A Randomized Controlled Trial of a Culinary Medicine Intervention in a Virtual Teaching Kitchen for Primary Care Residents

Abstract

Background

For decades, physicians have received inadequate nutrition education. “Culinary medicine,” an emerging pedagogy in medical education, seeks to address this by integrating hands-on cooking to enhance nutrition training. While cohort and cross-sectional studies have demonstrated culinary medicine’s efficacy, no randomized controlled trials to date have been conducted among medical trainees.

Objective

To evaluate the efficacy of a hands-on culinary medicine curriculum compared to didactics-only nutrition education.

Design

Two versions of a nutrition education curriculum were developed: a culinary medicine curriculum (intervention) and a didactics-only curriculum (control). The curricula were assessed using a non-inferiority randomized controlled trial design.

Participants

All active Yale Primary Care residents were randomized to receive either the intervention curriculum or the control curriculum.

Main Measures

Residents completed surveys at baseline, immediately post-session, and 8 weeks post-session assessing nutrition knowledge, attitudes regarding providing dietary counseling, and behavior in providing nutrition resources to patients.

Key Results

Nutrition knowledge increased from baseline to immediately post-session in both groups (control (mean percent correct 54% to 94%, P = 0.001), intervention (60% to 92%, P = 0.001)). Compared to the control group, the intervention group gained more confidence in counseling patients on a plant-forward diet (F = 5.44, P = 0.03). Residents in the intervention group reported providing nutrition resources to their patients significantly more frequently at 8 weeks post-session than at baseline (mean frequency per week 0.1 to 0.9, P = 0.002), a change that was not demonstrated among control group participants (0.1 to 0.5, P = 0.35).

Conclusions

Both culinary medicine and didactics-only pedagogies can be effective approaches to teaching nutrition. Culinary medicine was found in this trial to be non-inferior to a didactics-only approach and may be superior in improving participants’ confidence in providing dietary counseling to patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11606-025-09652-x.

INTRODUCTION

Globally, 11 million deaths in 2017 were attributable to dietary risk factors.¹ These dietary risk factors included a high intake of sodium and a low intake of whole grains and fruit. In the USA, poor-quality diet is the leading risk factor for mortality,² and cardiovascular disease (CVD) is the leading cause.³ The US Preventive Services Task Force recommends that adults with risk factors for CVD receive behavioral counseling to promote a healthy diet (grade B recommendation),⁴ which has been shown to positively impact dietary habits, body weight, and blood pressure.⁵ However, physicians provide dietary counseling in as few as 12% of office visits,⁶ citing low confidence due to inadequate nutrition training as one of their biggest barriers.^7,8

In 1985, the National Academy of Sciences recommended that medical students receive a minimum of 25 h of nutrition instruction.⁹ Nevertheless, medical students currently only receive an average of 11 h.¹⁰ In all, 71% of US medical schools serving 75% of medical students fail to provide the minimum recommended training,¹¹ and only 26% of residency programs include a formal nutrition curriculum.¹²

Recently, there has been renewed interest in reforming nutrition education in both clinical contexts¹³ and medical training.^10,14,15 One proposed path forward is “culinary medicine,” an innovation in medical education that teaches culinary arts and nutrition science through hands-on cooking. Culinary medicine can be taught either in-person in physical teaching kitchens or virtually in “virtual teaching kitchens.”^{16,17,18,19,20,21}

Studies to date have demonstrated that culinary medicine is not only “highly acceptable” among participants²² but also effective across a number of domains. Culinary medicine interventions are consistently associated with improvements in nutrition knowledge, attitudes regarding nutrition in clinical practice, and confidence in providing dietary counseling.^23,24,25 Several studies have also demonstrated improved personal dietary habits among medical trainees after completing a culinary medicine curriculum.^26,27,28,29 The pedagogy’s effectiveness and enjoyability are attributable, at least in part, to its focus on hands-on skill-building.^30,31 It is for these reasons that culinary medicine is being increasingly implemented for medical trainees in the USA and abroad.³²

However, notable gaps in the research of nutrition and culinary medicine in medical education exist. Many culinary medicine interventions are offered on a voluntary basis, introducing self-selection bias among participants.²⁶ Curricular content areas are often not based on published guidelines.¹⁴ Most apparent is the absence of any randomized controlled trials (RCTs) among medical trainees, which authors have previously called an “urgent need” in the field.³³ Instead, studies comparing culinary medicine and didactics-only curricula among medical trainees have been cohort and cross-sectional designs.^{27,28,34,35,36}

In this study, we developed a culinary medicine curriculum for resident physicians focused on the prevention of CVD based on established curricular guidelines. We then conducted the first-ever RCT of a culinary medicine intervention among medical trainees, hypothesizing that it would be non-inferior to a standard, didactics-only curriculum.

METHODS

Needs Assessments

Following Kern’s six-step approach to curriculum development,³⁷ we first conducted a general needs assessment to assess the state of nutrition education among medical trainees. We then developed a targeted needs assessment to elicit Yale Primary Care (YPC) residents’ training in nutrition, attitudes regarding dietary counseling in the clinic setting, and preferred learning environments. See Appendix. During a mandatory didactics session, all YPC residents (n = 52) were invited to participate in the needs assessment survey via Qualtrics.

Curriculum

Collectively, our team included general internists, chefs, registered dietitians, diet and nutrition researchers, and a preventive cardiologist at the Yale School of Medicine and Yale New Haven Health. We developed two versions of a nutrition curriculum: a culinary medicine curriculum with hands-on cooking instruction (the “intervention” curriculum) and a didactics-only curriculum with a video-based lecture (the “control” curriculum). See Table 1.

Table 1.

Plant-Forward Nutrition Education for the Prevention of Cardiovascular Disease: Curriculum and Assessment Overview

Intervention group	Control group	Session	Learning objectives	Educational methods	Assessment tools
X	X	Yale Office-Based Medicine: Dietary Counseling in Primary Care41 (45 min)	1. Describe evidence-based dietary counseling interventions for preventing cardiovascular disease 2. Use the Five A’s framework and SMART criteria to structure dietary counseling in the primary care setting 3. List evidence-based guidelines and budget-friendly resources for dietary education and counseling	Learner-led small group discussion Journal article review Case-based learning Knowledge questions review	Self-reported confidence via Likert scales
X	X	Interactive Lecture: Plant-Forward Nutrition Education for the Prevention of Cardio-vascular Disease (60 min)	1. Describe a “plant-forward” dietary pattern 2. Describe why ultra-processed foods are considered “unhealthy” and plants are considered “healthy.” 3. Identify the contribution of systemic/structural racism to food insecurity and the disproportionate burden of cardiovascular disease among minoritized populations 4. List the three main categories of dietary fats and, for each, a food that contains a high quantity of that dietary fat 5. Define a serum lipid profile that is protective against cardiovascular disease 6. Explain how common foods and dietary patterns impact serum LDL, HDL, and triglyceride levels 7. Explain how dietary patterns can reduce blood pressure for the prevention and treatment of hypertension	Interactive lecture	Self-reported confidence via Likert scales Multiple-choice nutrition knowledge quiz
X		Culinary Medicine: Lentil Bolognese and Heart-Healthy Recipe Modification (60 min)	1. List five strategies for improving the heart-healthiness of a recipe 2. Cook a delicious, affordable (< $2/serving), plant-forward meal comprised of widely available ingredients 3. Describe how the prepared recipe was adapted — according to the aforementioned five strategies — to improve the heart-healthiness of the recipe	Hands-on cooking in a virtual teaching kitchen Small group discussion	Self-reported confidence via Likert scales Recipe modification activity
	X	Nutrition Made Clear 42 Video-Based Lecture (60 min)	1. List the three main categories of dietary fats and, for each, a food that contains a high quantity of that dietary fat 2. Define a serum lipid profile that is protective against cardiovascular disease 3. Explain how common foods and dietary patterns impact serum LDL, HDL, and triglyceride levels 4. Explain how dietary patterns can reduce blood pressure for the prevention and treatment of hypertension	Video-based lecture	Self-reported confidence via Likert scales Multiple-choice nutrition knowledge quiz
X	X	“What Next?”: A Discussion of Applying Nutrition Knowledge and Dietary Counseling Skills to Patient Care (30 min)	1. Describe the benefits of acquiring nutrition knowledge and dietary counseling skills as a provider 2. Explain how to administer and interpret the Hunger Vital Sign two-question screening tool for assessing for food insecurity 3. Explain what traditional heritage diets are and identify at least one culturally relevant source of patient and provider education on these diets 4. Identify at least one accessible resource for evidence-based patient education on a heart-healthy diet 5. Implement dietary improvements for the prevention of cardiovascular disease to live as better role models for patients 6. Apply the knowledge and skills learned in the “Plant-Forward Nutrition Education for the Prevention of Cardiovascular Disease” curriculum to real-life patient encounters	Interactive lecture Small group discussion	Self-reported confidence via Likert scales Nutrition in Routine Care Subscale of the NIPS43 U.S.-Based Dietary Fat and Free Sugar Questionnaire48 Self-reported assessment of dietary counseling habits
X	X	Dietary Problem-Solving 101: A Q&A with a Registered Dietitian Nutritionist (RDN) (30 min)	1. Describe the benefits of acquiring nutrition knowledge and dietary counseling skills as a provider 2. Recognize RDNs as valuable members of the interprofessional team for preventing and managing cardiovascular disease 3. Apply the knowledge and skills learned in the “Plant-Forward Nutrition Education for the Prevention of Cardiovascular Disease” curriculum to real-life patient encounters	Small group discussion	Nutrition in Routine Care Subscale of the NIPS43 Self-reported confidence via Likert scales Self-reported assessment of dietary counseling habits

Listed are session-by-session learning objectives, educational methods, and assessment tools for both the intervention group curriculum and the control group curriculum

Learning objectives for both were informed by the global and targeted needs assessments, registered dietitian nutritionists (RDNs), and the “Nutrition Curriculum Guide for Training Physicians”³⁸ of the Nutrition Academic Award Program.³⁹ The learning objectives also closely align with the nutrition competencies outlined in a recent expert consensus statement.⁴⁰

Several educational strategies were utilized to achieve the curricular learning objectives. Both curricula were dispensed during regularly scheduled ambulatory half-day didactics, which are a requirement of the residency program. The 4-h curriculum was taught to residents on two consecutive Monday mornings. The first morning began with time to complete the baseline survey. Then, there was a 45-min resident-led discussion of the “Dietary Counseling in Primary Care” chapter of the Yale Office-Based Medicine curriculum.⁴¹ This was followed by a live, 60-min lecture led by author N.W. for both curricular arms that detailed the connection between diet and CVD prevention.

In the control curriculum, residents viewed excerpts from the video-based lecture series Nutrition Made Clear.⁴² Segments were chosen for their relevance to CVD prevention and compiled into a 60-min lecture. The content of these video excerpts was similar in goals and scope to what was covered in N.W.’s live lecture.

In the culinary medicine curriculum, residents spent 60 min cooking a lentil Bolognese in their home kitchens while participating in a virtual teaching kitchen using Zoom. This recipe was designed to be plant-forward, affordable, and simple to make using easily accessible ingredients. The instructor N.W. cooked along from his own home kitchen, coaching residents through the process.

The first Monday morning concluded with a 30-min discussion of how to apply the knowledge and skills learned to patient care. The following Monday, residents engaged in a 30-min question-and-answer session with an RDN and were then given time to complete the immediately post-session survey. The total curricular time for each curriculum was 4 h.

In a mandatory didactics session 8 weeks later, which did not include any curricular content related to this study, residents were provided with 15 min of protected time to complete the 8 weeks post-session survey.

Study Design and Population

This was a single-center, unblinded, RCT of a culinary medicine intervention compared to a control (i.e., didactics-only) curriculum. Using a random sequence generator (www.random.org), all 52 active YPC residents were randomized to receive either the intervention or control curriculum.

Demographics were collected at baseline to elicit any potential differences between the intervention and control groups. At baseline, immediately post-session, and 8 weeks post-session, residents completed a five-question, multiple-choice, nutrition knowledge test. The nutrition knowledge test was developed by the study team and used to evaluate the learning objectives for the lecture components of the curriculum. Residents’ confidence in providing various aspects of dietary counseling for CVD prevention to their patients was assessed via 6-point Likert scales (“strongly agree” to “strongly disagree”) at baseline and immediately post-session. Results were then dichotomized to “agree or strongly agree” versus “other.” These Likert scales were used to evaluate the Yale Office-Based Medicine and lecture components of the curriculum.

In the baseline and immediately post-session surveys, residents also completed a recipe modification activity. In this activity, they were given the name of a meal and its list of ingredients and asked to provide three recommendations to improve its heart-healthiness. Responses were graded against a standard rubric, resulting in a score from 0 to 3. Scores were then converted to percent correct. This recipe modification activity was used to evaluate the culinary medicine component of the curriculum.

Residents completed the validated subscale “Nutrition in Routine Care” of the validated Nutrition in Patient Care Survey (NIPS)⁴³ at baseline and immediately post-session to assess their attitudes regarding the importance of providing dietary counseling in patient care. This subscale contained eight questions rated on a 5-point scale from “strongly disagree” to “strongly agree” (score range 8–40), with higher scores indicating a greater perceived importance of incorporating dietary counseling into patient care. This NIPS survey was used to evaluate the portion of the curriculum in which participants participated in an interactive lecture and small group discussion regarding how to apply the nutrition knowledge and dietary counseling skills that they learned to patient care.

Residents self-assessed their dietary habits at baseline and eight weeks post-session using a US-based version of the validated Dietary Fat and Free Sugar Questionnaire (DFS) developed by the Modern Diet and Physiology Research Laboratory.⁴⁴ This instrument assessed participants’ dietary intake of saturated fat and sugar using 26 items, each scored 1–5 based on reported frequency of consumption (score range 26–130), with higher scores indicating a higher intake of saturated fat and sugar. In the baseline survey, residents were asked to assess their eating habits over the preceding 6 months. At 8 weeks post-session, residents were asked to assess their eating habits since participating in the curriculum. This was to assess whether or not the curriculum as a whole had any impact on participants’ personal dietary habits.

Patient counseling habits were assessed at baseline and 8 weeks post-session. At baseline, residents estimated the total number of times they had provided dietary counseling or nutrition education resources to patients in the preceding 6 months. In the 8 weeks post-session survey, residents were asked to estimate the total number of times they had completed these actions since the curriculum. Results were normalized to report counseling frequency in average number of times per week. Residents were also asked if and how they had incorporated what they had learned into caring for patients. These outcome measures were used to assess whether or not the curriculum as a whole had any impact on participants’ care of patients with CVD risk factors.

Curricular feedback occurred immediately post-session. Residents completed a series of 6-point Likert scale-based attitude items that ranged from “strongly agree” to “strongly disagree.” Results were then dichotomized to “agree or strongly agree” versus “other.” Feedback was additionally sought via an open-ended question with free-text response.

All survey data were collected via Qualtrics. This study was deemed exempt by the Yale Institutional Review Board on February 8, 2023.

Statistical Analysis

All analyses were conducted in SPSS 28 (IBM, Armonk, NY). Statistical significance was defined as a two-tailed P ≤ 0.05. We used McNemar’s test for dichotomous outcomes. In the 8 weeks post-session survey, Fisher’s exact test was used to assess if residents had incorporated what they had learned into their clinical practice.

When comparing scores within a single group over time, we used paired t-tests and Wilcoxon signed-rank tests. When comparing scores between the two groups at a single time point, we used Student’s t-tests and Wilcoxon rank-sum tests. When comparing scores between the two groups over time, we used one-way ANOVAs with repeated measures for continuous variable outcomes and generalized linear mixed-effects models (GLMMs) for dichotomous and ordinal outcomes.

We used regression analysis to control for the number of hours of prior training in nutrition received in medical school and a sensitivity analysis to examine the potential effects of outliers. The datasets analyzed during this study are available from the corresponding author on reasonable request.

RESULTS

Of the 52 residents, 36 (69%) completed the needs assessment. All but one respondent (97%) “agreed” or “strongly agreed” that primary care providers should be able to provide at least basic dietary counseling to their patients, and 94% felt that learning about the connection between diet and disease was an important use of curricular time in residency. Few “agreed” or “strongly agreed” that they had the necessary nutrition knowledge (36%) or skills (39%) to provide dietary counseling to patients. Only 6 (17%) “agreed” or “strongly agreed” that their training to date had been sufficient in preparing them to provide dietary counseling to patients.

Ninety-four percent of residents “agreed” or “strongly agreed” that obtaining additional training in nutrition would allow them to provide better clinical care in preventing and managing chronic diseases. When asked to rank the top three learning methods by which they would prefer to receive this education, 77% of residents ranked “teaching led by an interprofessional team of physicians and RDNs,” and 62% of residents ranked “hands-on training in a teaching kitchen.”

Due to one absence, 51 total residents participated in the curriculum: 26 in the control and 25 in the intervention. Of these 51, all (100%) elected to also participate in the RCT. Forty-six (90%) participated in the baseline survey (22 of 46 [48%] in control, 24 of 46 [52%] in intervention, P = 0.35). Participant characteristics are described in Table 2.

Table 2.

Demographic Characteristics of the Participants at Baseline

Characteristic	Intervention: Culinary medicine	Control: Traditional nutrition education	Total	P value
Gender — No. (%)
Man	5 (21)	8 (36)	13 (28)	0.33
Woman	19 (79)	13 (59)	32 (70)	0.14
Non-binary/third gender	0 (0)	0 (0)	0 (0)	> 0.99
Other	0 (0)	0 (0)	0 (0)	> 0.99
Prefer not to say	0 (0)	1 (5)	1 (2)	0.48
Year in residency — No. (%)
PGY-1†	7 (29)	10 (46)	17 (37)	0.25
PGY-2	9 (38)	6 (27)	15 (33)	0.46
PGY-3	8 (33)	6 (27)	14 (30)	0.66
Prior training in nutrition
Degree in nutrition — No. (%)	0 (0)	1 (5)	1 (2)	0.48
Curricular time received in medical school — hours	5.0 ± 7.5‡	9.7 ± 12.3	7.3 ± 10.2	0.002*
Curricular time received in residency — hours	1.4 ± 2.4	4.1 ± 8.4	2.7 ± 6.2	0.07
Curricular time received in culinary medicine — hours	5.7 ± 7.7	9.6 ± 25.4	7.6 ± 18.3	0.81
Time spent on self-directed learning — hours	21.5 ± 30.0	37.8 ± 37.3	27.2 ± 33.8	0.36
Total — hours	35.1 ± 38.6	57.1 ± 62.5	45.7 ± 52.0	0.10

^*Statistical significance P ≤ 0.05

^†PGY denotes post-graduate year

^‡Plus-minus values are mean ± standard deviation

Forty-two residents (82%) completed the immediately post-session survey (19 of 42 [45%] in control, 23 of 42 [55%] in intervention, P = 0.14). Twenty-four residents (47%) completed the 8-week post-session survey (7 of 24 [29%] in control, 17 of 24 [71%] in intervention, P = 0.003).

Nutrition knowledge scores increased significantly from baseline to immediately post-session in both the control group (mean percent correct 54% to 94%, P = 0.001) and intervention group (60% to 92%, P = 0.001). See Fig. 1. Score increases were maintained over time, with no statistically significant changes between the immediately post- and 8 weeks post-session scores in either group (control (94% to 97%, P > 0.99), intervention (92% to 99%, P = 0.16)).

Figure 1.

Nutrition knowledge scores in intervention and control groups. Asterisk denotes statistical significance P ≤ 0.05.

Residents’ confidence in performing dietary counseling for CVD with patients increased significantly in two of the five domains in the control group and all five domains in the intervention group (all P < 0.05). See Table 3.

Table 3.

Self-assessed Confidence in Providing Dietary Counseling

Knowledge or skill concept	Intervention: Culinary medicine			Control: Didactics only
	Confidence Baseline	Confidence Immediately Post	P value	Confidence Baseline	Confidence Immediately Post	P value
Foods’ pathophysiologic impact on cardiovascular health	17%	48%	0.04*	18%	53%	0.29
Dietary counseling for dyslipidemia	13%	52%	0.01	9%	63%	0.008*
“Plant-forward” dietary counseling	8%	74%	< 0.001*	27%	68%	0.06
Counseling on accessible, heart-healthy meals	8%	52%	0.002*	36%	63%	0.45
Providing educational resources for cardiovascular disease	4%	57%	< 0.001*	9%	74%	< 0.001*

^*Statistical significance P ≤ 0.05

At baseline, residents in the control group were significantly more confident in their ability to suggest accessible, heart-healthy meals to their patients compared to the intervention group (8 of 22 [36%] in control, 2 of 24 [8%] in intervention; P = 0.03). This difference between groups was no longer significant at the post-session timepoint (12 of 19 [63%] in control, 12 of 23 [52%] in intervention, P = 0.47). For all other confidence outcomes, no statistically significant differences existed between the two groups at baseline or immediately post-session timepoints.

Scores on the Nutrition in Routine Care subscale of the NIPS did not increase significantly from baseline to immediately post-session in the control group (mean score 33.1 to 34.3, P = 0.08) but did in the intervention group (34.7 to 36.1, P = 0.04).

In the recipe modification activity, scores did not significantly increase from baseline to immediately post-session in the control group (mean percent correct 71% to 83%, P = 0.17) but significantly increased in the intervention group (74% to 91%, P = 0.008). See Fig. 2.

Figure 2.

Recipe modification scores in intervention and control groups. Asterisk denotes statistical significance P ≤ 0.05.

Scores on the DFS did not change significantly from baseline to 8 weeks post-session in either group (control (mean score 48.4 to 46.6, P = 0.36), intervention (61.0 to 50.7, P = 0.16)).

The average frequency with which residents reported giving educational resources to patients at 8 weeks post-session compared to baseline did not significantly change in the control group (0.1 to 0.5 times per week, P = 0.35) but significantly increased in the intervention group (0.1 to 0.9, P = 0.002). The increase in average frequency with which residents reported giving dietary advice to patients at 8 weeks post-session was not significant in either group (control (0.4 to 0.9 times per week, P = 0.23), intervention (0.4 to 1.5, P = 0.08)).

When comparing groups over time using a GLMM, the intervention group gained more confidence in their ability to counsel patients on a plant-forward diet compared to the control group (F = 5.44, P = 0.03). For all other outcomes assessed across time points using GLMMs and repeated measures ANOVAs, no statistically significant differences occurred between groups.

In the 8 weeks post-session survey, 6 out of 7 (86%) control residents compared to all 17 (100%) intervention residents reported that they had incorporated something from the sessions into caring for patients. Open-ended responses revealed that residents felt more comfortable dispensing dietary counseling, increased the frequency with which they discussed diet with patients, placed referrals to RDNs more often, offered specific examples of dietary substitutions, and more consistently provided educational resources on nutrition.

In the immediately post-session survey, all residents (100%) in both groups either “agreed” or “strongly agreed” that they would recommend these curricula to fellow residents and would like to receive more education like it in the future.

DISCUSSION

Nutrition education in medical education has needed reform since at least the 1985 National Academy of Sciences training recommendation.⁹ The recent innovation of culinary medicine, which has been shown to be both effective and enjoyable for medical trainees,²² seeks to address this deficit. In this study, we found that our residents were receiving no formal nutrition education, as is the case with the majority of internal medicine residents nationally.¹² While providing dietary counseling was felt to be part of their role as primary care physicians, residents did not feel adequately trained to do so, similar to studies at other institutions.^8,45 Almost universally, residents felt that additional training would positively impact patient care, and the majority desired to engage with culinary medicine in teaching kitchens.

Our culinary medicine intervention proved effective in several domains. Like its didactics-only counterpart, it was successful in conveying nutrition knowledge to residents. This knowledge was maintained over time, similar to prior studies.²⁶ Scores on the Nutrition in Routine Care subscale of the NIPS significantly increased only in the intervention group, demonstrating the positive impact of culinary medicine on residents’ belief that nutrition should be discussed with patients.

Scores on the recipe modification activity also increased significantly only in the intervention group. Culinary medicine interventions may be more effective in teaching residents to identify practical, actionable steps to improve dietary patterns that could then be passed on to patients. However, neither curriculum had a demonstrable effect on learners’ personal intake of dietary saturated fat or sugar according to measured DFS scores.

The culinary medicine participants reported increased confidence in providing dietary counseling to patients across all five domains assessed, whereas increases in confidence among control group participants were only demonstrated in two of the five domains. It seems that this increase in confidence then translated to positive changes in patient care, with intervention participants reporting that they provided nutrition education resources to patients more frequently in the weeks after the session, a change not seen in the control group.

We demonstrated potential superiority of the intervention in improving residents’ confidence in providing plant-forward dietary counseling to patients. This suggests that culinary medicine interventions may instill more confidence in participants to provide dietary counseling than didactics-only curricula. However, all other GLMM and ANOVA analyses yielded no statistically significant results, which may be due to low statistical power resulting from the relatively small number of participants in each group. Our results suggest that culinary medicine is at the very least non-inferior to didactics-only nutrition education curricula.

Both curricula were received favorably by residents. However, in this unblinded study, residents in the control group reported feeling that they had “missed out” on the culinary medicine teaching that their co-residents received.

Significance

Culinary medicine in this study appears to be non-inferior to didactics-only nutrition curricula and may be superior in improving trainees’ confidence in providing dietary counseling to patients. With these new findings, institutions can be better equipped to make decisions regarding the provision of nutrition education to their medical trainees. For institutions that do not have the staff or resources to teach culinary medicine, didactics-only teaching is still effective.

For institutions that do have the resources necessary to implement it, culinary medicine may offer the more potent intervention for learners. These necessary resources include available curricular time, adequately trained staff, funding for groceries and cooking equipment, and a teaching kitchen. Adequately trained staff can be a barrier for many institutions, as an ideal team for teaching culinary medicine would likely be comprised of a physician, a dietitian, and a chef.⁴⁶ Chefs and dietitians already employed by an affiliated hospital system or university may be willing to collaborate with a physician leader to teach these classes. Funding for groceries can be sought through organizations such as the American College of Lifestyle Medicine, as was done in this study. If there is limited curricular time for trainees, culinary medicine interventions can be offered on an elective basis. For institutions lacking access to a physical teaching kitchen, virtual teaching kitchens are an economical and effective alternative.

There are several limitations of this study. First, the attrition rate among participants may have introduced selection bias. Attrition rates were not the same between the two groups, however, with more residents in the intervention group completing follow-up surveys. The low completion rate of the 8 weeks post-intervention survey among participants in the control group is particularly notable. The relatively greater adherence to the study protocol by the intervention group could indicate a higher acceptability of the intervention curriculum.

The study was conducted in a single program at a single institution, limiting potential generalizability. The number of participants was also relatively small. Statistical power to detect small effect sizes and differences in means between groups was likely limited by this factor. In addition, despite randomization, control group participants reported receiving a significantly larger number of hours of nutrition education in medical school than those in the intervention group. However, regression models controlling for this difference yielded no change in statistical results.

Finally, although survey outcomes included several objectively scored and validated metrics, including the NIPS, DFS, multiple-choice nutrition tests, and recipe modification activities, there were also several self-reported outcomes. These outcomes introduce the possibility for recall and social desirability bias.

CONCLUSIONS

This study is the first RCT to investigate the effectiveness of a culinary medicine curriculum compared to didactics-only nutrition education among medical trainees. Our results indicate that culinary medicine curricula are non-inferior to didactics-only curricula and may be superior in their impact on residents’ confidence in providing dietary counseling to patients.

The work of evaluating culinary medicine curricula is currently limited by the absence of dedicated, validated tools. Future research could contribute to the field by assessing changes in patient biometric outcomes that may result from their physicians receiving culinary medicine training (Kirkpatrick level 4⁴⁷).

As nutrition education becomes increasingly emphasized in medical training, culinary medicine represents a potential gold standard for equipping physicians and other medical professionals with the knowledge and skills necessary to help their patients prevent and manage chronic, diet-related diseases.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contribution

All authors contributed to the study’s conceptualization and design, including the development of the control and intervention curricula. Data were collected and analyzed by N.W. Data interpretation was done by N.W., D.S., R.F., and D.W. All authors were involved in writing and/or editing of the manuscript.

Funding

Support for the funding of the groceries used in the culinary medicine intervention was provided by two micro-grants from the American College of Lifestyle Medicine.

Data Availability

The datasets analyzed during this study are available from the corresponding author on reasonable request.

Declarations

Ethical Approval

This study was deemed exempt by the Yale Institutional Review Board on February 8, 2023.

Consent to Participate

This study was deemed exempt, so explicit consent to participate was not required. Participants were made aware that the study surveys were optional. By completing the surveys, they were consenting to participate in the study.

Consent to Publish

No identifying data from participants were collected as part of this study. All authors have given their consent for these data to be published in their current form.

Conflict of Interest

Author Erica Spatz reports ongoing research projects supported by grants from the Patient-Centered Outcomes Research Institute, National Institutes of Health, National Institute on Minority Health and Health Disparities, and Centers for Disease Control and Prevention. Author Max Goldstein reports compensation for serving as an instructor for virtual community cooking classes through the American College of Culinary Medicine. No other authors report any conflicts of interest.