The Warren Alpert Medical School of Brown University
Using Community-Based Participatory Research to Create a Healthy Latinx Cookbook
Authors: Rocío Oliva, MS, Megan Duckworth
Purpose/Hypothesis: Obesity is a chronic disease of pandemic proportion that disproportionately burdens people of Hispanic/Latinx heritage. Progreso Latino, a nonprofit organization in Central Falls, RI, aims to diminish the growing health disparities that exist between the Latinx community and the rest of the population. Progreso Latino stakeholders identified the need for a culturally appropriate, language concordant cookbook following the Harvard MyPlate guidelines to promote healthy eating among the community. We aimed to 1.) understand facilitators and barriers to cooking and eating nutritious food, 2.) identify popular recipes that are often seen as potential barriers to eating healthfully, and 3.) develop a culturally appropriate, Latinx-specific cookbook.
Methods/Design: We conducted 20 in depth, semi-structured interviews by telephone with Progreso Latino members. Latinx-identifying community members who participate in Progreso Latino programs were eligible if they spoke English or Spanish and were 18 years or older. Using immersion-crystallization techniques, we analyzed the transcripts for themes of facilitators and barriers to eating healthfully. We compiled 14 original recipes from interview participants. Recipe adaptations followed a recipe modification framework created with assistance from a local culinary nutrition expert following the principles of health, accessibility, cost, and variety/flexibility.
Results: Facilitators to cooking and eating healthfully included accessibility of fresh foods, nutrition education program referrals in a clinical setting and active participation in such programs, a family tradition of cooking, and fear of chronic diseases. Barriers include cost of healthy foods, time, cooking for a family, and the oversaturation of processed food options. Participants discussed the mental health impacts of chronic disease: loss of self-esteem and motivation, anxiety, and depression. Recipes were adapted successfully and a cookbook was created.
Conclusions of Clinical Interest: More family-focused nutrition programs are urgently needed to promote healthy habits throughout the life cycle. Participants expressed interest in tailored nutrition information linked directly to their medical care; strengthening nutrition program referrals or integrating nutrition services into clinical settings would meet these needs. We suggest educating physicians on the importance of nutrition among the communities they serve and promoting physician advocacy to improve access to affordable healthy foods.
Summary: Obesity disproportionately burdens Latinx communities. Progreso Latino, a nonprofit organization in RI, identified the need for a culturally appropriate, language concordant cookbook to promote healthy eating among community members. We aimed to 1.) understand facilitators and barriers to cooking and eating nutritious food, 2.) identify and adapt popular recipes, and 3.) develop a culturally appropriate cookbook. We conducted 20 semi-structured interviews with Progreso Latino members. Using immersion-crystallization, we analyzed the transcripts for facilitators and barriers to eating healthfully. We compiled and modified 14 recipes for the cookbook. Facilitators to eating healthfully included accessibility of fresh foods, nutrition education program referrals in clinical settings and participation, family tradition of cooking, and fear of chronic diseases. Barriers included cost of healthy foods, time, cooking for a family, and the accessibility of processed foods. Family-focused nutrition programs and increased physician nutrition education are urgently needed to promote healthy habits throughout the life cycle.
Mount Carmel Grove City Health System
Title: Disease Intervention Through Culinary Education (DICE)
Authors: Elizabeth Howcroft, Ryan Eversole, Lisa Hamilton
Learning Objective: To improve chronic disease management through nutrition education and cooking instruction.
Background & Purpose: Despite recognition of the importance of lifestyle therapy in the prevention and treatment of type 2 diabetes mellitus (T2DM), implementation represents a major challenge for the health care system and for patients. This deficiency is particularly acute in underserved areas where lack of income, access to healthy food options, or education act as roadblocks to implementing nutrition therapy as part of a comprehensive treatment plan for T2DM. This, in turn, is hypothesized to lead to progression of disease resulting in decreased quality of well-being and reduction in life expectancy. We hypothesized an interactive cooking class could be an effective treatment modality for our clinic patients with higher than average rates of chronic disease. After our intervention, we expected participant knowledge of disease process plus healthy dietary habits to increase and stress level to decrease.
Study Type: Community intervention trial with a quasi-experimental (pre/post) design.
Design: The intervention consisted of a three hour nutrition education class and hands on cooking session led by a multidisciplinary team. Baseline and post-intervention questionnaires were administered at the beginning and immediately following the three hour session. A 5-point Likert scale assessed participants’ pre- and post-intervention perceived knowledge. Pre- and post-intervention stress level was assessed using a 10-point scale.
Outcomes Measured: The differences in participant pre- and post- intervention knowledge, attitude, and beliefs related to the diagnosis and dietary management of diabetes, their overall stress level, and their response to a multidisciplinary led cooking class.
Study Setting: Mount Carmel Healthy Living Center, Columbus OH.
Results/conclusion: A statistically significant increase in self-reported understanding of T2DM was seen from pre-to-post intervention (median change=1.0, p=0.0010). Participant stress level decreased pre-to-post intervention (p-value: 0.0127) from 6 (SD=2.5) to 4.2 (SD=2.4). Participants who responded to the post survey (N=17) stated the program was helpful, cooking skills were learned, and they would recommend the class. While our project was small and isolated to our outpatient clinic, it nevertheless provides evidence that disease education and hands on nutrition classes can increase knowledge, reduce stress and ultimately lead to improved outcomes.
Poster Summary: Despite the importance of lifestyle therapy in the prevention and treatment of chronic disease, implementation represents a major challenge. This deficiency is particularly acute in underserved areas where lack of income, education and food insecurity act as roadblocks to implementing nutrition therapy into chronic disease treatment. We hypothesized that an interactive cooking class led by a multidisciplinary team could be an effective treatment modality to empower patients with the nutritional knowledge and cooking skills to initiate lifestyle and dietary changes at home. Since our residency clinic serves a predominantly health illiterate, underserved patient population in Central Ohio, we thought it would be a good patient population to study. Our patients have a higher than national average of cardiovascular disease and 1/3 have diabetes. After attending a single session cooking class, we expected participant knowledge of their disease process and dietary/cooking habits to increase and their stress level to decrease.
Olivewood Gardens & Learning Center
Title: Cooking for Salud®: A Culinary and Lifestyle Program for Older Adults: Assessing Impacts on Chronic Disease Biomarkers and Health Outcomes
Authors: Sabrina A. Falquier Montgrain, MD; Callie Brust, MPH, RDN, CHES; Jen Nation, MA; Patty Corona
Background: Olivewood Gardens & Learning Center’s Cooking for Salud® program is a 7-week lifestyle modification program that gives participants tools to change their food-related habits by participating in culinary instruction in a teaching kitchen centered around nutrition, mindfulness, and wellness. Each week focuses on different aspects of nutritional knowledge and culinary skills which builds on the previous weeks and features guest chefs leading hands-on cooking classes on site. Topics covered include: drink alternatives to sugar-sweetened beverages, incorporating culturally-relevant vegetables and fruits into every meal, whole grains, knowledge of oils, well thought-out protein options, batch cooking, cooking on a budget, nutritional knowledge, effects of balanced meals compared to high sugar, fat, or processed grain on the body short and long term.
Olivewood Gardens & Learning Center is located on 8 acres and cultivates 2 acres for growing produce. The non-profit serves local kids, teens, and adults in National City, CA which reports the highest rates of death from chronic diseases (60%) in San Diego county, including diabetes and heart disease. Through nutrition education, hands-on garden programming, and practical cooking classes, community members are equipped with tools needed to make healthy choices for themselves and their families. Cooking for Salud® began in 2012 and now has 260 program graduates, or Kitchenistas®. The Kitchenistas® engage in ongoing, peer-led health and wellness education, personal and professional development, and community outreach.
With this in mind, in the Fall of 2018, Olivewood Gardens hosted a group of 15 older adults for the 14th cohort of Cooking for Salud®. Data were collected to monitor participants’ behaviors, knowledge, and mindfulness along with biomorphic data, including lab values, to assess improvements in chronic disease risks as a result of this program. The objective of the study was to evaluate the clinical health outcomes of participants in Cooking for Salud®, a culinary-based lifestyle modification program.
Methods: Participants were recruited during nutrition classes at local senior centers and senior living facilities
Recruited individuals 55+
Effort to utilize participants’ cultural food traditions
Baseline survey and biomorphic data were collected prior to the intervention and again at the completion of the program
Biomorphic data included: HgbA1c, LDL, HDL, Triglycerides, blood pressure, weight, height, BMI, and visceral fat
Observational and focus group data obtained
Focus group discussions were held 3 months post-intervention
Hybrid traditional pre-post survey design with a retrospective pre-post design
Quantitative data analysis included descriptive statistics to summarize the data and paired- sample t-tests
Qualitative data were analyzed using content analysis for theme identification
Surveys were adapted from validated surveys
Conclusions: These pilot data suggest that an innovative culinary-based lifestyle modification program can positively impact biomorphic data and behavioral change indicators
A culinary-based program can be utilized as an effective method for chronic disease improvement and prevention.
Texas Christian University
Title: Culinary Medicine and a Multisite Longitudinal Study: Cooking for Health Optimization with Patients (CHOP)
Background: Preventative health and disease management has become one of the most talked about areas of medicine during recent years..
With chronic diseases such as type II diabetes, coronary heart disease and morbid obesity on the rise, it has become increasingly important for doctors and medical professionals to counsel their patients and clients about preventative health measures that include nutrition and healthful eating habits.
With this in mind, the Culinary Medicine curriculum was developed in 2012 by Tulane University and the Goldring Center for Culinary Medicine (GCCM) to train medical professionals about nutrition and healthy eating practices. Currently, 22 medical schools and institutions nationwide provide this program and also participate in a 10-year longitudinal study (Cooking for Health Optimization with Patients, CHOP) to assess training outcomes.
Methods: During 2014-2015, 66 medical students from UNTHSC Texas College of Osteopathic Medicine participated in the Culinary Medicine course. Students were assessed following course participation by completing a 4-part survey including demographics, attitudes, dietary habits, and degree of proficiency in professional competencies related to clinical nutrition knowledge.
Student responses were compared with 554 CM and non- CM students from seven partner institutions. Study procedures were approved by Tulane University and Texas Christian University IRB, and participants’ informed consent was obtained. Data was analyzed to meet study objectives (SPSS, P<0.05).
Summary: Significant (P value < 0.05) post-course results showed that, compared to non-CM students, UNTHSC/TCOM students who participated in the Culinary Medicine course reported greater proficiency and more confidence in their understanding and ability to inform patients about the following competencies related to clinical nutrition knowledge:
• (1) health effects of the Mediterranean, Dash, and low fat diets,
• (2) dietary patterns for type 2 diabetes, celiac disease, and food allergies,
• (3) weight loss strategies,
• (4) recognizing warning signs/symptoms of eating disorders, and
• (5) the role of fiber and omega-3 fatty acids in disease prevention and heart health.
West Virginia University School of Medicine
Title: The use of the Mediterranean Diet Score as a medical student patient counseling tool in the primary care setting
Authors: Jessica Arvon, MS3; Ryan Quigley, MS3; Kate Webster, MS3; Vincent Morrow, MS3; Dr. Rosemarie Lorenzetti, M.D.; Dr. Madison Humerick, M.D.
Background/Objective: The rural environment of WV contributes to the inability to educate patients on nutrition. Counseling by health-care providers is an effective tool in promoting behavior change. The Mediterranean Diet has been adopted in the ACC/AHA guidelines for prevention of stroke and cardiovascular disease. The Mediterranean Diet Score (MDS) has been used as an assessment of patients’ adherence to the diet. In this study, medical students used the MDS as a dietary assessment tool and basis for counseling patients on healthy nutrition to determine if patients increased their score over a three-month time-period.
Method: In this prospective cohort study, ten WVU SoM medical students were trained in calculating a patients’ MDS in WV Eastern Panhandle primary care clinics. One point was given for meeting the requirement in the following categories: fruits/nuts, vegetables, whole grains, legumes, unsaturated fats, red wine, fish, limited amounts of dairy and red meat, with a maximum score of 9. The patient’s score was calculated during the visit and two personalized health goals were developed. The patients were randomly stratified into 2 groups: group 1 received calls at weeks 4, 8, and 12, while group 2 received a call only at week 12. Adherence to diet and health care goals were examined to assess the effectiveness of medical student coaching on health outcomes.
Main results – summary: 106 patients were interviewed; 61% had a MDS between 0-3, 26% between 4-5, and 13% between 6-9, with an average score of 2.97. There was no correlation between MDS and BMI or blood pressure. Of the 53 patients in group 1, 22 patients participated in the week 4 phone call with no change to their diet. (58 words). The rest of the patients were lost to follow-up.
Conclusions of clinical interest: Data obtained from patients in rural WV primary care clinics showed an average MDS score of 2.97, which is consistent with theoretical data showing the standard American diet is an average score of 2. A shortcoming of this study was lost to follow up. Further investigation is merited, but with a more effective means to communicate with patients and reduce the attrition rate in follow-up.
Summary: The Mediterranean diet is a well-established regimen associated with reduced incidence of cardiovascular events and cancer, reduction in total mortality, and overall improvement in health and well-being. WV consistently has some of the highest rates of diabetes, heart disease, and other poor indicators and predictors of health, making it a good candidate for improvement in the health of its patrons by the implementation of a regimented diet. In this investigation, medical students were trained to calculate a patient’s Mediterranean Diet Score (MDS) and use it as a gauge and predictor of health status and set goals for improvement along the Mediterranean scale. This study demonstrated an average MDS score of 2.97 upon initial interview and had high attrition rate and lost to follow up. Further investigations are warranted that better assess the changes in dietary habits following medical student coaching.
Georgetown University School of Medicine
Title: Transforming a Culinary Medicine Elective for Medical Students into a Virtual Format
Authors: Katheryn A. Bell, BA; John Hunting, MPH; Yumi Shitama Jarris, MD
Contact Info: [email protected]
Background/Objective: We sought to convert an in-person culinary medicine course for second year medical students into a virtual format. The course objectives were for students to be able to experience the benefits of culinary medicine in improving personal and patient wellbeing, develop cooking skills to make healthier food choices, engage patients in conversations about dietary lifestyle changes, evaluate the evidence base for nutrition science, and recognize the social and economic conditions that lead to poor nutritional health.
Methods: Our virtual course consisted of four 60 to 90-minute afternoon sessions and four 2-hour evening sessions with 12 students convening over Zoom. Afternoon classes consisted of didactic learning, while evening classes consisted of cooking. During cooking sessions, students were divided into breakout rooms with 2-3 students per instructor in order to receive real-time feedback on culinary skills. Students completed pre-course and post-course surveys assessing their perceived competence in nutrition counseling, attitudes in nutrition counseling, and current dietary intake. Additionally, the post-course survey assessed the students’ reaction to the course, including the virtual format. The pre-course survey was also sent to the entire second-year class as a control to ensure results would be generalizable.
Overall impressions of the endeavor: The virtual course proved to be feasible, enjoyable, and meaningful for students. In addition, the virtual format may allow us to offer the course to more students in the future. This was conducted with the second year med students in the Culinary medicine Course at Georgetown University. The entire class was used as control
Conclusions of clinical interest: Results of pre-and post-course surveys are presented to show trends. Data analysis, including a 6-month post-course survey will be completed in March 2021. Overall satisfaction with the course was very high, and students reported that the virtual format of the didactics and cooking sessions were effective in meeting the course objectives. Perceived competency in nutrition counseling was very high post-course, with 11/12 students reporting competence in all areas assessed. Students tended to eat more vegetables and whole grains, and fewer whole milk dairy foods, red meat, and processed foods post-course. Students also reported preparing more meals for themselves post-course.
Students completed pre and post course surveys assessing their perceived competence in nutrition counseling, attitudes in nutrition counseling, and current dietary intake. Additionally, the post course survey assessed the student’s reaction to the course, including virtual format, The pre-course survey was also sent to the entire second year class as a control to ensure results would be generalizable
Summary: We sought to convert an in-person culinary medicine course for second year medical students into a virtual format. The course objectives were for students to experience the benefits of culinary medicine in improving personal and patient wellbeing, develop cooking skills to make healthier food choices, engage patients in conversations about dietary lifestyle changes, evaluate the evidence base for nutrition science, and recognize the social and economic conditions that lead to poor nutritional health. Our virtual course consisted of eight sessions with a mix of didactic learning and cooking. During cooking sessions, students were divided into Zoom breakout rooms with 2-3 students per instructor. Students completed pre-course and post-course surveys, which showed that the virtual course was effective in meeting the course objectives and appeared to improve students’ confidence in nutrition counseling and personal dietary habits. Overall, the virtual course proved to be feasible, enjoyable, and meaningful for students.
PennState College of Health and Human Development
Title: Culinary Medicine for Family Medicine Residents
Authors: Emily A Johnston, Amrita Arcot, Jennifer Meengs, Tomi D. Dreibelbis, Penny M. Kris-Etherton, Joseph P. Wiedemer
Contact Info: [email protected]
Outcome measures: Survey on knowledge, confidence, and relevance to practice.
Setting: Teaching kitchen in nutritional sciences department of Penn State University.
Population: 13 family and community medicine resident physicians.
Background: The medical school curriculum provides little nutrition education resulting in a lack of nutrition counseling by physicians in clinical practice. The obesity epidemic continues to grow, while physicians report feeling inadequately prepared to effectively provide lifestyle counseling for obesity management. Our objective was to increase physician knowledge of nutrition interventions for obesity management and provide practical discussion points for patient care.
Summary: Family and community medicine residents participated in one (3 hour) culinary medicine course taught by two Registered Dietitian Nutritionists (RDN) during a Resident Retreat on the Penn State University Campus in University Park, PA in March, 2020. The focus of the course was counseling points and food preparation skills related to weight management. No financial support was received.
Initial impressions: Culinary medicine is a hands-on, engaging program that teaches participants to cook healthy, tasty meals while increasing knowledge of evidence-based nutrition care. This group of residents recognized the importance of nutrition in clinical care and found the information they learned to be applicable to practice. These findings will help enhance nutrition training for medical residents at this institution.
Summary: Promotion of a healthy lifestyle is encouraged to reduce risk of chronic disease; however, nutrition is poorly integrated into the patient-provider visit1. Medical training does not adequately address lifestyle interventions for the prevention and management of obesity, leading to poor rates of obesity counseling. Culinary medicine classes provide an evidence-based approach to nutrition education for healthcare providers, with real-world patient cases and a hands-on culinary session.
Thirteen Family and Community Medicine Resident Physicians engaged in a culinary medicine module where we discussed patient-physician scenarios requiring nutrition counseling, with a culinary component. The aim was to dismantle misconceptions surrounding nutrition counseling complexity. All residents (n=13) reported the workshop increased their knowledge and most (n=11) reported they intended to make changes in their own practice. Nine residents reported knowledge gained was relevant to >25 of their weekly patient load. Future directions include offering culinary medicine modules to the residency program annually.
University of Arkansas for Medical Sciences
Title: Interprofessional students’ perspectives of a culinary medicine training: Intentions from Plate to Practice
Author: Lauren Haggard-Duff PhD, RN, CNE
Contact Info: [email protected]
Purpose: The purpose of this pilot study was to determine the impact a culinary medicine teaching activity had on interprofessional healthcare students’ knowledge confidence and intent to apply practical dietary principles in practice.
Methods: Thirteen interprofessional students (n=13) completed a 3 hour, hands-on culinary medicine session focused on recipe conversion and nutritional coaching skills to modify a favorite comfort food into a significantly more nutritious, Mediterranean diet-based meal. Participants produced variations of a recipe to gain a deeper understanding of how diet modifications that are considerate of taste and nutritional value can treat health conditions. Pre-and Post-session surveys were administered to evaluate participants’ knowledge and intent to apply culinary medicine principles into their respective healthcare practices.
Findings: Students reported an increase in the belief that nutritional counseling should be included in routine appointments, and increased confidence in their ability to implement culinary medicine into practice. All students reported intentions to integrate culinary medicine into practice, and an likelihood to recommend culinary medicine training to other healthcare professionals.
Conclusion: Interprofessional students reported learning satisfaction throughout the hands-on, chef-led and faculty facilitated culinary medicine teaching activity, and found the nutritional content to be especially transferable to working with patients during routine encounters.
West Virginia University – Eastern Campus
Title: Close but Socially Distanced Encounter of the Nutrition Kind: Virtual Cooking Experience for 3rd Year Medical Students
Authors: Rosie Lorenzetti MD, MPH and Madison Humerick MD
Background/Objective of the Study: WVU School of Medicine starting having a once a year cooking class for all third year medical students in 2015. All medical students are introduced to the Health meets Food curriculum in their 3rd year orientation bootcamp. They have a nutrition lecture to introduce Health meets Food, they get the log-in information for the HmF site, and are told which modules would correspond to each clerkship that they have over the 3rd year. Then, in the fall semester, each campus has a four hour teaching kitchen dedicated to HmF module. This year, due to COVID, the school wanted to maintain the annual nutrition/cooking class, and asked faculty to create a virtual format to facilitate instruction to nearly 100 students. With 1 week notice, the instructors developed a virtual nutrition and cooking experience for 3rd year medical students.
Methods: 97 medical students from the Morgantown and Charleston campuses were split into 2 groups of 45. The group was split in half to allow for breakout rooms and more interaction between the students and instructors. Each group was scheduled for a 2 hour class. The instructors included 2 faculty members who are CCMS certified and one chef. Prior to class, the students were given a homework assignment to complete the CHF and Neuro-cognition Health meets Food online modules. They were provided with all the recipes that would be prepared during the session, to allow students the opportunity to purchase the ingredients for any recipe that they wanted to prepare along with us. During class, the instructors facilitated a brief overview/discussion of the modules, and the chef gave a knife skills demonstration to each group. The faculty introduced the recipes, talking about the important points and learning lessons of each recipe. The students were asked to answer questions pertaining to the main themes in each module. The students were then put into breakout groups to discuss the HmF cases associated with each module. They then returned to the main room to discuss the cases. Students completed a voluntary post-workshop evaluation. Since this was converted to a virtual format in less than a week, feedback was appreciated to hone the series for the future.
Outcomes: 52% of the students completed the post-workshop evaluation. Three free-text questions were asked and answered by the students. The answers to these free-text questions were then sorted into prevailing themes and will be presented in graph format on the poster. The questions were #1. What did you like the most? #2 What could be improved for the next time? Question #3- what practical advice will you use in future as a result of this session?
In response to these questions – #1What did you like the most? Case review, and recipes and practical advice and technique demonstrations were the most applauded. Question #2 what can be improved? the prevailing comment was better organization on the session and expectations set for the students. In answer to #3 Question, which asked for the practical advice that the student felt that they can take home from the session, understanding salt and salt substitutes and food swaps for healthier eating were the most popular topics.
Overall impressions of the endeavor: This virtual cooking demo and nutrition lessons for ninety-seven 3rd year medical students was received favorably overall. They appreciated the practical aspects of the lessons- and took home much practical tips and advice. The organizers put this together quickly- and learned that better organization of the session and expectations to be set for the students could make this endeavor even more productive. Keeping the lesson to one theme might have been more productive as well.
Conclusions of clinical interest: In these times of social distancing due to the COVID pandemic, teachers can still do productive lessons with the online format of HMF modules combined with the virtual technology of classes, utilizing breakout rooms for smaller group discussions.
University of Michigan Medical School
Title: Improving Medical Students’ Knowledge of Nutrition and the Health Impacts of Food Insecurity as Part of a Pilot Culinary Medicine Program.
Authors: Sangini Tolia, B.S., Keerthi Gondy, B.S., Brigid Gregg, M.D., Roma Gianchandani, M.D.
Background/Objective: Medical education historically has focused on physiology, pathophysiology, and pharmacologic therapy. Nutrition education in medical school is mostly based on micronutrient deficiencies. While this knowledge base is critical for shaping competent physicians, medical students lack the knowledge and skills to adequately counsel patients on actionable aspects of nutrition. Therefore, Culinary Medicine electives have been created to remedy this gap in medical education. These courses aim to not only teach medical students how to prepare the diets they prescribe, but also provide tools to guide patient-centered and culturally competent discussions with patients.
Methods & Study Setting: The Culinary Medicine elective taught at the University of Michigan was first piloted in 2018 as an abbreviated and modified version of the Goldring curriculum. The second reiteration of the course continued to be available to fourth-year medical students and included both didactic and hands-on cooking lessons. A session on food insecurity was also created by the co-authors to supplement the curriculum. This included a case-based discussion of the features and consequences of food insecurity, followed by a discussion with local food bank leaders. A 19-question survey was administered to students who attended in order to assess its efficacy.
Overall Impressions of the Endeavor / Conclusions of Clinical Interest: Qualitative and quantitative results from a pre-post survey based on responses from ten student participants indicated that the students who participated in the elective had an improved self-reported knowledge base and comfort with counseling patients about the Mediterranean and DASH diets, portion control, and carbohydrate choices in diabetes. After course completion, students indicated that they anticipated incorporating the evidence behind prescribed diets when counseling future patients. Results from the food insecurity survey demonstrated that students gained a deeper understanding of how food insecurity presents, what factors affect it, and how it connects to health. Students also reported an improvement in their degree of comfort in discussing food access with patients and directing them to appropriate resources. Looking forward, we hope to use this data to improve future iterations of the course and provide a framework for other institutions to implement hands-on nutrition and food insecurity education into medical school curricula.
Title: “Building a Food Foundation:” An Assessment of Clinical Nutrition Education
Author: Amy Xia
Contact Info: [email protected]
Background/Objective: Beyond limited didactic education focused on vitamin deficiencies and fad diets, nutrition education in medical school is limited. In the context of high burden of disease attributed to poor nutrition, physicians have a responsibility to provide evidence-based nutrition counseling to patients about the effects of lifestyle on health. “Building a Food Foundation” is an optional fourth year medical school elective at UT Southwestern that aims to increase nutrition education opportunity through a self-guided and personalized approach.
Methods: The goals of the elective include exposure to evidence-based nutrition approaches to prevent and address chronic diseases, case-based learning to improve patient care about nutrition, and culinary skills while ultimately promoting the personal health and well-being of students. Through learning in a kitchen with a chef-trained dietitian and physician, students became more comfortable with nutrition by cooking recipes in teams. All recipes are affordable, nutritious, straightforward, and based on Mediterranean diet principles. Students have opportunities to further explore food through the lens of politics, media, and medicine, analyzing how these variables affect patients’ perceptions of food. We analyzed evaluations from 25 fourth year medical students who completed pre- and post-surveys. In addition, students completed a previously validated survey testing their knowledge of nutrition in patient care through intern level clinical scenarios and decision making.
Results: The survey demonstrated that 90% of students did not believe that there was sufficient exposure to clinical nutrition in medical school. The intervention successfully improved every student’s performance (% correct) on the previously validated study, with an overall average 18% increase in score. Overall, 95% of students would highly recommend the elective.
Conclusions: The success of this elective demonstrates a potential solution to help solve the problem of lack of clinical nutrition education. In order to better address the multitude of health needs associated with poor nutrition, there needs to be improved medical education on how to effectively counsel patients about diet and lifestyle in a supportive way. To fully address the impact of lifestyle on health care morbidity, mortality, and cost, physicians must take ownership of nutrition knowledge, both in the kitchen and in the clinic.
West Virginia University School of Medicine
Title: Course Evaluation of an Online Elective in Nutrition for 4th year Medical Students
Authors: Ali Mientus, PGY1, and Madison Humerick, MD
Study Setting/Population: Fourth year medical students from WVU School of Medicine (SoM) were given a course evaluation survey after completion of a new 2-week online elective in nutrition.
Background or Objective of this endeavor: The traditional medical school curriculum lacks sufficient education in nutrition. Health meets Food (HmF) offers a unique online nutrition curriculum that teaches medical students practical knowledge in nutrition that can be applied to patient care. WVU School of Medicine offered a new 2-week online elective for 4th year medical students utilizing the HmF online modules with two additional modules created by a WVU SoM medical student and faculty team entitled, Food Insecurity and Interpreting Nutrition Literature, as well as reflection questions for each HmF module. The aim of this survey was to evaluate the course’s learning objectives, organization, materials and instructors with the intention to use this data to better shape future elective nutrition courses.
Method Used: Fourth year medical students can voluntarily enroll in the online course. They complete 6 HmF modules of their choice in addition to the Intro to Culinary Medicine, Interpreting Nutrition Literature, and Food Insecurity modules. They complete all reflection questions associated with their module, prepare 3 recipes from the HmF site, and post to a discussion board on the elective course site. A voluntary course evaluation was distributed electronically to all fourth year medical students upon completion of the course.
Initial impressions of the endeavor: 48 students took the course during the 2019-2020 school year. 27% of students completed the course evaluation. Overall, the feedback from students was positive regarding the logistics of the course format and content taught during the course. Some students gave more detailed information about individual modules which can provide a framework for future course modifications. 46 students have enrolled for the 2020-2021 school year.
Conclusion of clinical interest: Fourth year medical students at WVU SoM have had a positive experience in taking this 2 week online nutrition elective and enrollment is stable with the course entering its 2nd year. Future work would include a pre and post assessment of students’ confidence and knowledge in counseling patients about nutrition.
Poster Summary: In a time where online education is more important and nutritional guidance is at the forefront of lifestyle management, there is a stress to educate students on nutritional guidelines while lending hands-on instruction. Currently, medical students report receiving inadequate amounts of nutritional guidance during medical school. In order to address this, faculty at WVU SoM devised a 2-week online elective to educate fourth year medical students on nutrition and its instrumental value in preventative medicine. Students were required to complete a total of six online modules from the Health meet Food website of their choice, 3 required modules, prepare three recipes, and answer reflection questions pertaining to each module. Upon completion of the course, students voluntarily completed a survey addressing their opinions on the course content and medium. The discussion board, survey, and personal feedback received from students was positive and will be utilized to improve the course moving forward.
University of South Carolina School of Medicine Greenville/Prisma Health – Upstate
Title: The importance of integration of food education in patient care: curricular integration and quality improvement
Authors: Temas MD, Mashala. Jindal MD, Meenu
Contact Info: [email protected]
Background: Nutrition counseling is recommended by the USPSTF for patients with obesity, diabetes, hypertension and dyslipidemia. A 2018 study described the correlation between nutrition education in residency and counseling of patients regarding nutrition. That study highlighted the lack of formal nutrition education across internal medicine residencies and “only 22% of residents reported counseling their patients often/always on dietary changes.”
Methods: We are integrating culinary medicine into ambulatory practice through establishment of a two-week culinary medicine elective. While development of specific objectives is ongoing, the current drafted objectives cover: the relationship between food and specific disease states, cooking styles and techniques, cost-effective adaptations of healthy eating, and applying these concepts to patient education.
To assess the impact of the elective on resident knowledge and integration into practice, a 3 question survey was developed as part of a quality improvement project regarding resident comfort with nutrition, comfort educating patients regarding disease-specific nutrition, and frequency of discussion regarding nutrition with patients on a scale of 1-3 with 3 being high comfort or high frequency of counseling.
Impression: 28 residents responded to the survey. 70% of residents were moderately comfortable with nutrition in general and 19% were minimally or not at all comfortable. 29% reported feeling minimally or not at all comfortable discussing food with their patients as it relates to their disease states. 32% reported rarely or not discussing specific nutrition information with their patients at all.
Conclusions of clinical interest: Through a brief survey of the residents, it is evident that nutrition education is significantly lacking. Several of the residents specifically commented that they wanted more nutrition education. By implementing a culinary medicine elective, we are encouraging residents to seek this knowledge and increase their comfort discussing nutrition with their patients. After implementation of the culinary medicine elective, repeating the same survey will allow us to measure the impact of the integration on resident understanding and ability to discuss nutrition with patients. We hope this will lead to an increased emphasis on discussion of food as medicine and patient education regarding the effects of food on chronic diseases and their health overall.
Summary: Nutrition counseling is recommended by the USPSTF, though such education is notably lacking in internal medicine resident education. We aim to integrate culinary medicine and nutrition education into ambulatory internal medicine education through establishment of a two-week culinary medicine elective. To assess the impact of the elective on resident knowledge and it’s integration into practice, a 3 question survey was administered before elective implementation which showed 70% of residents were moderately comfortable with nutrition discussion in general and 19% were minimally or not at all comfortable. We will repeat the survey after residents participate in the elective. We hope this will lead to an increased emphasis on the discussion of food as medicine and patient education regarding the effects of food on chronic diseases and their health overall.
West Virginia University School of Medicine
Title: Describing the characteristics of patients who sought treatment in a multidisciplinary weight management clinic in West Virginia
Authors: Ashton Cross MS3, Jessica Arvon MS3, Laura Davisson MD, Treah Haggerty MD
Purpose/Hypothesis: Obesity is an increasing problem in West Virginia, with the obesity rate exceeding 35%. Obesity-related complications such as cardiovascular disease and cancer are leading causes of premature, preventable death and cost billions of dollars each year. WV is a rural state, making it more difficult for patients to access dietitians and other weight management experts. The purpose of this project is to explore the demographics and comorbidities of patients in rural West Virginia that sought treatment in a multidisciplinary weight management clinic. This comprehensive team-based clinic addresses food, movement, behavior change, and medical factors that affect adherence to lifestyle changes.
Outcome Measures: In this retrospective chart review study, baseline factors were explored for patients that entered the weight management program from inception. These include comorbidities, medications, weight, BMI, waist circumference, vitals, and laboratory values. A data collection sheet and coding sheet were created for recording and stratifying data. The Slicer Dicer tool within Epic’s EMR was used to obtain baseline results for demographics and comorbidities.
Study Setting: Multidisciplinary weight management clinic in Morgantown, WV.
Population: Patients in WV that were either referred by providers internal and external to the health system or self-referred.
Results: Through August 31, 2020 the program had seen 683 unique patients. The majority were female (83%). 18.8% have had prior bariatric surgery. Analysis of comorbidities identified that the most common were hypertension (63%), depression (59%), GERD (57%), hyperlipidemia (55%), obstructive sleep apnea (38%), NAFLD (14%), and PCOS (9%).
Conclusions: Data obtained from retrospective chart review of patients in a multidisciplinary weight management clinic in Morgantown, WV showed that certain patient demographics and comorbidities were found more frequently than others. For example, a greater percentage of participants were women (63%). Also, a large number of patients had comorbidities such as hypertension (63%), depression (59%), GERD (57%), hyperlipidemia (55%), obstructive sleep apnea (38%), NAFLD (14%), and PCOS (9%). This is important as all of these comorbidities can be prevented or greatly reduced with lifestyle changes such as dietary modifications and exercise implementation. Next steps of this project should include how implementing a personalized diet plan affects these comorbid conditions listed above.