Table 2.

Mapping the LM Subcompetencies to the ACGME Core Competencies

ACGME Core Competencies

Patient care and procedural skills

Medical knowledge

Practice-based learning and improvement

Interpersonal and communication skills

Professionalism

Systems-based practice

LM Subcompetencies

A. Introduction to LM 1. Discuss LM and its unique role in health care practice (Medical Knowledge and Systems-Based Practice) 2. Describe the LM core competencies as identified by a national consensus panel (Medical Knowledge) 3. Compare and contrast LM with other fields of health and medicine (Medical Knowledge) 4. Summarize the scientific evidence that shows health behaviors are associated with key health outcomes (Medical Knowledge) 5. Describe the evidence showing that lifestyle interventions effectively impact disease pathophysiology (Medical Knowledge) 6. Describe the priority of LM in the spectrum of treatment algorithms for chronic, lifestyle-related diseases across the lifespan (Medical Knowledge) 7. Discuss the prevalence and associated cost burden of lifestyle-related disease, such as hyperlipidemia, cardiovascular disease, prediabetes, diabetes, hypertension, obesity, and cancer (Medical Knowledge and Systems-Based Approach) 8. Explain the impact of lifestyle choices on planetary health and sustainable living (Medical Knowledge and Systems-Based Approach)

B. The role of the practitioner’s personal health and community advocacy 1. Examine scientific evidence that suggests practitioners who practice healthy lifestyles are more likely to offer counseling, serve as role models, and improve patient outcomes (Medical Knowledge) 2. Develop a culture of leadership by modeling personal health behaviors (Professionalism) 3. Describe strategies for incorporating personal wellness for practitioners into clinics, medical offices, or other health care settings, including wellness programs (Systems-Based Practice) 4. Examine essential practitioner characteristics and practices that increase the capacity and impact of the therapeutic alliance (Interpersonal and Communication Skills) 5. Integrate personal readiness assessments and lifestyle action plans into sustainable life patterns for practitioners (Professionalism) 6. Explore the role of LM in promoting personal practitioner resiliency and reducing burnout (Professionalism) 7. Advocate for LM directly with patients and their families, as well as policy and decision makers within the community (Interpersonal and Communication Skills and Systems Based Practice)

C. Nutrition science, assessment, and prescription 1. Assess food intake patterns and nutrients of deficit and excess (Patient Care and Procedural Skills) 2. Analyze food labels for the health impacts of ingredients (Medical Knowledge and Patient Care And Procedural Skills) 3. Discuss commonalities and key messages of global dietary guidelines (Medical Knowledge) 4. Summarize the health impact of prominent dietary patterns, including plant-predominant and non–plant-predominant patterns (Medical Knowledge) 5. Describe how the level of processing in a food affects health and discuss the evidence base for these effects (Medical Knowledge) 6. Describe the practice of culinary medicine and its role in sustainable healthy eating behavior (Medical Knowledge) 7. Summarize the major studies of nutrition in the prevention, treatment, and reversal of hyperlipidemia, cardiovascular disease, prediabetes, diabetes, hypertension, obesity, and cancer (Medical Knowledge) 8. Apply nutrition prescriptions on the basis of science that shows how nutrition can address the pathophysiology of most chronic diseases, including inflammation, oxidation, glycosylation, epigenetic expression, and the microbiome (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 9. Demonstrate the ability to write evidence-based nutrition prescriptions (Patient Care and Procedural Skills) 10. Describe indications for referral to a LM-trained registered dietician to translate and further personalize nutrition prescriptions (Systems-Based Practice)

D. Physical activity science, assessment, and prescription 1. Discuss the aerobic, strength, flexibility, and balance components of physical activity (Medical Knowledge) 2. Examine the evidence and pathophysiology between physical activity components and health outcomes (Medical Knowledge) 3. Describe the benefits of physical activity in preventing or treating disease in special populations, such as healthy older adults, pregnant women, children and adolescents, persons with obesity or disability, cardiovascular disease, diabetes, cancer, disability, and stroke (Medical Knowledge) 4. Summarize the role of physical activity guidelines (Medical Knowledge) 5. Integrate key physical activity assessment tools into clinical practice (Patient Care and Procedural Skills) 6. Define fitness terminology relevant to writing exercise prescriptions (Medical Knowledge) 7. Integrate evidence from relevant physical activity literature into treatment protocols for management, remission, or reversal in patients with diabetes, cancer, cardiovascular, and cerebrovascular disease (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 8. Describe indications for referral to health fitness professionals (Systems-Based Practice) 9. Develop physical activity prescriptions appropriately modified for special populations, such as healthy older adults, pregnant women, children and adolescents, persons with obesity or disability, cardiovascular disease, diabetes, cancer, disability, and stroke (Patient Care and Procedural Skills)

E. Sleep health science and interventions 1. Describe sleep’s role with health and chronic disease pathophysiology (Medical Knowledge) 2. Perform sleep assessments to identify patients with insufficient or poor-quality sleep (Patient Care and Procedural Skills) 3. Summarize lifestyle-based interventions that can improve sleep health (Medical Knowledge) 4. Assess the risk for common sleep disturbances, such as obstructive sleep apnea, chronic insomnia, and restless legs syndrome and refer to sleep specialists when applicable (Patient Care and Procedural Skills) 5. Describe the indications for referral to a sleep specialist or for a sleep study to assess for sleep apnea (Systems-Based Practice) 6. Describe indications for referral to a program or specialist in cognitive behavior therapy for insomnia (Systems-Based Practice)

F. Treating tobacco use disorder and managing other toxic exposures (including vaping, alcohol use, and other illicit substances) 1. Describe the health effects of tobacco, alcohol, and other frequently used substances and the benefits of cessation (Medical Knowledge) 2. Apply patient screening tools for substance use (Patient Care and Procedural Skills) 3. Create patient-centered substance use treatment plans using practice guidelines and behavioral interventions (Patient Care and Procedural Skills) 4. Summarize the diagnostic criteria for common substance use disorders (Medical Knowledge) 5. Integrate behavior therapy with pharmacotherapy for tobacco and other substance use disorder plans and refer to a substance use disorder specialist when indicated (Patient Care and Procedural Skills and Systems-Based Practice) 6. Apply the United States Preventive Services Task Force guidelines for patients with tobacco use disorder (Patient Care and Procedural Skills)

G. Key clinical processes in LM 1. Integrate lifestyle vital signs into components of the patient history and physical examination (Patient Care and Procedural Skills) 2. Analyze and implement evidence-based clinical practice guidelines relevant to LM for prevention, treatment, and reversal of chronic diseases (Practice Based Learning and Improvement and Patient Care and Procedural Skills) 3. Describe the treatment of disease with the LM pillars as compared with medication (Medical Knowledge) 4. Demonstrate how to screen, diagnose, treat, and monitor a lifestyle-related disease and provide LM-focused anticipatory guidance (Patient Care and Procedural Skills) 5. Discuss strategies for a clinical practice to access and implement use of local, national, and global resources (Systems-Based Practice) 6. Describe the key strategies for leveraging interprofessional teams to enhance health behavior change interventions (Systems-Based Practice) 7. Examine how group visits and telehealth can optimize LM treatment encounters (Practice Based Learning and Improvement) 8. Create and use data from office systems, such as electronic health records with LM guidance, in clinical decisions and care, including tracking screening frequency, test results, referrals, and recommended follow-up (Systems-Based Practice) 9. Analyze the evidence for collaborative and chronic care models on improved lifestyle outcomes (Practice Based Learning and Improvement) 10. Discuss successful primary care and office-based models for lifestyle modification (Systems-Based Practice) 11. Design a quality improvement project for LM clinical practice, using tools, such as Plan-Do-Study-Act cycles (Practice Based Learning and Improvement) 12. Explain principles of evidence-based medicine and their application to LM (Medical Knowledge and Practice Based Learning) 13. Describe methods of assessing effectiveness of interventions, such as patient activation measures and the therapeutic alliance measures (Medical Knowledge and Practice Based Learning and Improvement)

H. Fundamentals of health behavior change 1. Summarize health behavior change theories, such as the health belief model, the social learning theory, and the transtheoretical model (TTM), and their application to LM practice (Medical Knowledge) 2. Demonstrate key elements of conducting a patient assessment within the TTM and collaborate to develop stage-matched responses (Patient Care and Procedural Skills) 3. Apply the process of building effective and therapeutic alliances with patients that foster their personal growth (Interpersonal and Communication Skills) 4. Explain how to collaborate with your patients to promote health behavior changes (Medical Knowledge) 5. Apply motivational interviewing, cognitive behavioral, health coaching, and positive psychology techniques (Interpersonal and Communication Skills) 6. Summarize the evidence to support the use of behavior change techniques in clinical practice (Medical Knowledge) 7. Use the skills of open inquiry, reflections, and empathy to develop and maintain a therapeutic alliance (Interpersonal and Communication Skills) 8. Describe the impact of positive emotions on the success of health behavior change (Medical Knowledge) 9. Develop patient-centered, written action plans on the basis of the appropriate stage of change of the TTM (Patient Care and Procedural Skills) 10. Summarize the process of follow-up for ongoing lifestyle change progress, including building patient self-efficacy and relapse prevention (Medical Knowledge and Patient Care and Procedural Skills) 11. Describe the factors that support sustained behavior change (Medical Knowledge and Interpersonal and Communication Skills) 12. Explain the role of family and other support to initiate and maintain health behavior change (Medical Knowledge) 13. Manage disruptions to the therapeutic alliance (Interpersonal and Communication Skills) 14. Identify patient resources for sustainable behavior change in relation to the pillars of LM (Medical Knowledge)

I. Emotional and mental health assessment and interventions 1. Apply screening tools for stress, depression, and anxiety in clinical practice (Patient Care and Procedural Skills) 2. Explain the relationship and pathophysiology between emotional and physical health (Medical Knowledge) 3. Summarize the nature of stress, the role of stressors, such as adverse child experiences, and identify manageable elements of pathogenic stress reactions (Medical Knowledge) 4. Describe and use evidence-based and patient-centered mental and emotional health, including self-management and resilience-building techniques (Patient Care and Procedural Skills) 5. Analyze the clinical relevance and evidence base for mindfulness-based stress reduction and related stress management strategies (Practice Based Learning and Improvement) 6. Manage treatment plans for lifestyle-related mental health diseases, such as depression and anxiety (Patient Care and Procedural Skills) 7. Describe indications for referral to mental health professionals (vs when clinically indicated) (Systems-Based Practice) 8. Apply mindfulness skills to enable presence, clarity, and curiosity in the clinical encounter (Patient Care and Procedural Skills and Interpersonal and Communication Skills)

J. The role of connectedness and positive psychology 1. Apply positive psychology in health behavior change counseling (Patient Care and Procedural Skills) 2. Describe how positive psychology strategies support achieving and sustaining healthy behaviors (Medical Knowledge) 3. Compare and contrast eudaimonia and hedonia and explain their effect on physical health, including longevity (Medical Knowledge) 4. Describe how social connectedness and social networks effect emotional well-being, physical health, and longevity (Medical Knowledge) 5. Summarize the deleterious and positive effects social media has on emotional well-being and flourishing (Medical Knowledge) 6. Explain the relationship among the lifestyle pillars, positive emotions, and flourishing (Medical Knowledge) 7. Describe positive psychology activities that can boost emotional well-being and flourishing (Medical Knowledge)

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; LM, lifestyle medicine.