Advanced Nutrition Clinical Research Fellowship Objectives
Introduction To The Advanced Nutrition Fellowship At The University Of Alberta (RAH)
Program Director: Dr. Jennifer Jin
Introduction
The goal of this fellowship is to provide training and research experience at a sufficient level for the fellow to acquire competency in the field of Nutrition. At least major research project is to be undertaken during the fellowship. To be eligible for training in the subspecialty of clinical nutrition, a physician must have completed categorical residency training. This training may be in Internal Medicine, Surgery, Pediatrics, Family Medicine or subspecialty training such as adult or pediatric gastroenterology, endocrinology, or critical care.
Selection Criteria
Candidates are selected based on the following:
- Knowledge in Nutrition
- Letters of recommendation
- CV
- Research interest and experience
- Communication skills (written and oral)
- Overall fit for program
Program Overview
The nutrition support program of Northern Alberta is based primarily at the Royal Alexandra Hospital (RAH). Fellows will be expected to participate in research meetings and observation of clinical activities at other sites, specifically at the University of Alberta (UAH), and within the region as it pertains to their research.
Programs, facilities and resources that will support the fellowship include:
- Interdisciplinary Inpatient Nutrition Support Services - RAH, UAH
- Northern Alberta Nome Nutrition Support Program
- Home Enteral Nutrition - RAH
- Home Parenteral Nutrition -UAH
- Intestinal failure and Transplant Program - UAH
- Malnutrition clinic - RAH
- Agriculture Life and Environmental Sciences lecture series, University of Alberta
Fellowship Overview
To acquire competency as a specialist in the field, training will comprise of a minimum of 6 months and up to 12 months of supervision of research activities, formal instruction, and observation of clinical nutrition care. One research project during the fellowship is required. The goal of the research project will be to present findings in a peer reviewed journal or meeting. Clinical exposure will include observation in both inpatient and outpatient settings. An individual embarking upon fellowship training in Nutrition will work with their designated supervisor to detail specifics of their training relative to their future career and practice goals.
Clinical training is required to provide a background understanding of research. It will focus on observation of assessment and management of nutrition related issues in patients, ranging from critically ill inpatients to ambulatory outpatients of all ages, including children and older adults, with a wide variety of common and uncommon nutrition related disorders. Training is supervised by physicians (Dr. Leah Gramlich, Dr. Jennifer Jin) and will be supported by an interdisciplinary team inclusive of dietitians, pharmacist, nurses and other physicians. The program includes opportunities to observe the role of Nutrition consultant for other physicians and services in both inpatient and outpatient settings. Instruction will include formal, didactic and informal modes of instruction.
CanMeds Roles and Objectives
Medical Expert:
Be able to function at the level of a medical specialist in clinical nutrition in the topics outlined in the fellowship learning objectives (see below).
Communicator:
Use basic science and clinical knowledge to discuss research plans with an interdisciplinary nutrition support team.
Collaborator
Collaboration in research in the nutrition team which is interdisciplinary, including dietitians, nutrition support nurses, pharmacists, graduate students, research students, and other attending physicians.
Manager
Be able to understand the allocation of healthcare resources and apply quality improvement principles effectively.
Health Advocate
Be able to identify socioeconomic determinants of health in patients and communities, and understand when and how to advocate appropriately on behalf of patients and communities.
Be able to discuss the ethical and legal issues surrounding nutrition support.
Scholar
Develop a plan for reading and continuing education.
Participate in critical appraisal and prepare biweekly rounds or journal club both for personal learning projects and also contribute to teaching transmission of knowledge.
Participate in a research project with the goal of presenting the project at regional, national, international meeting, and/or submitting to a peer reviewed journal for publication.
Professional
Be able to demonstrate integrity, honesty, compassion and respect for diversity.
Apply ethical principles appropriately, seek and accept advice and have awareness of personal limitations.
Meet deadlines and be punctual.
Clinics
The fellow may attend clinics where he/she will observe care and management of patients with gastrointestinal issues which may include:
- Home Enteral Nutrition Support clinic
- Home Parenteral Nutrition Support clinic
- Malnutrition clinic
Inpatient Service
There is no requirement for inpatient service for this fellowship.
Procedures
There are no procedural requirements for this fellowship.
Call
There is no call for this fellowship.
Core Curriculum/Rounds
The program will provide the fellow with formal teaching and supervision as follows:
- Weekly Nutrition Support Rounds - RAH, UAH
- Small Bowel Transplant Rounds, UAH
- Weekly GI rounds RAH
There is published data that the area of nutrition is not adequately taught in medical school and residency training programs. As such, a background understanding of the fundamentals of clinical nutrition is required even for research fellows. In order to be able to be a competent researcher in any area of clinical nutrition, a foundational understanding of nutrition in imperative.
The following is required knowledge base for trainees who complete this fellowship training program:
- Nutrients
- Describe the physiology of the absorption and digestion of macronutrients and micronutrients
- Understand the different requirements of macronutrients, micronutrients, and fluids
- Describe deficiency states and toxicities of micronutrients
- Nutritional Assessment
- Be aware of evidence based methods for malnutrition screening and assessment of nutrition status
- Understand anthropometry and methods for body composition especially as it relates to nutrition research
- Be aware of the high prevalence of malnutrition in certain populations and be familiar with the body of literature in malnutrition in the cancer, the elderly, and chronic disease
- Nutritional Therapy
- Be familiar with the indications and delivery of enteral and parenteral nutrition
- Understand the issues with the composition of different formulas and complications of therapy
- Understand the different components of parenteral nutrition and the changing research and knowledge around macro and micronutrients
- Home nutrition support
- Be able to discuss current research areas in long term home parenteral nutrition therapy patients including long term complications from therapy, new formulations of lipid solutions, and novel solutions to catheter related bloodstream infection
- Be aware of and potentially participate in the ongoing local research in this topic
- Intestinal Failure
- Be able to describe the physiology of intestinal failure and short bowel syndrome
- Diet and Activity
- Be familiar with common diets including vegetarianism, fad diets
- Be able to discuss principle and indications of different therapeutic diets (eg. gluten free, ketogenic, low FODMAP, six food elimination diets)
- Be familiar with the Canada Food Guide for Healthy Living, activity guidelines
- Nutrition and Disease States
- Discuss the physiology of related issues of common diseases such as: inflammatory bowel disease, chronic liver disease, celiac disease, acute and chronic pancreatitis, intestinal failure/short bowel syndrome, gastrointestinal fistulas, small bowel bacterial overgrowth, cystic fibrosis, connective tissues diseases.
- Identify specific nutrition issues specific to critical care patients
- Nutrition and the lifecycle
- Be able to describe growth and development and identify nutritional issues in pregnancy
- Be aware of the growing research in nutrition and aging
- Bariatric Medicine
- Describe the epidemiology and the obesity epidemic
- Discuss the physiology in obesity including gut hormones involved in appetite and satiety
- Understand dietary, medical, and surgical therapy including different types of bariatric surgery
- Understand the physiology of NAFLD/NASH and novel therapies and new research in diet and exercise interventions
- Enhanced Recovery After Surgery
- Understand the world wide initiative to improve surgical recovery and in particular the role of nutrition in this practice
- Be aware of the growing body of literature
- Be aware of and potentially participate in the ongoing local research in this topic
Meetings
The fellow may be expected to attend:
- One conference to present an accepted abstract
- Selected external meetings: eg. American Society of Enteral and Parenteral Nutrition
Research
Development and/or participation in at least one research project will be undertaken during the course of training. It is expected that the research findings be presented at relevant local, national and international meetings, and submitted for publication in a peer reviewed Clinical Nutrition or Gastroenterology journal. The research project will be supervised with goals related to creating competency in clinical research and enhancing research capacity.
Specific research objectives:
- To develop an appreciation for the breadth and scope of gastrointestinal/endoscopic research.
- To appreciate the importance of asking relevant questions and framing them in a way that can be addressed by the scientific method.
- To develop an appreciation for the scientific method including hypothesis generation, hypothesis testing and statistical evaluation of results.
- To develop the skills of critical appraisal in reviewing new pieces of information published in the medical literature.
- To develop the foundation and framework for further training if a career in research is planned
Potential research topics will be discussed at the commencement of training. Relevant topics for research may include but are not limited to: Home Parenteral Nutrition Patients and the Canadian Home TPN Registry, the inpatient Nutrition service, Enhanced Recovery After Surgery (ERAS) etc.
Participation of Educational Events
The fellow will participate in the educational activities of the Division of Gastroenterology both at the UAH and at the RAH Sites. The program will provide the fellow with formal teaching and supervision as follows:
- Nutrition Journal Club and Rounds: Second and last Friday of each month - 0730 to 08:30
- Preparation of a learning topic that is chosen by the fellow or attending. The presentation will be informal.
- If there is a postgraduate gastroenterology core trainee on a Nutrition rotation, they will be asked to participate as well
- The topic may be taken from the learning objectives in the curriculum, or may arise from a clinical question that has been encountered during a patient case
- On alternating Fridays there should be a journal article selected for discussion
- The Journal article should be critically appraised (eg PICO method for therapeutic intervention trials)
- RAH Division of Gastroenterology Grand Rounds - every Monday from 1200-1300
- The fellow will present up to 2 rounds per year
- Gastroenterology subspecialty Academic Half Day - Tuesday afternoons
- The fellow may be requested to participate in teaching as appropriate
Evaluation
The fellow will meet with the program director every 3 months for a formal evaluation. It is also expected that the fellows will provide feedback and evaluation of the training experience at least every 6 months.
The fellow will be encourage to study for and sit a certification examinations where applicable (eg. American Board of Physician Nutrition Specialists)
Benefits/Funding
Funding will be determined on an individual basis
Recommended Texts/Papers
Modern Nutrition in Health and Disease, Shils, Olson, Shike
Rotation Schedule
- 10 months of clinical rotation
- Malnutrition, Home Parenteral Nutrition, and Home Enteral Clinics
- PN rounds at RAH and UAH
- Malnutrition and PN consults in the Northern Alberta Zone
- 1 month of research
- 1 month of off service clinical rotations (eg. Nutrition related clinical activities in the IBD, NAFLD, cirrhosis clinics)