The primary mission of the Nutrition in Medicine (NIM) project is to provide tools to facilitate the nutrition training of undergraduate medical students. NIM has developed and distributed a CD-ROM–based nutrition curriculum to medical schools since 1995. However, the medical school environment is changing rapidly; there is pressure to do more in less time, and many schools are emphasizing independent and integrated learning. The need for a nutrition curriculum that is more flexible and more accessible has driven the evolution of the NIM curriculum from CD-ROM–based delivery into a more modular curriculum with Web delivery. Such changes facilitate access and eliminate the need for installation of CD-ROMs and the associated technical support issues. In addition, the instructional units are smaller and more modular.

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Eventually, the authoring system will allow instructors to put together a course to meet their specific instructional needs. Our future plans also include custom-tailoring that will allow students to opt out of learning material on the basis of pretest scores if they are already proficient in the content. In this update, we provide a detailed description of the new system and the rationale for the modifications we made. Furthermore, we describe how each change addresses barriers to nutrition education as identified from our surveys and others and from direct user feedback. These innovative strategies should allow a better fit of NIM within diverse medical school environments and help to promote incorporation of the curriculum into more medical schools. INTRODUCTION The mission of the Nutrition in Medicine (NIM) project at the University of North Carolina at Chapel Hill is to develop a core curriculum in nutrition for medical students that covers the preventive and therapeutic aspects of nutrition, spans the preclinical and clinical training of physicians, and is flexible and interactive.

Since 1995 the NIM project has developed, updated, and distributed free of charge to all US medical schools a CD-based nutrition curriculum. This curriculum consists of 10 titles () and provides many opportunities for the student to apply knowledge and build experience; such approaches may result in greater success in preparing students to deliver health-promoting services confidently. Efficacy data for several of the titles have been published elsewhere, as has a detailed description of the curriculum (-). In brief, each CD-ROM educational module contains lessons that teach basic nutrition science and center around patient cases. In the video case segments, the virtual mentor asks the student to apply the knowledge learned in the lessons.

Interactive exercises and animations are included within lessons, along with pop quizzes and short case studies. Each section begins with learning objectives and ends with key concepts. Hyperlinked text in the lessons takes the user to the glossary section of the references where they can view a definition of the term; other items included in the references include diagnostic tests, nutrient allowances, a bibliography, and in the most recent titles, a supplement index. Three board-type exams are accessible at any time. The curriculum topics and coverage are based on the American Society for Clinical Nutrition's consensus guidelines (). The currently available CD content addresses most other published recommendations as well, including most of the recently published Nutrition Academic Award's Nutrition Curriculum Guide (-).

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Content is developed by faculty of the Department of Nutrition at the University of North Carolina at Chapel Hill, which is part of both the School of Public Health and the School of Medicine. Furthermore, content review and direction are provided by an advisory board of medical educators and nutrition experts from academia, government, and industry. Because many medical schools do not have faculty who are experts in nutrition, this system provides a credible and consistent source of nutrition information for such institutions. The CD-ROM system provides a means of delivering consistent nutrition education across institutions and instructors. Our database records indicate that this curriculum has been distributed to all 125 US medical schools, to most US osteopathic schools, and to 110 international medical schools. Ongoing surveys show that at least 129 medical schools use the modules in some way (92 US schools, 37 international schools), and an additional 56 medical schools are planning on using or are evaluating the modules for incorporation.