1. Introduction to the Pre-Graduate LLL Programme

2. Nutrition Education The importance of nutrition in maintaining good health is widely recognized. Addressing nutrition in patient care is among the core responsibilities of doctors. However, numerous surveys report insufficient knowledge and skills related to nutrition. One important reason is that medical students receive an insufficient nutrition education during medical training. Therefore, there is a manifest interest to enhance the nutrition education received by medical students.

3. Nutrition Education in Medical Schools Medical schools around the world may suffer a scarcity of nutrition teachers and the optimal delivery and evaluation of medical nutrition education is under debate. Teaching tools made available to teachers in Medical School can contribute to improve the provision of knowledge to students. ESPEN has one important mission promoting the knowledge of Clinical Nutrition along with scientific research in this field

4. ESPEN-Life Long Learning Programme ESPEN has been very successful in developing a flourishing Education Programme in Clinical Nutrition, the Life Long Learning (LLL) International Programme on Clinical Nutrition. It is based on live and online Courses developed by a multinational group of authors. The main educational unit of LLL-Programme is the module. Each module consists of an updated review on a certain problem, clinical case and test. The modules are freely accessible on-line after registration. http://lllnutrition.com/mod/resource/view.php?id=1499

5. Achievements of LLL-Programme More than 100 modules are on the website and 20 Live courses are available. Its content is periodically revised More than 32’000 participants are registered on the LLL- Programme on-line. 950 LLL Live Courses have been organized and roughly 35’000 participants have attended LLL Live Courses in 62 countries, 5 Continents in last 10 years ESPEN LLL Diploma in Clinical Nutrition provides recognition of skills and competences in Clinical Nutrition to the owner of the Diploma. 280 out of 355 participants have passed the final exam and got the ESPEN Diploma. Further information: http://lllnutrition.com/mod/url/view.php?id=1597 http://lllnutrition.com/mod/url/view.php?id=1597

6. Development of the Pre-G LLL Programme I Pre-G LLL A structured Pre-G LLL course on Clinical Nutrition aiming to improve the knowledge and skills of medical students was developed, based on the material of the world known educational ESPEN LLL Programme on Clinical Nutrition Pre-G LLL Pre-G LLL course The Pre-G LLL course on Clinical Nutrition consist of 11 essential and 7 optional topics. The unique Pre-G LLL course could be constructed for 10-15 topics/hours. Pre-G LLL course Creation of optional topics along with the essential topics aims to increase the adaptability of the Pre-G LLL course

7. Development of Pre-G LLL Programme II ESPEN experts A list of essential and optional topics has been developed by ESPEN experts with the supervision of an International Review Committee. The existing teaching materials of LLL Programme have been adapted and upgraded by the authors to develop the slides (45 per topic), texts and clinical cases of each topic of the Pre-G LLL Programme. Explanations for each slide are added as a note. Each topic has been reviewed and edited according to comments by the LLL Team Directors and by the International Review Committee.

8. Essential Topics 1. Malnutrition, Nutritional Screening and Assessment 2. Nutrition Requirements: Energy, macronutrients, water, electrolytes 3. Nutrition requirements and common deficiencies of vitamins, trace elements and antioxidants 4. Metabolic Response to Starvation, Surgery and Acute Illness 5. Medical Nutritional Therapy - Part 1 6. Medical Nutritional Therapy - Part 2 7. Obesity 9. Nutrition in Liver and Gastrointestinal Diseases 9. Nutrition in Cancer 10. Pediatric Nutrition 11. Nutrition in the Elderly Pre-G LLL Programme

9. Optional Topics Optional Topics (under development) 1. Nutrition in Primary Care – Atherosclerosis, Diabetes, Osteoporosis (Vitamin D), Exercise Counselling 2. Renal Diseases 3. Respiratory Diseases 4. Neurology Disease 5. Eating disorders 6. Ethics in Nutrition 7. Probiotics, Prebiotics and Complimentary and Alternative Medicine (CAM) Pre-G LLL Programme

10. Future Plans for Pre G LLL Programme Development of versions of the Pre-G LLL Programme aimed at teaching students of different Health Care Professions. Update of the contents of topics according to new scientific data, guidelines and the feedback of users of the programme. Addition of multimedia files to favour the understanding of the concepts explained in the Topics.

11. Pre-G LLL Programme Pre-G LLL Pre-G LLL course on Clinical Nutrition could be used for teaching pre-graduate students all over the world Pre-G LLL Pre-G LLL course is Flexible and adaptable to the Programmes offered in Medical Schools Pre-G LLL Pre-G LLL course on Clinical Nutrition is intended for use by Teachers in Medical School. All the materials of the Pre-G LLL will be hosted in the LLL Programme server. Access to this material for Medical School Teachers will be awarded by LLL Team after request.

12. Acknowledgments I We are indebted to all the work done by the authors of the modules of the different topics of the LLL Programme. The Pre-G LLL topics are based on slides coming from one or more modules along with other slides created specifically for them. LLL Programme authors are given credit at: http://lllnutrition.com/mod/resource/view.php?id=1499 where their names and titles of each module are listed. The current authors of the Pre-G LLL Programme are commended for their commitment to the development of this educational tool.

13. Acknowledgments II We thank the contributions made by the authors of Pre-G modules from KEPAN team and particularly by R. Haldun Gundogdu for his support in the coordination of the Project. We thank the contributions made by the International Review Committee: We also thank Kolacek S and Moreno JM for their comments. ESPEN ECPC Committee Chairman, Schneider S, has fully supported the Pre-G LLL Programme. Forbes A edited the texts of each module. LLL Directors, Komsa-Penkova R, Leon-Sanz M, and Meier R, have final responsibility for the development of the Pre-G LLL Programme. Baik HW Pichard, C Boseaus, I Singer, P Higashiguchi, T Waitzberg, D

14. Acknowledgments III The Life Long Learning (LLL) Programme in Clinical Nutrition and Metabolism is an innovative and effective educational programme for medical doctors and health specialists offering training on-line and at live courses, by a variety of modern training methodologies and resources. Pre-G LLL We are indebted to all the work done by the authors of the modules of the different topics of the LLL Programme. The Pre-G LLL Topics are based on slides coming from one or more Modules along with other slides created specifically for them. LLL Program Authors are given credit at: http://lllnutrition.com/mod/resource/view.php?id=1499 where their names and titles of each Module are listed.