Despite the known importance of nutrition in the prevention and management of chronic diseases, comprehensive nutrition education is lacking in medical schools, and many graduating physicians are not prepared to address the nutritional concerns of their patients [1,2,3]. The National Research Council (NRC) recommends at least 25 h of dedicated nutrition curricula; however, a mere 30% of medical students will graduate having met this recommendation [4]. On average, 19 h of medical curricula are dedicated to nutrition education, and this has decreased over the last decade [5]. In 2023, the Accreditation Council for Graduate Medical Education hosted a summit to discuss the current state of medicine as it relates to nutrition, with the conclusion that diet-related diseases are the most prevalent causes of illness in the United States. Suggestions were made to integrate nutrition into existing medical school coursework to teach students about the relationship of nutrition to health and how it acts as a social determinant of health [6].

In fact, 79% of medical school instructors agree that students need more nutrition instruction, and that current nutrition education is not sufficient to build student confidence in delivering nutrition counseling [1, 7]. Only 18% of medical schools nationwide require a nutrition course, and among those, there is no set standard in the content taught and how it is delivered [3, 5]. Even in review books for the US Medical Licensing Examination (USMLE), the content is focused on vitamin and mineral deficiencies in relation to conditions, such as scurvy, and not clinical nutrition related to prevention of chronic diseases [8, 9]. For example, discussions on how to manage cardiovascular conditions (i.e., type II diabetes, hyperlipidemia) with dietary modifications is lacking. In a 2017 study, 85% of medical students in their clinical years indicated they were not confident in their preparedness to counsel patients on nutrition topics, and 86% indicated they would be interested in further practical, evidence-based nutrition education [10].

Physicians cite many barriers that prevent them from delivering nutrition counseling services [11,12,13,14,15]. In 1995, Kushner et al. surveyed primary care physicians nationwide about their perceived barriers to nutrition counseling. Of the physicians that responded, the 4th and 5th most commonly encountered barriers were lack of training in counseling skills and a deficit of knowledge about nutrition [12]. The top barrier was lack of time with patients [12]. In addition, physicians do not feel confident in their perceived ability to positively influence the lifestyle and eating habits of patients [14]. A follow-up study in 2010 demonstrated nutrition counseling continues to be lacking among today’s physicians [11, 12]. Fortunately, there is increasing recognition among physicians of the importance of possessing the knowledge and ability to counsel patients about nutritional lifestyle changes [6, 16,17,18]. Studies have also shown that physicians who personally practice healthy habits are more likely to spend more meaningful time counseling patients [18, 19]. Of note, links have been found between dietary habits and mental health status [20]. With high burnout rates and stress facing medical students and health providers, it is worth exploring if acquiring nutrition knowledge correlates with personal mental health benefits in students [21].

Multiple barriers hinder the ability to formally incorporate nutrition into medical school curricula, such as limited curricular time, lack of funding, and qualified instructors [10, 22]. In the mentioned 2017 study, the proposed nutrition elective was not sustainable due to a lack of facilitators to maintain the program [10]. Our theoretical framework relies on the fact that online modular learning has long been used in medical training as a method for teaching new concepts to medical students, with proven efficacy [23,24,25]. In a leukemia learning module, the authors used pre- and post-test assessments immediately preceding the module and 2 weeks after completion to determine its efficacy. The module was designed with interactive questions and activities [23]. Another online module aimed to teach students about wound care through the use of knowledge checks, pictorial examples, and videos, with proven success as well [25].

Hence, online modular learning can be an efficacious, cost-efficient, and sustainable way of teaching medical students about nutrition that gives students the flexibility to complete on their time. For example, the Department of Nutrition at the University of North Carolina at Chapel Hill created an online module called the Nutrition in Medicine Project. The project delivers nutrition curriculum to their medical students without needing faculty to invest ongoing teaching time [2, 26]. In another example, Rutgers Robert Wood Johnson Medical School utilized a 30-min online nutrition education module to help medical students identify signs of malnutrition in hospitalized patients. After completion of the module, students demonstrated an improvement in their knowledge base [27]. Other existing nutrition modules are not in an online format and require multiple hours of instruction in-person over several days [28]. While in-person lecture formats may be effective teaching tools, their delivery format may not be a sustainable solution to existing curriculum barriers given the need for dedicated classroom time. The existence of other publications working to tackle the lack of nutrition education in medical curriculum strongly supports the necessity for change to occur. However, the majority of the publications focus on in-person didatic sessions that also require dedicated faculty teaching the material.

The online nutrition education module, entitled Foundations in Nutrition, is distinct from other existing modules as it is based on specific student knowledge gaps including foundational nutrition topics, taught through interactive exercises, case-based learning, and nutrition counseling approaches. The purpose of this study is to determine the efficacy and impact of teaching medical students about fundamental nutrition topics in about 45 minutes via a flexible, online format. It utilizes active learning to improve student learning and retention [29]. The pre- and post-assessment structure is also intentionally designed given the module’s structure to encourage retention through the testing effect [30]. The online module can be completed in less than an hour, at any time, to accommodate the existing, demanding schedule of medical students, and the interface allows for quick and easy updates to the content as nutrition research evolves.