Today’s Dietitian
Vol. 28 No. 3 P. 28
In today’s evolving health care landscape, integrating nutrition into primary care is more critical than ever. Unfortunately, nutrition education—including emphasis on the importance of referring to dietitians—is lacking in medical training. By including dietitians in graduate medical education clinical settings, a gap can be bridged between clinical nutrition and medical education.
Future primary care physicians can benefit from having direct access to a dietitian within an integrated care setting, where the interdisciplinary structure reinforces evidenced-based nutrition and the value of RDs’ input.
The dietitian-provider team has the potential to enhance patient outcomes, support chronic disease management and prevention, improve quality of patient care, and increase patient engagement. At the same time, dietitians can complement medical resident training through educational opportunities that strengthen nutrition knowledge, model collaborative practice, and reinforce the value of referrals to nutrition professionals.
Nutrition Education in Medical Residency Training
Clinical practice guidelines for the management of diabetes, hypertension, and CVD consistently endorse lifestyle modifications as foundational components of standard care.1-3 Despite strong evidence linking diet and lifestyle to the prevention and management of chronic disease, many physicians and medical students feel unqualified to discuss dietary recommendations.4 A critical yet often overlooked component of medical training, particularly during residency, is formal, factual, and evidenced-based nutrition education.
Some medical students report a belief that it is the primary care physician’s responsibility to provide nutrition counseling and meal planning, and feel confident to do so, but lack the fundamental knowledge of dietary reference intakes and evidence-based nutrition principles.5
While medical students are generally aware that RDs are part of the interprofessional health care team, many lack a clear understanding of the dietitian’s scope of practice, expertise, and specific role in patient care.5 This knowledge gap can directly influence referral patterns and limit optimal utilization of dietitians in clinical practice. For this reason, incorporating nutrition-focused education led by RDs into residency training programs offers a practical way to address this missing piece and foster meaningful interdisciplinary collaboration.
Critical Pushback
The need for improved nutrition education in medical training has been recognized for decades. In 1985, the US Committee on Nutrition in Medical Education recommended at least 25 hours of nutrition instruction during medical school.6 Despite this recommendation being in place for four decades, recent data reveals that fewer than 22% of US medical schools meet the minimum recommendation.7 In response, the US Department of Health and Human Services with the support of the US Department of Education, have launched an initiative for medical schools to implement comprehensive nutrition education and training.8
Although this initiative aims to improve medical students’ foundational understanding of nutrition, it raises important concerns and has prompted critical pushback from some physicians and dietitians. Some are concerned that increasing nutrition education in medical school risks reinforcing the misconception that physicians should act as nutrition experts. Maintaining professional boundaries and understanding scope of practice for all involved is essential for providing high-quality patient care. Critics argue that medical school nutrition education should complement, not replace, the extensive and specialized nutrition training provided by dietetics programs and professionals. Furthermore, excluding dietitians from nutrition education policy discussions devalues nutrition professionals and reinforces the historical underutilization of dietitians in primary and specialty care. Ultimately, expanded nutrition education in medical training should reinforce the specialized roles of each profession while recognizing both as essential members of the interdisciplinary health care team.
While medical education continues to fall short of its own nutrition education recommendations, RDs remain the preferred and most qualified source of evidence-based nutrition information. Therefore, integrating dietitians into residency training programs can ensure that future physicians receive practical, clinically relevant nutrition education while promoting appropriate nutrition referrals to RDs. Increasing visibility of RDs in these educational paths reinforces not only the principle that nutrition is fundamental to health and disease management, but also the unique ability of RDs to educate patients as well as future providers about the scope of their expertise.
Creating a Collaborative Learning Environment
Given the well-documented insufficiency of nutrition education in medical school, residency training creates an opportunity to advance nutrition knowledge through structured didactic lectures and patient-centered clinical treatment decisions led by dietitians. Research shows that medical students generally lose interest in nutrition-related topics if they are not reinforced or actively observed in clinical practice led by graduate medical education faculty. An additional challenge is presented though a lack of current requirements regarding ongoing nutrition education for practicing physicians.9
The Accreditation Council for Graduate Medical Education (ACGME) program requirements for internal medicine residency include structured didactic activities, which may include lectures, conferences, simulations, or case discussions.10 These educational formats provide an invaluable opportunity for RDs to position themselves as key educators within graduate medical education. By leading didactic lectures, interdisciplinary conferences, and case-based discussions, dietitians can directly facilitate the integration of evidence-based nutrition science into physician training. It has been advised that each education block includes at least one nutrition lecture, as proper nutrition supports every organ system.5 This approach does not suggest that physicians should take on the responsibilities of dietitians, but that they should appreciate nutrition’s clinical significance and refer to the dietetic profession, who is specifically trained to provide evidenced-based MNT.
Beyond formal didactics, collaborative interprofessional teams bring together multiple disciplines to support behavior change and inform treatment decisions within a health care system.1,2,3 Within primary care residency clinics, RDs can lead patient-centered nutrition interventions while partnering with medical residents to develop and implement evidenced-based nutrition-related treatment strategies and comprehensive care plans. Additionally, encouraging residents to observe dietitians in clinical practice further reinforces the dietitian’s role as the nutrition expert and highlights the critical role they play in collaborative patient care.5 Fostering mutual respect among interprofessional teams will prepare residents to practice and excel within integrated, team-based models of future care.
The Role of Dietitians in Interdisciplinary Care
Effective patient care increasingly depends on collaboration among diverse health professionals. Within team-based care models, dietitians play a critical role in addressing nutrition-related concerns, providing evidence-based interventions, and supporting overall health outcomes. Dietitian-provided care has been shown to be cost-effective and to improve both patient and provider satisfaction while enhancing quality of care.11
The importance of improved availability of comprehensive nutrition interventions provided by RDs is further reinforced by the 2025 position statement of the Academy of Nutrition and Dietetics, which states:
It is the position of the Academy of Nutrition and Dietetics that all individuals with nutrition-related health conditions or risk factors should have access to Medical Nutrition Therapy (MNT) provided by a registered dietitian nutritionist (RDN). MNT provided by RDNs is effective in improving health outcomes for many chronic conditions that are leading drivers of morbidity, mortality, and rising health care costs in the United States. Widespread access to MNT using an individualized, client-centered, and evidence-based approach has the potential to improve population health, reduce health disparities, and reduce health care costs associated with nutrition-related health conditions.12
Embedding dietitians within primary care teaching clinics allows dietitians to model client-centered, evidence-based nutrition counseling while collaborating directly with medical residents to provide clinical decision-making support.13 In these settings, dietitians serve as content experts, but also as educators and clinical leaders, highlighting their essential role within graduate medical education and reinforcing when referrals to dietitians are indicated.
RDs do not work alone in supporting patients with complex medical needs within interdisciplinary care models. One of the key responsibilities of the dietitian on the care team is to educate—not only patients but all members of the team—regarding nutrition interventions. The interdisciplinary team can provide cohesive, patient-centered care through unified messaging regarding nutrition concepts. At the same time, each interdisciplinary team member brings specialized expertise within their respective fields and approaches patient care through their unique professional lens. These varied perspectives can occasionally conflict with the dietitian’s recommendations; therefore, effective interdisciplinary patient care requires ongoing collaboration and coordination among a diverse team of professionals.
Everyone Has a Part to Play
This collaborative care team network may include pharmacists, community health workers, social workers, nurse case managers, and financial advisors.14 Pharmacists can help ensure medication prescriptions align with dietary recommendations and reduce the risk of drug-nutrient interactions. Community health workers can reinforce nutrition guidance in culturally appropriate ways and connect patients to community resources.14 Social workers help address social determinants of health such as food insecurity and provide mental health counseling. Nurse case managers assist with coordinating care and monitoring adherence to both medical and nutritional interventions. Financial advisors also assist patients in navigating insurance coverage and availability.
Each team member brings their own unique expertise to address medical, social, and economic factors influencing health outcomes and creates a comprehensive patient support system that amplifies the impact of each provider.15 Incorporating this multidisciplinary team of professionals into graduate medical education enhances communication, problem-solving, and shared decision making. These core competencies required for patient-centered medical care continue to emphasize the inclusion of dietitians as integral participants within the health care team.
Challenges to Integration
Although many stakeholders recognize the value RDs bring to graduate medical education teams, challenges must be addressed to realize the full potential. Common barriers include the following:
- perceived time and resource constraints;
- financial considerations; and
- institutional support for including dietitians as faculty members within medical education programs.
Primary care resident clinic appointment visits are generally scheduled for thirty-minute blocks or less. This limited timeframe can make it difficult for stakeholders to envision how to add RDs to the clinic’s existing workflow. However, the clinic setting is an opportunity for dietitians to be viewed as time-extenders instead of time burdens. Integrating dietitians into residency clinics can lessen the resident’s time spent delivering behavior change education and nutrition counseling.16 This allows residents to focus on medical decision-making while ensuring patients receive evidenced-based nutrition care from a qualified expert.
Additionally, the physical location of dietitians’ workspaces is a relevant factor in successful integration. Physicians have reported a preference for and subsequently increased referral rates when dietitians are located on-site.13 Colocation improves interdisciplinary collaboration, enables warm handoffs for patients, and allows for real-time mentoring of medical residents. In this context, nutrition care becomes a visible and an incorporated component of routine clinical practice.
Improving access to RDs for both patients and future physicians should be viewed as a long-term health care investment strategy. Although public and private health insurance coverage for MNT is generally limited, nutrition support can be highly cost-effective and cost-saving to health care systems.17 As a response to the changing health care landscape and as reimbursement models continue to shift toward value-based care, improving access to integrated RDs promotes improved patient outcomes and chronic disease management.18
An added benefit of integrating dietitians within graduate medical education settings is the opportunity for medical residents and RDs to collaborate and collect outcome data. Data can be collected and analyzed related to nutrition interventions and quality improvement initiatives. Beyond patient outcomes, integrating RDs as graduate medical education faculty can help prepare future physicians to value preventive care, better utilize nutrition expertise, and promote team-based approaches to health in an evolving health care environment.
Takeaway: Integrate. Educate. Refer.
Dietitians are professionally trained to provide evidence-based nutrition interventions that improve health outcomes and support disease prevention and long-term disease management. Therefore, increasing access to RDs within graduate medical education integrated care settings not only increases utilization of nutrition services provided, but also enables the next generation of physicians to understand and value the nutrition interventions applied in clinical practice. At the same time, patients benefit from improved outcomes, reduced medical complications, and lifestyle change support that complement their medical treatment.
In conjunction with this work, exposure to dietitians during graduate medical education reinforces nutrition as a core component of medical care. Including dietitians in residency training may help shape future physicians’ practice to prioritize nutrition referrals, foster interdisciplinary collaboration, and prepare physicians to practice within prevention-focused models of care. This approach not only improves patient care and outcomes but also creates a generation of providers poised to recognize dietitian-led MNT as essential to achieving clinical success.
— Melissa Stiffler, RD, LD, is an integrated dietitian with OhioHealth Doctors Hospital Graduate Medical Education, the nation’s second largest osteopathically recognized residency program. She has dedicated much of her career to inpatient clinical nutrition and has also contributed to complex cardiac care as part of an Advanced Heart Failure Program. She is passionate about elevating the role of dietitians in health care.
References
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