Skip to main content
Log in

Physicians and nurses can be effective educators in coronary risk reduction

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript


OBJECTIVES: 1) To compare the impact of a brief physician or nurse education session with the impact of education provided by dietitians on patient knowledge regarding coronary risk factors, dietary recommendations, and compliance, and 2) to determine the value of additional formal dietary counseling on knowledge, dietary fat, and serum lipids.

DESIGN: Primary care physicians and their office nurses were compared with inpatient dietitians by evaluating patient performance on a standardized test and three-day dietary food choices. Neither the educators nor the patients were aware of the study. Supplemental information was provided by a study dietitian and patients were reevaluated six weeks later.

SETTING: Preventive cardiology program in a university-affiliated teaching hospital.

PARTICIPANTS: Fifty consecutive patients referred to a preventive cardiology program who had received dietary and cardiac risk factor information within the preceding six weeks by a physician and office nurse (27) or an inpatient dietitian (23) were enrolled. Forty-five patients completed the study objectives.

INTERVENTIONS: The patients completed a three-day food record, fasting lipids, and a test of knowledge of coronary risk factors and dietary concepts. The correct answers were discussed and a standard American Heart Association phase I diet was recommended. Six weeks later dietary food records, fasting lipids, and the test were repeated.

MEASUREMENTS AND MAIN RESULTS: By participant recall, the dietitians (group II) spent an average of 30.6±25 minutes, compared with 8.2±14.4 minutes by the physicians and nurses (group I) (p<0.05). Group II patients had a higher total knowledge score, but they were no better in risk factors, weight control, or calculated dietary fat or cholesterol. There was no correlation between time spent and percentage of calories from fat or total test score. Six weeks after the program instruction the mean cholesterol level for all the participants was reduced, and group II had a lower fat intake than did group I, which was associated with significantly lower serum cholesterol, not present at entry.

CONCLUSION: Primary care physicians and their office nurses, using less time than do dietitians, can be effective educators in providing patient education for coronary risk reduction and dietary fat intake. A second formal dietary consultation appears beneficial in improving compliance and lipid control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. The Expert Panel. Report of the National Education Program. Expert panel on detection, evaluation and treatment of high blood cholesterol in adults. Arch Intern Med. 1988;148:36–9.

    Article  Google Scholar 

  2. Kuper N. Steiner R. Medical nutrition education: an assessment of nutrition education in a family practice residency program. J Am Diet Assoc. 1985;85:973–4.

    Google Scholar 

  3. Englert D, Crocker K, Stotts N. Nutrition education in schools of nursing in the United States Part 1. J Parenter Enter Nutr. 1986;10:522–7.

    Article  CAS  Google Scholar 

  4. Podell R, Gary L, Keller K. A profile of clinical nutrition knowledge among physicians and medical students. J Med Educ. 1975;50:888–92.

    PubMed  CAS  Google Scholar 

  5. Wayland MT, Culik D, Goldsby C, et al. Screening by family practice and internal medicine residents and the effect of an intervention program. J Med Educ. 1987;62:519–22.

    PubMed  CAS  Google Scholar 

  6. Linn BS, Zeppa R. Effect of a clerkship on students’ attitudes toward practice problems and preventive care. J Med Educ. 1987;62:408–17.

    PubMed  CAS  Google Scholar 

  7. McBride PE. Teaching preventive cardiology in primary care: an integrated curricular approach. Am J Prev Med. 1990;6(2 suppl):70–6.

    PubMed  CAS  Google Scholar 

  8. McBride PE, Plane MB, Underbakke G. Hypercholesterolemia: the current educational needs of physicians. Am Heart J. 1992;123:817–24.

    Article  PubMed  CAS  Google Scholar 

  9. Scott CS, Leaf D, Neighbor WE, et al. Preventive cardiology education and practice in residency training: residents’ attitudes, perceptions, and practices. Am J Prev Med. 1990;6(2 suppl):60–9.

    PubMed  CAS  Google Scholar 

  10. Read M, Fisher K, Bendel R, Bhalla V. et al. Dietary fat intake: demographics. J Am Diet Assoc. 1989;89:830–1.

    PubMed  CAS  Google Scholar 

  11. Lavie CJ, Mihani RV. Factors predicting improvements in lipid values following cardiac rehabilitation and exercise training. Arch Intern Med. 1993;153:982–8.

    Article  PubMed  CAS  Google Scholar 

  12. Wrisley D, Rubenfire M. Ineffectiveness of standardized dietary counseling in hypercholesterolemic patients with coronary disease. J Cardiopulm Rehabil. 1988;8:226–30.

    Article  Google Scholar 

  13. Underbakke G, Plane MB, McBride PE. A survey of dietetics professionals knowledge of and attitudes toward cholesterol management. J Am Diet Assoc. 1993;93:301–4.

    Article  PubMed  CAS  Google Scholar 

  14. Disbron D. A cost-benefit analysis of nutrition service for the prevention of coronary heart disease. Top Clin Nutr. 1988;3:31–45.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Additional information

Received from the Preventive Cardiology Program. Section of Cardiovascular Medicine, Department of Medicine, Sinai Hospital, Detroit, Michigan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Peiss, B., Kurleto, B. & Rubenfire, M. Physicians and nurses can be effective educators in coronary risk reduction. J Gen Intern Med 10, 77–81 (1995).

Download citation

  • Issue Date:

  • DOI:

Key Words