty million disability adjusted life years.

这个数据既包括过早死亡的生命损失，也包括过早伤残。

And so what that is is it includes lives lost, so premature death, as well as premature disability.

也就是患病状态下生存的年数。

So lives where so the number of years also living with disease.

因此，这基本上包括了总生命损失以及健康寿命的损失。

And so it's basically your total lives lost as well as healthy years lost.

这表明我们有很大的机会来改善和减轻人口中的疾病负担，包括身体负担、情感负担、对医疗系统的财务负担，尤其是美国的医疗成本高得惊人，但我们在实际健康结果上的回报却很少。

And so it basically shows that there's a huge opportunity here to fix and reduce the disease burden on our population, both the physical burden, the emotional burden, the financial burden on our system, the health care costs, specifically within The US are astronomical, and we don't get much return on our actual health outcomes.

所以我认为教育医生肯定能在这方面起到一定作用。

And so I think that educating doctors will definitely put a dent in that.

我不认为这是唯一的解决方案。

I don't think it's our only solution.

这是整个拼图中的一块。

It's one part of the puzzle.

需要在非常广泛的层面上做几件事。

So there's a few things that need to be done at a very broad level.

对医生进行营养教育是其中之一，与之相关的是改善跨专业协作。

Nutrition education for doctors is one, and adjacent to that is improving interprofessional collaboration.

但正如你我多次讨论过的，还需要解决食品环境问题。

But then, as you and I have discussed many times, is, you know, also addressing the food environment.

因此，在政策层面开展工作，同时改善许多人获取健康食品的途径。

And so working on the policy front, as well as improving accessibility to foods for healthy foods for a lot of people.

所以我认为所有这些事情必须齐头并进，而且需要在所有这些方面开展工作。

So I think all these things have to go hand in hand, and there has to be work to be done within all these fronts.

但我觉得很棒的是，已经有人在所有这些领域开展工作了。

But I think what's great is there's people working within all these areas.

因此，我们有望逐步汇聚到一个点，建立起能够相互支持这些结构的基础。

And so slowly, we'll hopefully converge to a point where we'll have the foundations where they can support each other, these structures.

你已经提到过，在理想情况下，我们会有一个标准化框架，所有人协同工作并了解当前进展。

You've already mentioned that in an ideal world, we would have a standardized framework and everyone working together and aware of what's going on.

目前，我们还没有这种条件。

At the moment, we don't have that luxury.

因此有很多人正在尝试推动这些有趣的倡议，或者开展试点项目等等。

And so there's a lot of people that are trying to get some of these interesting initiatives going or do pilot programmes like done and so on.

根据你的经验以及从中汲取的教训——包括进展顺利和不顺利的方面，以及你可能事先预料到的一些挑战等等。

From your experience and some of the learnings you took from that, the things that went well that didn't go well, that maybe some of the challenges you could have imagined beforehand, etcetera.

对于那些正在考虑启动某种倡议或试点项目，以期探索更有效实施方式的人，你有什么建议可以分享吗？

What are some of maybe what are some pieces of advice you might give to people who are considering wherever they are starting some type of initiative or pilot to see how things could be implemented in a more effective way?

这是我工作中一个意想不到的收获：许多其他项目的医学生联系我，表示也想在他们学校从零开始建立类似体系。

And this has been something that was a unexpected effect of my work is I've had a lot of medical students reach out from other programs and say, wanna build this from the ground up at my school too.

你能和我聊聊你是怎么做到的吗？

Can you talk to me about how you did it?

我会给他们提供建议。

And I'll advise them.

我认为这件事最酷的一点在于，它是由对此充满热情的学生自发推动的。

And I think that's one really cool aspect of this is that it's student driven by students that are very passionate about this.

所以他们正在从零开始构建。

So they're building it from the ground up.

他们正在与管理部门接洽。

They're approaching administration.

他们正在制定计划并明确表示：这就是我们想要实施的方式。

They're coming up with the plans and saying, this is how we wanna do it.

我会建议首先评估你们项目中现有的教学模式有哪些。

And I would say, first assess what are the existing teaching modalities used within your program.

所以如果你要向管理层提出一个想法，你需要展示你已经考虑过具体将如何将其融入课程体系。

And so if you're going to go to your administration with an idea, you wanna show that you've already thought about it in the sense that where would you implement it specifically into the curriculum?

你将如何实施？

How would you go about that?

这需要多少成本？

How much would that cost?

学校需要为此承担费用吗？

Would that cost the school anything?

因为他们想确认你已经全面考虑过这些问题。

Because they wanna know that you've thought about all these things.

这些都是我通过反复试错才学到的，因为我之前没有任何课程开发的经验。

And these are all things that I had to learn through trial and error because I had never had any experience with creating curricular work.

因此我建议在向管理层提案前制定一个周详的计划，这样他们更容易接受。

And so I would say come up with a well thought out plan before you pitch this to your administration because they're more likely to be receptive.

现在我要说的是，由于整体环境的变化，许多医学教育工作者现在更愿意接受这个议题，因为患者强烈要求将营养学更系统地纳入日常诊疗。

Now I will say a lot of medical education faculty are now more receptive due to a changing just climate in the sense that there's huge patient demand for nutrition to be more regularly incorporated into patient care.

医生群体对此也有强烈的学习需求。

There's huge demand from physicians to learn it more.

学生在申请医学院时就开始提出这方面的要求。

The students are asking for it when they're applying to medical schools.

比如在面试环节，就有学生专门询问过我们项目的营养学课程发展情况，说听说这里正在开展系列讲座。

Like, there have been students that have asked at interview days for our program, like, oh, I heard about the lecture series going on and the growth of nutrition.

这确实吸引我加入这个项目。

That really drew me to the program.

因此需求很大。

And so there's a lot of demand.

最后一点能提高教职员工接受度的是来自联邦层面的巨大压力。

And then the last one that increases receptiveness from faculty is there's a lot of pressure from the federal level.

最近这件事闹得沸沸扬扬的原因是罗伯特·肯尼迪宣布将要求医学院实施营养学课程。

So the reason why this whole thing stirred up recently was because RFK junior said that he's going to require medical schools to implement nutrition.