O067 - HIERARCHY GRADIENT AND KNOWLEDGE–PRACTICE GAP IN NUTRITIONAL SCREENING AMONG INTERNAL MEDICINE PHYSICIANS: A NATIONWIDE STUDY WITH A VALIDATED SCALE

O067

HIERARCHY GRADIENT AND KNOWLEDGE–PRACTICE GAP IN NUTRITIONAL SCREENING AMONG INTERNAL MEDICINE PHYSICIANS: A NATIONWIDE STUDY WITH A VALIDATED SCALE

Z. Irmak Kaya^1,* on behalf of the DAHUDER Nutrition Study Group, H. H. Çoban¹, K. işsever², S. Yaylacı³, S. Ocak Serin⁴, K. Konur⁵, A. Oral⁶, Ö. Kama Başcı⁷, I. A. Kurtulmuş⁸, M. S. Mamiş⁹, E. Burak¹⁰, N. Koca¹¹, S. Uyar¹²

¹Internal Medicine Department, Eskişehir City Hospital, Eskişehir, ²Internal Medicine Department, Giresun University, Giresun, ³Internal Medicine Department, Sakarya University Faculty of Medicine, Sakarya, ⁴Internal Medicine Department, Umraniye Training and Research Hospital, İstanbul, ⁵Internal Medicine Department, Recep Tayyip Erdogan University, Rize, ⁶Internal Medicine Department, Biruni University, İstanbul, ⁷Internal Medicine Department, Balıkesir University , Balıkesir, ⁸Internal Medicine Department, Ege University, İzmir, ⁹Internal Medicine Department, Siirt Research and Training Hospital, Siirt, ¹⁰Internal Medicine Department, Umraniye Training and Research Hospital, istanbul, ¹¹Internal Medicine Department, Bursa City Hospital, Bursa, ¹²Internal Medicine Department, Antalya Education Research Hospital , Antalya, Türkiye

Rationale: Internal medicine has the highest malnutrition prevalence, yet a profound "implementation gap" exists between mandatory policies and bedside reality. We aimed to map nutritional competence via a validated scale, quantify the hierarchy gradient, and identify barriers to the knowledge-to-practice transition in a DAHUDER Nutrition Study Group nationwide cohort covering all 81 Turkish provinces.

Methods: This cross-sectional study included 573 internal medicine physicians (284 residents, 198 specialists, 91 faculty). Nutritional competence was assessed via a newly developed and EFA-validated scale (KMO=0.868, Cronbach’s α=0.824, McDonald’s ω =0.841), with discriminative power confirmed by ROC analysis (AUC=0.892). Multivariate logistic regression analyzed the impact of formal nutrition training and professional barriers.

Results: NRS-2002 usage increased linearly across the hierarchy: residents (18.8%), specialists (44.2%), and faculty (67.4%;p<0.001). While mean competence was 64.2±11.4, a paradox emerged: 65.8% of physicians exceeding the 71-point threshold did not screen routinely. Multivariate analysis identified postgraduate training as the strongest predictor (OR=6.42,95% CI:4.12–9.84,p<0.05). However, systemic barriers, chronic time constraints (62.1%) and staffing shortages (24.4%), emerged as more dominant determinants than knowledge or seniority in predicting actual screening behaviour.

Conclusion: Nutritional management remains a theoretical concept, not clinical reality. Mandatory digital fields create a false sense of security; 65.8% of knowledgeable physicians still fail to screen. This structural bottleneck (beyond a training deficit) requires a digital ecosystem to transform screening from bureaucracy into a life-saving clinical standard.

Disclosure of Interest: None declared