American Society for Nutrition

Interviewer: When did you first get involved with ASN? What factors motivated you to do so?

Dr. St. Jeor: It seems that I have always been a member of ASN, but I felt the need to become more active and involved when I was appointed the Director of the Nutrition Education and Research Program at the University of Nevada School of Medicine (UNSOM) in 1982. As a unique, school-wide program established directly under the dean, I felt I needed national directions and support to be able to lead the program effectively since the integration of nutrition into medical education faced a lot of challenges as a non-traditional area. I looked to ASN and colleagues as consultants to help develop and maintain our program. The UNSOM is the only school of medicine in the state, so contacts and directions provided by ASN on a national level were and continue to be really invaluable.

Fortunately, we were able to obtain grants from the National Fund for Medical Education to get us started and a series of education research grants (R25s) from the National Institutes of Health, 2 from the National Cancer Institute (NCI) and the latest one from National Heart Lung and Blood Institute (NHLBI) as a Nutrition Academic Award.    These grants provided us with the opportunity to appoint an advisory board to help with the direction of the program and the integration of nutrition in the medical school. So several advisors, whom I met through ASN, willingly agreed to serve on our advisory board, and included Elaine Feldman, Eleanor Young, and Michael Brooks, George Blackburn, Ken Fujioka, John Foreyt, Gary Cutter and Steve Blair). Other ASN members, including Maurice Shils, and later Steve Ziesel and his group) also came out very willingly and gave several lectures in the nutrition and cancer series. With the first grant from NCI, we were able to introduce a 20-hour medical nutrition course as a “required” course and this course that has been ongoing since 1985.

    It was around that time that the first Institute of Medicine (IOM) report came out on nutrition and medical education. With these directions, the UNSOM, being a small, progressive medical school, was able to break tradition and introduce innovative programs. I believe with the help of the ASN leadership on our advisory board, I was able to do things here in Nevada that you probably wouldn't be able to do at many other medical schools. The program being under the dean was also helpful because it was school-wide, allowing us to accomplish a longitudinal integration into the various clinical as well as some of the basic science departments. The grants also had a focus on prevention, which was a little bit difficult; but we were able to integrate a lot of the new and important prevention concepts into the medical nutrition curriculum as well. I really appreciated the help from the ASN leadership to set me on the right course in these efforts.

Interviewer: Is that how you became a member of the Graduate and Professional Education Committee?

Dr. St. Jeor: Yes, although I wasn't officially a member of the Graduate Professional Education Committee until 2007.However, I was appointed to the previous Committee on Medical/Dental Nutrition Education around 1989 and as part of that committee, I was part of a site visit team that surveyed other medical schools and determined what some of the best residencies were providing in the way of nutrition education. I discovered that there was a lot of innovation and support for nutrition at these medical schools. So these programs encouraged models I used to establish medical nutrition here at the University of Nevada. Eventually my involvement with that committee and with ASN in general along with election to the Medical Nutrition Council led to my membership with the Graduate and Professional Education Committee.

Interviewer: How has being involved with ASN councils and RIS helped further your professional development?

Dr. St. Jeor: The recognition for national leadership that comes with being a member of these councils gave me credibility at my own institution. The committees I have been on with ASN have been recognized by our administration as important. Being the lead person here in nutrition, it was so important that the administration recognize that I was pursing national directions. Thus, these ASN activities and publications (along with the IOM report) helped us establish medical nutrition at the UNSOM. The second grant in 1990 helped us develop an innovative SQIN (Special Qualifications in Nutrition) or elective fellowship program for medical students.   Doug Heimburger of ASN helped us develop the model and the ASN summer fellowship program (for which I was a resource) gave us ideas.    So now the medical students are chosen at the end of their freshman year to participate in this fellowship program that includes a research project as a MSI and 40 extra hours/year for the following 2 years (MSII-III) and a 2-4 elective rotation as a MSIV. Some of these fellowships were sponsored by NIH grants, but we also received funding from the Reno Cancer Foundation, and other sources, including industry. The SQIN Program has been ongoing since 1999 and we have graduated 10 medical school classes with a total of   29 medical students recognized at graduation.

Interviewer: What other aspects of your membership with ASN have been most helpful to you?

Dr. St. Jeor: ASN has offered national support for our ideas, recognition for achievement, and an opportunity for our faculty and students to present their research.

Importantly, in 2005, I was awarded the Roland L. Weinsier Award for Excellence in Medical/Dental Education and that really helped me here at my institution when nutrition like other new areas was being critically evaluated.. The support that I've had from ASN and from its constituency has been just amazing. Being active in ASN allows me to network with so many people … these people are incredible- the way they share their ideas. If we can foster that for young leaders and people who are struggling with nutrition education in medical schools or with nutrition research, I think this is where ASN can be most helpful.

As a result of ASN's programs and directions, we here at the University of Nevada have been able to survive. We've tried everything in our medical nutrition course, and many of the great ideas for that course have come from ASN members. For example, we've used the CD-ROM from the Nutrition in Medicine Series (Steve Ziesel's group) to help us and we have one-on-one experiential exercises and case studies. With our transition to the Department of Internal Medicine we have more physician involvement, which is so important. Now our unit, which is the division of Endocrinology, Nutrition, and Metabolism has a physician head, (Ray Plodkowski who is also active in ASN) which has really added to our credibility. So, I think getting more physicians involved could be very beneficial to them as well as ASN, particularly endocrinologists. It provides them with so many new opportunities and collaborations.

Interviewer: Tell us a little about your upcoming presentation for Experimental Biology 2010. Can you give us a quick overview of some of the medical education practices and programs you and Drs. Heimburger, Kris-Etherton, and Eisenstein will be touching on?

Dr. St. Jeor: We are conducting a symposium called “Nutrition at the Forefront of Medical Education,” which is being sponsored by the MNC and GPEC. It will be held on Saturday. I will be discussing the challenges for developing and sustaining curricular opportunities in nutrition as part of medical education. The reason I was chosen to do this was because we were initially established as a separate program under the dean in 1982, when nutrition was not a priority in medical school. So even though we had our separate program for many years, we still faced decreased funding and competition with other departments. After about 20 years, we were put under the Department of Internal Medicine in 2003. Once there, we had to deal with budget cuts, other priorities, etc. Fortunately, I received a third grant through NIH--the Nutrition Academic Award, which is sponsored by NHLBI and that helped us create and support an interdisciplinary weight-management clinic in the department. That clinic, I believe, is one of the first to be physician-directed and independently “dietitian-led” in a medical school. There were 21 schools that received five-year Nutrition Academic Awards through the NHLBI. Through that grant, we were able to make an impact on the way nutrition is taught in medical school, involve physicians and nutritionists/dietitians many of whom are ASN members (Drs Pearson, Ziesel, Heber, Van Horn, Kris Etherton, Hark etc.) Most of our presentations were done at ASN. In addition, students have presented at ASN/FASEB. Last year, one of our interdisciplinary SQIN students (PhD candidate in Computer Science and Engineering) presented the development of charts and wheels to more easily calculate REE from our Mifflin-St.Jeor predictive equation.

Interviewer: Have you found it beneficial to be integrated into the Department of Internal Medicine?

Dr. St. Jeor: Yes and no … it's good because you have a department chair to speak for you, but you have to be sure that nutrition is a priority within the department. We were fortunate because we were able to develop a Center for Nutrition and Metabolic Diseases and CNM interdisciplinary clinic supported partially by the Nutrition Academic Award. Importantly, the CNM now is the” home” for nutrition education and research within the department. Recognition within ASN as a national group has also helped me have credibility to keep nutrition a priority in the department. It's given me more negotiation power to bring nutrition to the forefront. That is really what I will be talking about at ASN--the challenges … and the opportunities. Looking at some of the recent, we can see that nutrition hasn't gained much as far as the number of hours required, even though it is becoming integrated into more curriculums. We still have to struggle to get that time in the curriculum with and qualified instructors. I look at it as a challenge--to find ways to keep nutrition active and integrated into the medical curriculum.

Interviewer: What other aspects of EB 2010 do you think will be most exciting for medical education?

Dr. St. Jeor: They are having a workshop for test item writing, which I think will be very interesting. The national board exams are one place where we are making progress. With the national step one step two examinations for the medical students, our administration has realized that nutrition is important. . I was able to participate with a group to develop and give input to these national board questions through the Nutrition Academic Award Program and members active in ASN.

Interview with Dr. Sachiko St. Jeor, ASN Member and Committee Leader

Interview with Dr. Sachiko St. Jeor, ASN Member and Committee Leader