Nutrition Professional of the Month: Elaine MacAninch RD

Elaine MacAninch RD, BSc (Hons), PGCE, MAcadMEd

To kick start our Nutrition Professional series, we are delighted to be featuring Elaine MacAninch. Elaine is a Registered Dietitian who splits her time working in clinical, education and research settings, focusing on improving nutrition education for doctors. Uniquely, Elaine is the first Research and Education Dietitian to be employed with the primary goal to improve nutrition content within Brighton and Sussex Medical school (BSMS). We caught up with Elaine to find out more about her role.

1. Hello Elaine, please could you tell us a bit about yourself?

I am a working mum of identical twin girls, splitting my time as a dietitian between clinical, education and research focusing on a doctor’s role in nutrition care. I am also completing my PGDip in Clinical Education with a hope to continue to my MSc next year.

For me, collaboration is a key part of addressing the complex nutrition problems we see in healthcare, and I am proud to work with other organisations with this shared common goal. I sit on the executive panel for NNEdPro Global centre for nutrition and health. I am the Nutrition Lead and a Director for Culinary Medicine UK, an organisation which delivers education for health professionals in the kitchen setting. I am also part of the UK Nutrition in Medical Education Review Board, which sits with the Association for Nutrition and is tasked with writing a nutrition curriculum to be implemented across the UK. Finally, I work closely with Nutritank, a medical student society campaigning to increase nutrition in medical education.

I am very honoured to be nominated for the 2019 Complete Nutrition Clinical Nutrition Professional of the year.

2. Could you talk us through your career journey to date?

I qualified as a dietitian in 1997 and have done a variety of jobs since then, including a complete career break to teach English in Asia for 2 years. For the last 10 years, I have been working as a Diabetes Specialist and continue to work in a diabetes antenatal clinic one day per week.

In 2016, I was appointed Research and Education Dietitian with the primary goal to improve nutrition content within Brighton and Sussex Medical school (BSMS). It is great to combine my love of teaching to this new field, although it hasn’t been without its challenges. There are very few dietitians in medical education and there are traditional barriers to introducing new teaching to the curriculum, which include competing with other topics and differing views on a doctor’s role in nutrition care.

3. How did you become a Nutrition Medical Educator?

In 2015, my colleague, Dr Kathy Martyn, reviewed the BSMS curriculum and found there was only one module with nutrition content in the entire 5-year medical degree training programme. This was used as evidence to collate a business plan for employing a Dietitian – I applied for the job and was delighted to get it!

On the job, I completed a PGCE in medical education, and I was then able to apply for membership as a Member of the Academy of Medical Educators (MAcadMEd).

4. What does a typical day of work involve?

Initially, my days were spent mapping opportunities and attending lots of meetings to negotiate teaching space. I now spend more time writing, delivering, evaluating and refining teaching plans. I also supervise student nutrition research projects, which has been a great way to increase capacity for local research and clinical audit and to engage more dietitians in this work.

My antenatal clinics are also used as teaching opportunities for medical students and other doctors. It really highlights the role of dietitians and how nutrition care fits into an MDT approach, as well as promoting the clinical relevance of nutrition to patient care and as integral to treatment.

5. Could you tell us more about how you’re integrating nutrition education into the Brighton and Sussex Medical School curriculum?

Rather than a standalone subject we are integrating nutrition (where relevant) to clinical areas or specialties. Time is tight, so many additions are short and focused e.g. incorporating nutrition into cardiology, renal, early years and general practice. We have longer workshops on nutrition screening, diabetes and a morning dedicated to behaviour change and communication. Macro and micronutrients, energy balance and an introduction to nutrition in disease is taught alongside the GI tract. We now offer various nutrition short course options including the microbiome, cancer cachexia, the patient experience of diabetes, a debate on fats and carbohydrates and food intolerances. In other areas, we have added essay titles or signposted to pre-existing resources and guidelines.

In addition, we have created opportunities for medical students to shadow other dietitian-led clinics and have created nutrition-related research projects including: clinical audits, surveying the hospital food environment, and a systematic review of using chewing gum or coffee to reduce post op ileus. We are currently writing up a survey of junior doctors and medical students to investigate views on nutrition and a doctor’s role.

6. Is there any outcome data available on the success of your initiatives?

Nutrition is now integrated into eight modules and into module assessments and written assignments. We have just had our first research paper accepted for print and have presented seven conference posters. Last year we held our first event to showcase our work so far and were delighted to sell out of all 200 tickets in 24 hours.

Our teaching receives good feedback and optional teaching such as clinics and short courses are all fully booked. The enthusiasm from medical students has been phenomenal and they are really driving change via their student voices, advocating for more nutrition teaching. 

7. Will other universities follow suit? Do you think that more Nutrition Medical Educator roles will be created for dietitians?

I hope so. I am currently working with the BDA and AfN. My role at BSMS is being developed as a case study that can be replicated in other medical schools.  We have set up the Education and Research in Medical Nutrition Network (ERImNN) seeking to link nutrition educators across the UK to pool resources and build capacity.

There will also be opportunities to work with organisations such as Nutritank and Culinary Medicine (see the web links below for details on how to sign up).

8. Could you tell us more about your role within the executive team of NNEdPro Global Centre for Nutrition?

I am co- leading on the Nutrition Education Policy for Healthcare Practice Training Package (NEPHELP), which aims to facilitate the provision of nutrition education, focusing on the hospital setting. We piloted this with 30 foundation doctors in Brighton with a plan to roll this out across the UK. We completed a review of all available UK survey data on medical student and doctor opinion on nutrition education needs and ideas for development. We presented our data at the BMJ Quality in healthcare conference in March 2019 and are hoping to publish our results soon.

Via NNEdPro, I have linked up with nutrition educators across the world and I am particularly inspired by work being carried out in India, Canada and Australia. We are hoping to replicate some of this back in the UK soon.

I will be presenting at both the NNEdPro summer school and summit in Cambridge this July.

9. Do you think that your work as a Nutrition Medical Educator will positively impact malnutrition? In what ways?

There are just over 4,000 dietetic full time equivalent posts in England and Wales but 150,000 doctors and 300,000 nurses. We want to make nutrition everyone’s business; nutrition and dietetics should be seen as an essential part of a patient’s care which is as important as medical treatment. We also want to ensure that health professionals are confident to discuss food in a way that is sensitive to individual requirements, including medical, cultural and environmental circumstances. Ultimately, we want patients to be referred on for dietetic support where appropriate by other health professionals.

10. We’ve heard that you’re also involved with Culinary Medicine? Could you tell us more about that?

I started working with Culinary Medicine to connect with doctors interested in nutrition and the work has snowballed. We run courses in a kitchen setting where participants complete online pre-learning so that the day itself can be spent discussing cases, adapting recipes and completing exercises to apply learning to practice. So far, we have trained over 50 doctors and have run eight modules for Bristol medical school. This year we are running a one-day course for all final year UCL medical students. All courses are run with a dietitian or AfN Registered Nutritionist. We are hoping to recruit more nutrition professionals soon, so watch this space!

11. What are the most rewarding aspects of your job(s)?

I get very excited about networking. There is already so much great work going on but too often people are working within the walls of their own profession. I love helping to break some of those barriers, connecting doctors, dietitians and students to share skills and resources. CMUK, Nutritank and NNEdPro have a shared aim for the UK to be world leaders in nutrition education for healthcare professionals. This requires creative thinking and energy to cut through traditional red tape.

12. Have you received support from other dietitians and our professional bodies?

Yes, I am working with both the BDA and the AfN to review the UK nutrition curriculum for medical education and the implementation.

13. And finally, do you have any advice for other dietitians who are keen to get involved in medical nutrition education?

As dietitians, we bring unique experience and knowledge of the day-to-day struggles that people have in navigating their health and making food choices. Nutrition research is fast paced and it’s great to see that we are widening the evidence base for both individualised nutrition interventions and public health strategies.

However, it is how we translate this that is important. We need to do more to find common ground, professional alliances and better communication around food with both our patients and our colleagues.

To really impact on malnutrition, we need to consider how best to educate all health professionals about incorporating nutrition into care plans and consultations. Doctors are often the first point of contact for patients and are therefore key in offering first line advice, signposting to services and acting as advocated for nutrition and dietetics.

There are lots of ways for dietitians to get involved in medical education; offer to run teaching sessions or invite medical colleagues to sit in on your clinics. Join the mailing list for NNEdPro to find out more. Or sign up to Culinary Medicine and Nutritank using the links below as both will be seeking dietitian educators soon.

Further Resources:

https://www.nnedpro.org.uk/

https://culinarymedicineuk.org/

https://nutritank.com/community/

Useful Contacts on Social Media:

• Twitter: @macaninch @erimnn @culinarymeduk @nnedpro
• Instagram: @medednutrition @culinarymedicineuk @nutritank_official