Ball, L

Bell, H

Crowley, J

Laur, C

Maddock, J

Ray, S

Public Health

Laur, C.

Ball, Lauren

Crowley, J.

Bell, H.

Maddock, J.

Ray, S.

Griffith Research Online

Enhancing breadth of knowledge within multidisciplinary doctoral research: reflections from the Cambridge Generic Nutrition Training course for non-nutritionist postgraduates and professionals

C. Laur

L. Ball

J. Crowley

H. Bell

J. Maddock

S. Ray

Crossref

UCL Discovery

1  Title: Enhancing breadth of knowledge within multidisciplinary doctoral research: Reflections from the Cambridge Generic Nutrition Training course for non-nutritionist postgraduates and professionals.   Journal: Public Health, Special Issue  Running Head: Enhancing breath of learning  Article Category: Short Communication  Key Words: postgraduate education; professional education; public health; nutrition  Authors: Celia Laur1,2, Lauren Ball1,3, Jennifer Crowley1,4, Haley Bell1,5, Jane Maddock1,6, Sumantra Ray1. 1 The Need for Nutrition Education/Innovation Programme (University of Cambridge), c/o MRC Elsie Widdowson Laboratory, 120 Fulbourn Rd, Cambridge, CB1 9NL 2 Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada. celia.laur@mrc-ewl.cam.ac.uk   3 Menzies Health Institute Queensland, G02.05A, Griffith University, Gold Coast, Australia l.ball@griffith.edu.au.   4 Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. jennifercrowley099@gmail.com  5 Haley Bell, Faculty of Life & Health Sciences, Ulster University, Londonderry, Northern Ireland. haley-08@hotmail.com.   6 MRC Lifelong Health & Ageing at University College London, UK. jane.maddock@ucl.ac.uk.  2  Corresponding Author: Dr (Prof) Sumantra Ray. The Need for Nutrition Education/ Innovation Programme (University of Cambridge), c/o MRC Elsie Widdowson Laboratory, 120 Fulbourn Rd, Cambridge, CB1 9NL sumantra.ray@mrc-ewl.cam.ac.uk   Conflicts of interest: None declared.  Ethics Statement: As this was an educational intervention and part of student professional development, ethics approval was not required.   Acknowledgements The authors wish to acknowledge the input of the Medical Research Council Human Nutrition Research Public Health Nutrition Forum, the Generic Nutrition Training course tutors, the NNEdPro Group and all who attended the course. Tutors included: Dr Birdem Amoutzopoulos, Dr Sharon Fulton, Claire Harris, Dr David Johns, Dr Glenys Jones, Dr Hilary Jones, Rebecca Lee, Dr Sophie Moore, Dr Dora Pereira, Marietta Sayegh, Dr Mario Siervo, Dr Toni Steer, Melina Tsiountsioura, Dr Michelle Venables, Dr Celia Walker, Dr Kate Ward, Jennifer Woolston, and Dr Jianhua Wu. Coordinators included Laura Fitzpatrick and Sarah Gibbings. Highlights  Doctoral students need to have breadth and depth within the understanding of their field.  Researchers require education on how to translate findings into meaningful improvements in public health.   The Generic Nutrition Training supports doctoral students and researchers to increase their breadth of nutrition knowledge.   Favourable evaluation of this course has resulted in a model that other research leaders can use.   3  Introduction Doctoral degrees traditionally involve a programme of research with a defined scope and research questions. Some universities require doctoral candidates to undertake coursework to obtain broad knowledge in their field. However, this requirement does not exist worldwide in all programmes. For countries/programmes without mandatory coursework, students may graduate with detailed expertise on a specific topic, yet lack general knowledge about the field. It is imperative for graduate students to understand the broader context of their field when translating their findings into practice.  This lack of knowledge regarding broader concepts is particularly evident in nutrition research, which covers a broad range of topics including biochemistry, physiology, food science, health services, and public health nutrition, among others. It is recognised that nutrition is integral in promotion and maintenance of good health1 and nutrition research is a recognised priority in many countries because of its potential to enhance population health outcomes.2 It can be challenging for graduate students to incorporate their work into this bigger picture, with only minimal understanding of the fields of nutrition or public health.2    Translating research for application to practice requires depth and breadth.3 Effectively communicating findings is important for contemporary scientists to have meaningful impact from their work.4 When doctoral training has not encompassed generic training about the field (some doctoral programmes do include this training), a comprehensive, theory-based education strategy is recommended.5 Innovative education strategies can increase doctoral researchers’ depth and breadth of knowledge using short, interactive sessions, which cover basic concepts and supplementary resources. The aim of this paper is to present an example of a model that other universities and research institutions could consider adopting when 4  aiming to ensure breadth of knowledge within doctoral students who do not undertake coursework. The example is an initiative undertaken to provide nutrition education to non-nutritionists working in a nutrition research setting.   Development of the Generic Nutrition Training (GNT)  The Generic Nutrition Training (GNT) course is an initiative of the UK Need for Nutrition Education/Innovation Programme (NNEdPro) Group,6 which is primarily based in Cambridge, UK, at the Medical Research Council’s (MRC) Elsie Widdowson Laboratory (EWL). The NNEdPro Group currently delivers a government-funded strand of nutrition training for medical students at the University of Cambridge, within the School of Clinical Medicine.7  The MRC hosts doctoral students/candidates at the University of Cambridge, through PhD Studentships, typically in nutrition or biology. Doctoral students conduct their research on a variety of topics from nutrition surveillance and epidemiology, though to nutritional biochemistry and molecular mechanisms. Many students studying at this nutrition research institution do not have a background in nutrition.   In 2013, the NNEdPro Group collaborated with MRC scientists to form the internal Public Health Nutrition (PHN) Forum. The Forum members included professionals from biochemistry, food science, nutrition surveillance and public health communication. Previous initiatives to increase the breadth of nutrition knowledge of doctoral researchers included 1-hour lectures on a variety of topics. Evaluations of the lectures indicated that an interactive course in nutrition may be more beneficial to increase breadth of knowledge.    5  The Generic Nutrition Training  The objective of the GNT was to provide comprehensive, introductory-level generic training on human nutrition and public health. The course included one teaching day every four months (each university term), totalling three days (18 hours) of professional development training each year. The format encompassed lectures and practical sessions. Supplementary material was provided to support learning. During the first year of implementation (2013/14), the GNT was free and voluntary for doctoral students and other MRC researchers, particularly in Human Nutrition Research (HNR). Favourable evaluations supported the course to become mandatory from 2014/15 for all new doctoral students. The course was opened in 2014/15 for postgraduates and professionals across Cambridge, with external participants attending from the Centre for Diet and Activity Research (CEDAR) and the Cambridge Institute for Public Health (CIPH). Using the Dreyfus Five Stage Model of Adult Skill Acquisition, it is anticipated that participants complete the training with an Advanced Beginner or Competent level of knowledge.8 The course aims to introduce generic concepts and provide skills for identifying further evidence-based resources. Topics covered in the course were initially decided by the PHN Forum and then refined based on evaluation from previous courses. Resources, such as the Association for Nutrition (AfN) core competencies9 were consulted. Standards for short courses, including the AfN Continuing Professional Development Endorsement criteria were considered.9 As this course is designed for increasing breadth of knowledge, rather than a regulated qualification, these standards were only used as a guide. This GNT is in line with the Research Council UK (RCUK) Statement of Expectations for Postgraduate Training, which aims to develop highly skilled researchers and emphasizes the importance of enhancing the excellence and quality of doctoral training.10 6  Key topic areas and learning objectives for GNT are included in Table 1. Tutors were nutrition specialists with experience that allowed explanation of foundation concepts in their respective speciality, supported by examples of their own research.  Learning sessions included practical activities such as anthropometric assessments, reading nutrition labels, writing press releases, developing nutrition messages for the public, tours of research laboratories, and critical appraisal. All sessions were evaluated to inform decisions regarding future delivery. In 2015, GNT materials and learning outcomes were endorsed by Cambridge University Health Partners (CUHP) to allow recognition of professional development. Evaluation  Evaluation is an important and evolving feature of any education intervention to ensure on-going quality improvement with each successive session. The evaluation of GNT had three aspects; (i) attendance records; (ii) quantitative measurement of researchers’ self-perceived level of information for each learning area, measured through a pre and post teaching questionnaire; and (iii) qualitative feedback on session delivery. The key performance indicator is the self-reported change in knowledge, attitudes and self-reported practices. It was not feasible to determine actual change in practice and impact on health-related outcomes.    Attendance varied from 18-38 participants per day (mean 29±8 participants). For 2013/14 and 2014/15 respectively, Day 1 attendance was n=28 (n=9 doctoral students, n=5 research staff, n=13 other) and n=30 (n=5 doctoral students, n=10 research staff, n=4 other, n=9 external students). On Day 2 n=35 (n=6 doctoral students, n=8 research staff, n=9 other) and n=31 (n=5 doctoral students, n=6 research staff, n=5 other, n=6 external students). On Day 3 n=20 (n=6 doctoral students, n=1 research staff, n=9 other) and n=18 (n=1 doctoral students, 7  n=4 research staff, n=2 other, n=1 external students). “Other” includes undergraduate placement students, visiting workers, etc. As attendance was based on attendance records and type of participant based on the pre-teaching questionnaire, participate type may not equate to attendance.  In 2014/15, it was mandatory for MRC HNR doctoral students to attend all three days. If a student had attended in 2013/14 they were exempt. Many staff attended in 2013/14, thus did not attend again in 2014/15. Both of these reasons account for the slight decreased attendance in 2014/15. Day 3 typically occurs in summer, and many students felt the topic, health policy, did not relate to their work, which may account for lower attendance than Day 1 or 2. By the end of Day 3, those who attended recognised why it is important for everyone in nutrition to be aware of health policy.  Participants’ self-perceived level of understanding for each learning area increased after each training day on all training days. Preliminary analysis was conducted for quality improvement within the training development. For example, in 2014/15, the proportion of participants who felt they had a good understanding of energy metabolism increased from 18% to 84% after Day 1. Based on these results, content in this session was updated each year but not modified further. Similarly, the proportion of participants who felt they had a good understanding of introductory nutritional epidemiology increased from 23% to 79% after Day 2. Feedback from researchers on the delivery of the teaching sessions was generally positive, and helpful for informing future teaching. “A very good 3-day course, but quite intensive so glad the days were separated”; “The organisation of day 3 was much better with the break out sessions straight after each talk”.   8  Next Steps  Interest in the GNT within Cambridge and more broadly has continued to increase. The GNT course has now expanded into a week-long Summer School in Applied Human Nutrition covering biochemistry, physiology, food science, health services and public health nutrition. This comprehensive certificate course is designed for doctoral students, health professionals and researchers from around the world. The content from the GNT forms the basis of three of the five days, with additional time allocated for deeper learning about research methods, knowledge translation and the role of nutrition in delivering safe and effective healthcare. The Summer School aims to provide foundation learning experiences about applied human nutrition and public health for researchers and non-nutrition health professionals.  Conclusion In order to translate research findings into meaningful improvements in population health, doctoral students need breadth and depth of knowledge within their field. A research project provides the depth, and a course, such as GNT, can help doctoral students without coursework to increase their breadth of knowledge.   References 1. World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation, Geneva, Switzerland: World Health Organization, 2003 WHO Technical Report Series; 916. 2. WHO. Global nutrition report 2014: Actions and accountability to accelerate the world's progress on nutrition. Washington, DC: International Food Policy Research Institute, 2014. 3. Straus S, Tetroe J, Graham I. Knowkedge translation in health care: Moving from evidence to practice, 2nd edition: BMJ Books; 2013. 4. Phillips DP, Kanter EJ, Bednarczyk B, Tastad PL. Importance of the lay press in the transmission of medical knowledge to the scientific community. N Engl J Med. 1991 Oct 17;325(16):1180-3. 5. Kattelmann K. What is Effective Nutrition Education? Journal of Nutrition Education and Behaviour. 2014;46(6):457. 9  6. Need for Nutrition Education/Innovation Programme (NNEdPro). Need for Nutrition Education/Innovation Programme  2015 [cited 2015 November 24]. Available from: http://www.nnedpro.org.uk/. 7. Ball L, Crowley J, Laur C, Rajput-Ray M, Gillam S, Ray S. Nutrition in medical education: Reflections from an initiative at the University of Cambridge. Journal of Mulltidisciplinary Healthcare. 2014;7:209-15. 8. Dreyfus S E. The Five-Stage Model of Adult Skill Acquisition. Bulletin of Science Technology & Society 2004; 24(177). 9. Association for Nutrition. Standards for AfN CPD Endorsement  London: Association for Nutrition; 2011 [cited 2016 June 6]. Available from: http://www.associationfornutrition.org/Default.aspx?tabid=194. 10. Research Council UK. RCUK – Statement of Expectations for Postgraduate Training  2015 [cited 2016 June 6]. Available from: http://www.rcuk.ac.uk/documents/skills/statementofexpectation-pdf/.   10  Table 1: The Learning Objectives for the Generic Nutrition Training course (2014/15) Day One: Basic Concepts in Human Nutrition            Comments  To provide an overview of diet and nutrition   definitions, classification, and demystification of concepts and conflicts providing a common denominator of language  To exemplify diet and nutrition research methods in human studies  appreciation of the limitations of current nutrition knowledge and changing paradigms due to research  To describe basic  principles  of  digestion,  absorption  and  energy  metabolism underpinning human nutrition  core understanding of the physiological processes and consequences of dietary intake  To outline basic principles of body composition and anthropometry, in relation to human nutrition  To highlight physiological roles of macro- and micro-nutrients in the diet  To establish the applied and translational nature of nutrition science   key properties of the main nutrients in the diet Day Two: Nutrition in Disease Prevention:   To provide an overview of nutritional epidemiology  appreciation of the scope of population studies in nutrition  To describe metabolic / endocrine disorders  nutritional aspects of disease aetiology and pathogenesis using a body systems approach  To outline the role of nutrition in musculoskeletal disorders    To critically appraise a scientific article  understanding the boundaries of breaking evidence on nutrition and disease  To understand how to deal with the media   To learn how vascular function can be measured   Preparation for the public interface Day Three: Public Health Nutrition, Policy and Practice:  To provide an overview of the double burden of malnutrition  the extent of the problem at population and individual levels  To outline the role UK National Diet and Nutrition Survey in policy and public health  surveillance to monitor nutrition risk  To learn how food labelling is regulated   individual level approaches to nutrition risk management  policy/population level risk management  To highlight the importance of national policy frameworks 11   To exemplify nutrition resources available  To describe international nutrition in a public health context  To demonstrate the impact food fortification has on public health  To provide an overview of the nutrition education leadership for improved clinical/public health outcomes    

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Enhancing breadth of knowledge within multidisciplinary doctoral research: reflections from the Cambridge Generic Nutrition Training course for non-nutritionist postgraduates and professionals

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