GEP Medicine in Society Guide 2021/22

6.10. Nutrition and gastrointestinal disorders

Preparatory work

In preparation students should have:

• Looked at some of the resources available on the NHS Live Well website focussing on healthy eating, exercise and weight management. 
• Reviewed the report by The Mental Health Foundation has produced some guidance on wellbeing and nutrition; they also have a podcast episode discussing this topic.
• Researched some chronic gastrointestinal conditions; the NHS inflammatory bowel disease information is a good place to start and the Crohn’s and Colitis UK website also has lots of information, including this video.
• Listened to Michael Serres talk about his bowel transplant to gain a patient’s perspective and specifically to hear his views about how healthcare practitioners should communicate with and involve their patients in the decision making processes.
• Considered watching Dr David Kessler's lecture “The End of Overeating - Taking Control of the Insatiable American Appetite” on YouTube (it is a bit of a slow start). 
• Thought about the sensitivities of investigating patients’ beliefs and attitudes towards weight, diet and exercise.

 

Aims

To increase students’ awareness of the relationship between food, health and ill health and to introduce students to patient presentations with GI disorders.

 

Learning outcomes

By the end of the day, students should be able to:

• Describe the components of a ‘healthy diet’
• List the current recommendations for daily exercise
• Describe some of the broad spectrum of symptoms that relate to the GI tract
• Describe the impact of a chronic bowel disorder on a patient’s life
• Discuss how embarrassing symptoms might influence people’s decision to visit their doctor
• Discuss the role of the primary care team in encouraging people to lead healthier lives

 

Example timetable

9.30 – 10.30	Tutorial on GI disorders
10.30 – 10.45	Tea break
10.45 – 11.45	Prepare for patient encounters Plan questions and observations   Patient encounters Interview a patient with a chronic GI condition or symptoms  Observe a new patient check and consider how lifestyle assessment and advice is broached Role play scenarios
11.45 – 12.45	Students feedback to group on their patient encounters and group discussion   Set up afternoon activity; In small groups visit or research local services/facilities supporting healthy lifestyle choices and/or meet someone involved with delivering these services
12.45 – 13.45	Lunch
13.45 – 15.00	Small group research/visits/interviews as planned   Includes tea break
15.00 – 16.00	Feedback to group about visit/research/interview; link this information into the community are profile started on day 1 of the placement   Set homework for next session.

Suggested Activities

• Tutorial on GI disorders – could include students presenting about different GI disorders, discussing common GI symptoms presenting in primary care, considering the role of the primary healthcare team in assessing and advising on diet and exercise.
• Introduction to abdominal examination and link this with GI symptoms.
• Interview a patient with a chronic GI condition.
• Role-play scenarios with a focus on how the doctor can help put a patient at ease and facilitate the discussion of potentially embarrassing symptoms and/or how to empathetically open discussions about diet and exercise with an overweight patient.
• Visit or conduct online research into a local organisation relevant to diet and/or exercise e.g. local group providing advice on diet, nutrition and/or cooking to young mothers. Interview a local provider of these services e.g. meeting with fitness instructor providing ‘exercise on prescription’ or an adviser from local ‘Weight Watchers’ group.
• Look at this open access collection of articles from the BMJ on nutrition and health, entitled “Food for thought” and choose an article to read and discuss as a group or in breakout groups. 
• Have an individual formative feedback discussion with GP tutor on progress on the course so far, including first written assessment, plan for poster assignment and professional attitude and conduct.

 

Questions for students to consider

• If you met a patient with a bowel disorder – how comfortable did they feel about discussing the problem?  How comfortable did you feel?  What helped or hindered your discussion?  What can you do to help put patents at ease in talking about potentially embarrassing topics?
• What did you learn about weight management and nutritional advice in primary care?  Did the healthcare team see this as an important part of their role?   Do you think this should be the responsibility of the healthcare team?  What alternative sources of help/support might patients use?